Healing. Reimagined. - Stamford Health · Reimagined. changing the way patients think about their...
Transcript of Healing. Reimagined. - Stamford Health · Reimagined. changing the way patients think about their...
2016 Clinical Annual Report
Healing. Reimagined.
Photograph: © Anton Grassl/Esto
Dear Colleagues,
As we approach the end of the calendar year and enter the holiday season, it is time to reflect on our achievements
of the past year and look to the excitement of 2017. I am pleased to share the 2016 Clinical Annual Report, which
has been carefully prepared by each of your Department Chairs.
2016 will forever be defined by the opening of the long-awaited new Stamford Hospital. The opening reception
for the Medical Staff, held in the lobby of the new hospital, was intentionally the first of many celebrations and
a recognized tribute to the importance of our physicians. The number of physicians in attendance was a new
record for any single event in the history of Stamford Hospital.
In this Annual Report, you will see the continued focus on safety and quality from each of the departments and
now, with the opening of our new hospital, an incomparable level of service. As a result of this, our medical staff
continues to grow and we consistently see an increase in the number of physicians joining our impressive, loyal
and experienced staff. The 2015 and 2016 Engagement Surveys show the level of engaged and aligned physicians
increasing, especially in the largest group, the independent physicians. And finally, our Physician Participation
Campaign has almost reached the anticipated goal of an unprecedented $4 million in contribution to the
Stamford Hospital Foundation.
So with gratitude, appreciation and pride, I prepare this letter for the third and final time, as I reflect on what
a privilege and a pleasure it has been to serve this extraordinary medical staff. I look forward to a continued
partnership with the physicians of our medical staff, Department Chairs, Hospital administrators and executive
leaders of Stamford Hospital.
I wish you and your families a happy and healthy holiday season and an exciting 2017!
Josh Herbert, MD
President, Medical Staff
Dear Colleagues,
It is that time of year again and I am pleased to share with you the 2016 Clinical Department Annual Report, prepared
by your respective Chairs. This year, our focus was on our journey of Healing. Reimagined. changing the way patients
think about their health.
The Chairs begin with a year in review, which provides a sense of the scope of the departmental efforts and
strategy. The overarching theme that emerges is one of multidisciplinary collaboration for the purpose of providing
high-quality patient-centered care. This is exemplified in the development of new programs and the expansion of
others; recruitment of new talent – adding 70 members to the medical staff; medical education and research; and
many accreditations and accolades. This work would not have been possible without a dedicated medical staff
committed to improving the health of our patients and community.
In the past year, there have been many remarkable achievements and growth. We opened a new hospital, expanded
our ambulatory footprint and significantly expanded our physician practice network; steps towards solidifying our
vision to be the recognized regional center of health. We announced several strategic collaborations: the Bennett
Cancer Center joined the Dana-Farber/Brigham and Women’s Cancer Care Collaborative and became the first member
in Connecticut; we partnered with Hospital for Special Surgery to develop a premier center for specialty orthopedic
care in New England; and we joined forces with Sacred Heart University to serve as the primary clinical rotation
placement site for the Physician Assistant training program. Additionally, in May we had our 1st Annual Research
Day, which was very successful. To date, 232 patients have been enrolled in clinical research trials. Also, we exceeded
our goal to decrease preventable harm to patients by 50% in two years, with a decrease of 64%.
Our mission, “Together with our physicians, we provide a broad range of high-quality health and wellness services
focused on the needs of our patients,” comes to life on the pages that follow. Towards this end, physician engagement
is at an all-time high, with improvements in all physician categories. Attendance at both the Doctor’s Day and the new
hospital physicians’ opening reception set historical records for physician attendance.
I want to personally thank the Chairs, medical staff and all the Hospital departments for this incredible body of work and
for all that you do for our patients. Together we move forward faster, and I look forward to our continued collaboration
and sharing this journey with each of you.
I wish you and your families a happy holiday season and a healthy and prosperous New Year.
Sharon C. Kiely, MD, MPM
Senior Vice President, Medical Affairs
Chief Medical Officer
Patient Safety Officer
3 2016 Clinical Annual Report
Table of Contents
Anesthesiology 04
Emergency Medicine 10
Family Medicine 18
Medicine 26
Obstetrics & Gynecology 58
Pathology 66
Pediatrics 74
Psychiatry 84
Radiology 92
Surgery 104
Stamford Health: Annual Report 2016
4 2016 Clinical Annual Report
We have extended our regional anesthesia service to include a broad range of surgical subspecialities, thereby decreasing
intra-op anesthetic requirements, reducing narcotic usage and greatly enhancing a patient’s post-operative comfort.
Anesthesiology
Recovery. Enhanced.
5 2016 Clinical Annual Report
Department of Anesthesiology: Annual Report 2016
This is a momentous year for Stamford Hospital with the opening
of the beautiful new hospital. Stamford Anesthesiology Services
(SAS) is proud to be a part of the Stamford Hospital team and the
extraordinary effort, time, planning and preparation by all involved
to ensure a seamless transition to the new hospital. With all new
things come change, and I am proud to say that SAS has made
advancements and growth of its own.
Stamford Anesthesiology’s ever-growing Department continues
to recruit highly qualified anesthesia providers. This year, the
SAS Cardiac Anesthesia team welcomed Devon Jeffers, MD, after
completing his training in cardiothoracic anesthesia at Johns Hopkins
and working at Suburban Hospital for two years. We also welcomed
Kanishka Rajput, MD, who completed her fellowship in Interventional
Pain at Medical College of Wisconsin in 2013. Dr. Rajput is board
certified in both anesthesia and pain management and has proven to
be a great resource for our team. Suhaib Chaudry, MD joins us after
finishing his residency at the University of Connecticut this summer.
SAS has also added five CRNAs to the group: Yana Krmic, Holly Thiel,
John Martinez, Jillian Davis and Vince Brunelli, who bring years of
experience to our practice.
Thanks to the support of Stamford Hospital, SAS has implemented
an electronic medical records system in partnership with iProcedures.
It is a cost-effective, comprehensive end-to-end mobile perioperative
information management solution designed and perfected
by practicing anesthesiologists. This anesthesia information
management system supports fast, accurate clinical documentation
and helps reduce medical errors, resulting in complete, compliant,
legible anesthesia records. It will now streamline the preoperative,
intraoperative and postoperative anesthesia workflow.
Every anesthetizing location is equipped with an iPad that is used
strictly for the iPro EMR system. Eric Jankelovits, MD has dedicated
countless hours in preparation for launching this system, and
we thank him for all of his hard work.
The iPro EMR has enhanced the Department’s quality measures
reporting and compliance. The Quality Measures Reporting portal
is a clinical data repository used for automatic registry reporting
of clinical outcomes and quality measures data required by
pay-for-performance metrics. The application collects the required
measures for AQI. Stamford Anesthesiology reports on the following
PQRS and non-PQRS measures: Preoperative Beta-Blocker in
Patients with Isolated CABG Surgery; Prevention of Central Venous
Catheter-Related Bloodstream Infections; Documentation of
Current Medications; Post-Anesthesia Transfer of Care Measure;
Anesthesiology Smoking Abstinence; Prevention of Post-Op
Nausea and Vomiting; Composite Anesthesia Safety; Perioperative
Mortality Rate; Injury from Central Line; Perioperative Temperature
Management; Overall Anesthesia Safety; Dental Injury; Corneal
Abrasions; and Care Plan.
The nerve block program remains strong and SAS maintains an
extraordinary number of providers who maintain clinical proficiency
in regional anesthesia. This is highlighted by a core team who,
through fellowship training or demonstration of clinical excellence,
serve as leaders. Although our number of regional anesthetics
has declined slightly, our percentage of patients receiving nerve
blocks continues to increase. Regional anesthesia has always been
a mainstay for orthopedic surgery, but SAS has extended this type
of service to include a broad range of surgical subspecialties. These
include: obstetrics and gynecology, general surgery, breast, colon
Betty Ann Robustelli, MDChair, Department of Anesthesia
A Message From The Chair The Year in Review
6 2016 Clinical Annual Report
Department of Anesthesiology: Annual Report 2016
and rectal, bariatric, thoracic, trauma, urology and gynecologic
oncology. These adjuncts decrease intra-op anesthetic requirements,
reduce narcotic usage and greatly enhance a patient’s post-operative
comfort. We anticipate, with the addition of the HSS/Stamford
Hospital collaboration in February 2017, our orthopedic volume
will increase, only furthering our regional block program.
Scope of Clinical Services
The Department of Anesthesia provides services throughout
Stamford Hospital at over 27 anesthetizing locations. In addition
to supporting basic surgical needs, the Department is an integral
part of obstetrical and maternity cases in Labor & Delivery,
Endoscopy, Interventional Radiology, MRI and CT Scan Studies,
the Cardiac Catheterization Lab, EP Studies and Emergency Room.
As shown in Figure 1, overall case volume for FY2016 was 20,891,
which was a slight decrease from 21,154 in FY2015.
Figure 2 highlights our surgical case volume by campus.
As shown in Figure 3, Stamford Anesthesiology delivered anesthetics
to 95% of the total Labor & Delivery cases for FY2016.
Figure 4 shows the number of procedures for single-shot nerve
blocks in FY2016 vs. FY2015, and Figure 5 shows the number of
continuous infusion procedures for the same time period.
Medical Staff
New Hires:
The Department of Anesthesiology welcomed the following
physicians and CRNAs in 2016:
• Vince Brunelli, CRNA • Yana Krmic, CRNA
• Suhaib Chaudry, MD • John Martinez, CRNA
• Jillian Davis, CRNA • Kanishka Rajput, MD
• Devon Jeffers, MD • Holly Thiel, CRNA
Active Staff:• Amy Crane, MD • Yevgeniy Printsev, MD
• Joseph D ’Agosto, MD • Shahid Rafiq, MD
• Margot Denham, MD • Betty Ann Robustelli, MD
• Kaili Dilts, MD • Elizabeth Rozen, MD
• Tara Doherty, DO • Nousheh Saidi, MD
• Elyse Goldblum, MD • Andrew Sosa, MD
• Steven Finkel, MD • Brian Sullivan, MD
FY2016 CASES
Hospital Tully
October-15 825 942
November-15 814 919
December-15 773 981
January-16 722 869
February-16 707 879
March-16 812 1,048
April-16 761 860
May-16 844 880
June-16 801 965
July-16 772 777
August-16 851 888
September-16 745 922
Total 9,427 10,930
Figure 1: Overall Anesthesia Case Volume
• Jay Freilich, MD • Richard Morgulis, MD
• Ronald Giannotto, MD • Benjamin Unger, MD
• Ewelina Gibek, CRNA • Shiry Weisberg, MD
• Juliet Jackson, MD • Thomas Wong, MD
• Eric Jankelovits, MD • Kristen Butkovsky, CRNA
• Jeffrey Klein, MD • Jen-Hwei Cheng, CRNA
• Alla Koorn, MD • Richard Libutti, CRNA
• Adnan Malik, MC • Rodrigo Mendes, CRNA
• Sergio Manimbo, MD • Donna Nunno, CRNA
• Maria Mazzeo, MD • Alan Summerfield, CRNA
Hospital Committees:
Department members participate in various Hospital
committees, including:
• Credentialing Committee – Dr. Steven Finkel
• Trauma Committee – Dr. Brian Sullivan and Dr. Tara Doherty
• Pharmacy & Therapeutics Committee – Dr. Joseph D’Agosto
• Resuscitation Committee – Dr. Betty Ann Robustelli
• Medical Executive Committee – Dr. Betty Ann Robustelli
• OB/Safety Culture Committee – Dr. Ronald Giannotto
• Culture of Safety Committee – Dr. Benjamin Unger
• Quality & Safety Committee – Dr. Betty Ann Robustelli
• OR Committee – Dr. Betty Ann Robustelli
• Total Joint & Spine Committee – Dr. Brian Sullivan
• Peer Review Committee – Dr. Betty Ann Robustelli
7 2016 Clinical Annual Report
Figure 2: Highlights our surgical case volume by campus
FY2016 CASES
Cardiac OB OR NORA ENDO
Main Hospital
October-15 11 187 497 34 52
November-15 10 198 444 37 52
December-15 13 211 476 36 60
January-16 6 186 408 46 53
February-16 7 156 394 36 57
March-16 9 195 473 46 60
April-16 12 156 453 50 55
May-16 10 194 432 38 54
June-16 10 171 509 43 57
July-16 11 180 442 51 46
August-16 6 221 445 36 74
September-16 6 220 448 43 59
Total 111 2,353 5,562 702 699
Tully
October-15 – – 401 – 541
November-15 – – 432 – 487
December-15 – – 407 – 574
January-16 – – 388 – 481
February-15 – – 407 – 472
March-16 – – 439 – 609
April-16 – – 365 – 495
May-16 – – 375 – 505
June-16 – – 382 – 583
July-16 – – 382 – 440
August-16 – – 334 – 554
September-16 – – 390 – 532
Total – – 4,657 – 6,273
Total Deliveries w/ Anesthetic
Labor Epidural
Emergency C-Section
Planned C/S
October-15 214 109 36 60
November-15 177 107 21 59
December-15 178 92 17 72
January-16 183 102 25 51
February-16 165 90 17 58
March-16 208 106 32 70
April-16 216 118 20 78
May-16 231 134 27 70
June-16 181 109 22 50
July-16 222 132 33 57
August-16 203 115 30 58
September-16 175 100 23 52
Total 2,353 1,314 303 736
Figure 3: Total Deliveries at Stamford Hospital
8 2016 Clinical Annual Report
Department of Anesthesiology: Annual Report 2016
Single Shot Blocks FY2015 FY2016
CPT code Description # of Procedures # of Procedures
62310 Cervical or Thoracic 21 2
62311 Lumbar or Scaral (Caudal) 13 16
64413 Cervical Plexus 2 1
64415 Brachial Plues 407 378
64417 Axillary Nerve Block 1 2
64420 Intercostal Nerve 32 90
64425 Ilioinguinal, Iliohypogastric Nerve 83 1
64445 Sciatic Nerve 95 23
64447 Femoral Nerve 92 79
64461 PVB = Paravertebral block thoracic, single – 18 New Block Code 201664462 PVB = Paravertebral block thoracic, (add-on additional) – 5
64450 Other Peripheral Nerve or Branch 714 578
64520 Lumbar or Thoracic (Paravertebral Sympathetic) 66 2
64530 Celiac Plexus 2 0
64486 Transversus Abdominis Plane, Unilateral w/US 258 321
64488 Transversus Abdominis Plane, Bilateral w/US 249 318
2,035 1,834
Continuous Infusion FY 2015 FY 2016
CPT code Description # of Procedures # of Procedures
62318 Cervical or Thoracic, Indwelling Cath, Continuous Infusion 64 31
62319 Lumbar or Sacral, Indwelling Cath, Continuous 39 9
64416 Brachial Plexus, Continuous Infusion 246 174
64446 Sciatic Nerve, Continuous Infusion 0 3
64448 Femoral Nerve, Continuous Infusion 268 226
64464 PVB = Paravertebral Block Thoracic, Continuous Infusion 0 1 New Block Code 2016
64487 TAP by Continuous Infusions, Includes US 8 8
64489 TAP Bilateral by Continuous Infusions, w/ US 90 134
715 586
Figure 4: Nerve Block Growth
9 2016 Clinical Annual ReportEmergency Department Entry
10 2016 Clinical Annual Report
Emergency MedicinePeople come to our emergency room in their moments of distress to be comforted and healed. They are greeted by
smiling faces and received into an open and airy, dedicated 52,000-square-foot, state-of-the-art Emergency Department
that is staffed by caring providers.
Innovation. Ignited.
11 2016 Clinical Annual Report
Imagine…healing reimagined and innovation ignited.
These are the underpinnings of a new Emergency Department,
one in red brick and glass that stands boldly against the skyline
of Stamford. People come to our emergency room in their
moments of distress to be comforted and healed. They are
greeted by smiling faces and received into an open and airy,
dedicated 52,000-square-foot, state-of-the-art ED that is
staffed by caring providers.
Our Zones
Much like a traffic light signals a driver, the zones in our
emergency room signify the level of a patient’s acuity.
Green – Ambulatory patients who may possibly go home soon -- green is good to go
Yellow – Sicker patients who may need multiple tests and possibly admission
Red – Critically ill or trauma patients requiring the most intense and immediate care
Purple – Our pediatric patients
Blue – Our behavioral health patients
In the green zone, or the rapid evaluation unit, patients are
triaged by a doctor and nurse team, have their blood tests done
and imaging ordered in start-up rooms and then are observed
until they may be ready to go home without having to enter the
main ED. Fast-track patients are also treated in this area. During
their evaluation, patients may also move to the yellow zone if a
more detailed work-up is necessary.
The yellow zone sees the majority of our patients who need
multiple tests, x-rays, CT scans and consultations with specialists.
Many of these people require an extensive work-up and may
be admitted to the hospital.
The critically ill arrive by ambulance into the red zone and are
greeted by an experienced triage nurse, then swept into one of
our state-of-the-art trauma rooms or cardiac resuscitation rooms.
Teamwork is critical at this point, and the emphasis is on speed,
quality and compassion. Heart attacks and strokes are treated
in the cardiac rooms by both emergency and stroke or cardiac
teams. Life-saving treatment within minutes, such as cardiac
catheterization in the Cath Lab just above the ED, is made possible
by this team approach. Stroke teams evaluate those with treatable
symptoms and medication can be administered in the ED within
the optimal treatment window. The trauma rooms are capable
of being converted to operating rooms within 30 minutes,
if a procedure must be performed emergently in the ED.
Children are cared for in the purple zone, where our youngest,
most fragile and vulnerable patients receive the best attention in
the hands of our pediatric emergency team. The equipment in our
Pediatric ED is state-of-the-art and is backed by a team of specialists
from other disciplines such as Cardiology, Anesthesiology and
Urology. The nautical theme in our specially designed pediatric
area creates a calm and soothing atmosphere for our youngest
patients and their families, sheltering our youngest and most
vulnerable patients from the main ED.
Scope of Clinical Services
The ED sees approximately 150 patients per day or 55,000 per
year and we anticipate growth of 5% per year. Figure 1 shows
Arun Nandi, MDChair, Department of Emergency Medicine
Department of Emergency Medicine: Annual Report 2016
A Message From The Chair The Year in Review
12 2016 Clinical Annual Report
the number of monthly visits and average daily visits for FY16
compared to the prior year.
Some of our key metrics for the year include:
• Door-to-bed time = 24 minutes
• Door-to-provider time = 25 minutes
• Door-to-discharge time = 182 minutes
• Door-to-admission time = 304 minutes
• Left Without Being Seen (LWBS) is well below the
national average at 0.5%
Figures 2 through 7 provide more detail on Arrival-to-Bed
Time; Arrival-to-Provider Time; Left Without Being Seen;
Length of Stay/Admissions; Total Length of Stay; and Length
of Stay/Treat & Release.
Stamford Health is recognized as being among the top 10% of
hospitals in the state to meet the door-to-provider time in under
the 30-minute benchmark.
US Acute Care Solutions (USACS) is a physician-owned group
that partners with Stamford Health in managing the Emergency
Department. USACS employs 1,400 physicians and 800 APPs
nationally, providing care to 4.3 million patients in 120 sites all over
the country. As physician owners, USACS physicians are motivated
to solve problems, find opportunities and create successes. Working
in a dynamic environment like Stamford Health provides USACS
employees the opportunity for self-improvement and leadership.
Care delivery has been carefully crafted to maximize safety,
throughput and quality. Physician-in-triage is an example of an
innovative process whereby a physician and nurse team are the
first point of contact for most of the patients arriving in the ED.
Multidisciplinary teams help coordinate the care and standardize
the approach to management of complex patients, such as trauma,
STEMI, sepsis and stroke. ED throughput is monitored closely by
USACS in partnership with Stamford Health. Metrics are monitored
daily in the form of a dashboard and reported out to the unit at
safety huddles each morning. A data-driven approach to streamlining
patient safety and patient flow is the cornerstone of this organization.
All of the rooms in the new ED are private and spacious. Digital
x-rays and ultrasounds are performed at the bedside to avoid having
to move the patient. The CT scan located in the ED is a dedicated,
state-of-the-art GE 128-slice scanner that delivers advanced image
clarity with an average of 50% less radiation than traditional scanners.
Pediatric Emergency Department
Stamford Hospital has the first dedicated Pediatric Emergency
Department in the region. The Department has its own waiting
and triage rooms, and children are seen in colorful, specially
designed private rooms completely separated from the adult
ED. The Pediatric ED currently operates between the hours
of 12 noon to 10 p.m. and is staffed by doctors experienced in
pediatric medicine and nurses who are specially trained for our
youngest and most fragile patients.
The Pediatric Emergency Department is headed by
Dr. Heather Machen, who trained in pediatric emergency
medicine at Texas Children’s Hospital, one of the premier
children’s hospitals in the nation. Under her guidance, the
focus has been on providing excellent and compassionate
care with established protocols and on reducing radiation
exposure and performing appropriate testing.
Department of Emergency Medicine: Annual Report 2016
Figure 1: ED Volume
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
65,000
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
145
140
135
130
125
120
115
FY15 FY16 FY17LWBS % LWBS % Target
126
134
142
129
131
136
139138
141 142
135
132 133
135
141
137
138136
141140
136137
140138
13 2016 Clinical Annual Report
Figure 2: Arrival-to-Bed Time
70
60
50
40
30
20
10
0
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
6
FY15 FY16 FY17Arrival to Bed Arrival to Bed Target
53 52
43
41
4741
4843 44
51 52 5046
5660 61
55
46
36 39 40
33
24
37
Figure 3: Arrival-to-Provider Time
25
60
50
40
30
20
10
0
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
6
FY15 FY16 FY17Arrival to Provider Arrival to Provider Target
3337
27 26 24 2427 25 26
32 33 33 3338
4144
5350 46 45 46
39
29
Figure 4: Left Without Being Seen (%)
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
6
1.8%1.6%1.4%1.2%1.0%0.8%0.6%0.4%0.2%0.0%
FY15 FY16 FY17LWBS % LWBS % Target
0.8%
1.3%1.5%
0.7%0.8% 0.8%
1.2% 1.2% 1.2% 1.2%
1.4% 1.4%1.5%
1.2%
1.0%
0.6%
1.7%
1.7%
1.3%1.3%
0.9% 0.9%
1.1%
14 2016 Clinical Annual Report
The equipment in our Pediatric ED is state-of-the-art and is backed
by a team of specialists from other disciplines such as Cardiology,
Anesthesiology and Urology. The nautical theme in our specially
designed pediatric waiting area creates a calm and soothing
atmosphere for our youngest patients and their families.
Departmental Safety and Quality
Members of the Department of Emergency Medicine play key roles
in ensuring and furthering the safety and quality of care we deliver.
Assistant Medical Director Suzy Shukovsky, MD, is responsible
for day-to-day operations of the Immediate Care Center (ICC) and
works with nursing leadership on ways to improve care delivery.
Through her collaboration with the ICC staff, she has worked to
improve the efficiency of the Department, and is focusing her
efforts on mechanisms to improve the overall patient experience
at the ICC.
As Chair of the ED Quality Review Committee, Alex Rafailov, MD,
oversees all quality-related reviews conducted by the Department.
Partnering with nursing leadership, he revises and improves
various departmental policies to ensure that we deliver the highest
possible quality of care. In addition, Dr. Rafailov reports to USACS
monthly to ensure that the clinicians are abiding by all clinical
policies set by the company.
As the EMS Medical Director for the Hospital, Douglas Gallo, MD, is
responsible for working with various community-based EMS services
to ensure the highest quality of training and medical oversight of
crews responding to those in need. As the Department considers
application to be an ACS-accredited Level 1 Trauma Center, Dr. Gallo’s
leadership will help to make the transition as seamless as possible.
One of the main goals in the ED is to provide care in a timely
manner. Through the “Physician First” staffing model, a board-certified
emergency physician is in triage during the busiest times of the day,
serving as the first point of contact for patients arriving at the ED.
Departmental Education and Teaching Activities
The success of our team depends on ensuring our providers and
nurses work together and participate in regular teaching activities
to remain abreast of evidence-based care that is both high in quality
and cognizant of the compassion that every patient deserves.
In addition to training our Department personnel, the Department
also provides medical oversight to Stamford EMS and other
EMS providers.
The ED also serves as a teaching center for Sacred Heart University
physician assistant students, as well as for Internal Medicine and
Family Practice residents. Additionally, we have medical students
from Columbia rotating through the Department as a part of their
educational experience. Recently, we were contacted by Fairfield
University to have its students rotate through our Department
as well.
Department of Emergency Medicine: Annual Report 2016
Suzy Shukovsky, MDAssistant Medical Director
Alexandr Rafailov, MD
Chair, ED Quality Review Committee
Douglas Gallo, MD EMS Medical Director
15 2016 Clinical Annual Report
Figure 7: Length of Stay/Treat & Release
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
6250
200
150
100
50
0
FY15 FY16 FY17Length of Stay-T&R Length of Stay-T&R Target
204 206186 176
187176
189 182 181193 198 198
188 207 207 208 206 203193 193 194 182 181 181
Figure 6: Total Length of Stay
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
6
231 339212 204 211
198212
202 201216 327 221
211230 229 228 228
220 210 213 212 205 208209
FY15 FY16 FY17Length of Stay-Total Length of Stay Total Target
250
200
150
100
50
0
Figure 5: Length of Stay/Admissions
333 339317 322 309 297 307 303 298
314327 322 308 315 318 306
321295 287 300 291 303
335320
400
350
300
250
200
150
100
50
0
Nov1
4
Dec1
4
Jan1
5
Feb1
5
Mar
15
Apr1
5
May
15
Jun1
5
Jul1
5
Aug1
5
Sep1
5
Oct1
5
Nov1
5
Dec1
5
Jan1
6
Feb1
6
Mar
16
Apr1
6
May
16
Jun1
6
Jul1
6
Aug1
6
Sep1
6
Oct1
6
FY15 FY16 FY17Length of Stay-Admits Length of Stay-Admits Target
16 2016 Clinical Annual Report
Medical Staff
Full-Time Physicians• Miriam Ambalu, MD
• Vanessa Brown, MD
• Michael D’Angelo, MD
• Douglas Gallo, MD
• Amy Gandhi, MD
• Randall Grant, DO
• Stephanie Hanna, DO
• Richard Katz, MD
• Heather Machen, MD
• Samuel Maryles, MD
• Ryan Mazin, MD
• Jose Mejia, MD
• Arun Nandi, MD
• Alexandr Rafailov, MD
• Suzy Shukovsky, MD
• Despina Trigenis, DO
• Dorothy Turnbull, MD
• Kim Marie Zeh, MD
Summary The new Emergency Department remains committed to providing prompt,
exceptional and compassionate care in a modern and state-of-the-art
environment. Our goal remains to be safe and swift, while never losing sight
of the patient who has trusted us in their most vulnerable moments.
Full-Time Advanced Practice Partners/PAs• Sarah Feigenbaum, PA-C
• Tyler Ferraro, PA-C
• Anthony Giannuzzi, PA-C
• Antonia Green, PA-C
• Joy Mullins, PA-C
• Vanie Mangal, PA-C
• Michael Moi, PA-C
• Laura Olson, PA-C
• Mordechai Sacks, PA-C
• Vanie Mangal, PA-C
• Julie Wilmot, PA-C
Department of Emergency Medicine: Annual Report 2016
17 2016 Clinical Annual ReportPediatric Emergency Department
18 2016 Clinical Annual Report
Family MedicineThe unique and special relationship of the family physician with his or her patient continues to be one of the most
important and meaningful of all human relationships. Family physicians strive daily to limit the intrusions and obstructions
that threaten to impact the care they give to and for their patients.
Practice. Strengthened.
19 2016 Clinical Annual Report
Department of Family Medicine: Annual Report 2016
Family physicians continue to feel the extraordinary burdens of
payment and regulatory changes. No longer is it sufficient to know
the important clinical conditions such as NSVD, MI, CVA and CKD.
Now family physicians must also master things like MACRA (Medicare
Access and CHIP Reauthorization Act), MIPS (merit-based incentive
systems), APM (alternative payment models), PQRS (Physician
Quality Reporting System), VPBM (Value-based Payment Modifier),
MU (meaningful use), CPIA (clinical practice improvement activities)
and CPC+ (Comprehensive Primary Care Plus). These abbreviations,
among many others, are essential for physicians in order to be
successful, if not survive, in their practices. Financial pressures on top
of pressure to see high volumes of patients, the shortage of primary
care physicians, liability concerns and less personal connections with
patients has led to a national crisis of burnout in family physicians
and primary care physicians in general. Fortunately, there is a light at
the end of the tunnel. The new payment systems in general are finally
recognizing the bedrock importance of a strong and vibrant primary
care base for an effective, safe, patient-centered, timely, efficient and
affordable healthcare system.
In keeping with Stamford Health’s s theme of Healing, Reimagined,
members of the Department of Family Medicine continued to have
an enormous impact on the health and well-being of their patients
and the Stamford community in 2016. The unique and special
relationship of the family physician with his or her patient continues
to be one of the most important and meaningful of all human
relationships. Family physicians strive daily to limit the intrusions and
obstructions that threaten to impact the care they give to and for
their patients.
The top DRGs for admissions by Department members in 2016 were:
• Chest pain • Syncope
• Sepsis • Coronary artery disease
• Congestive heart failure • Pneumonia
• Atrial fibrillation • Kidney and urinary tract infections
• Renal failure • Cellulitis
Scope of Clinical Services The members of the Department of Family Medicine continue
to provide a wide range of essential health services to the
Stamford community and Stamford Hospital, and serve in a variety
of roles including:
• School health physician • Indigent care
• Palliative care • Hospitalists
• Geriatrics and nursing • Integrative medicine home practice • Medical missions abroad
• Public health director • Graduate medical education
• Medical IT • Graduate nursing education
The geographic area served is from North Stamford to the South End,
from New Canaan to Stamford’s West Side. The patients cared for
include newborns, children, teens, maternity patients, adults, nursing
home patients and palliative care patients. The settings in which
care is provided range from solo, partnership and group practices to
Stamford Health Medical Group and community health centers.
Nine members of the Department continue to admit their patients
to the Hospital, the same number as last year, while others use
the increasingly popular hospitalist service for their inpatients.
Joseph Connelly, MDChair, Department of Family Medicine
A Message From The Chair The Year in Review
20 2016 Clinical Annual Report
Department of Family Medicine: Annual Report 2016
Ten members of the Department are in independent practices,
10 are employed by the Stamford Health Medical Group, eight
work for the hospital, and two are employed by community health
centers. There are 24 active medical staff members and six affiliate
staff members in the Department.
Stamford Hospital is fortunate to have one of the four Family
Medicine Residency Programs in Connecticut. At this time, 17 of
the 30 current members of the Department of Family Medicine
have come from this program. With the country in the midst of an
increasing shortage of primary care physicians, the value of
the Family Medicine Residency Program as a “feeder” of primary
care physicians into the community continues to increase. This is
an important factor in insulating the Hospital and community from
the serious quality and cost problems seen in areas with a dearth
of primary care physicians.
Milestones
The following Department members celebrated milestone
anniversaries as members of Stamford Hospital’s medical staff:
• Jennifer Bendl, MD — 5 years
• Lawrence Leibowitz, MD — 5 years
• Chander Devaraj, MD — 15 years
• Henry Yoon, MD — 15 years
• J. Robert Shapiro, MD — 35 years
New Staff
The Department of Family Medicine welcomed one new
physician in 2015 – 2016:
• Deborah Pinto, MD, MPH joined the Family Medicine
Residency Program as faculty.
Honors and Recognition
• Drs. Rod Acosta and Angelo Mallozzi were selected by
Connecticut magazine as “Top Docs.”
• Drs. Alan Falkoff, Joshua Herbert, Lawrence Leibowitz,
Angelo Mallozzi and Ann Williams were listed as a
“Top Doctor” by Castle Connolly in 2016.
• Dr. Lawrence Leibowitz served as Health Director of the
Town of Redding and as the advisory physician for the town’s
elementary and middle schools.
• Dr. Joshua Herbert served as Chair of the Medical Staff.
• High Ridge Family Practice (Dr. Alan Falkoff ) was designated
as a High-Performance Practice by the Medical University of
South Carolina.
• Dr. Rod Acosta served as President of Stamford Health
Medical Group.
Hospital Committee Participation
• Continuing Medical Education Committee — Drs. Joseph
Connelly, Henry Yoon
• Credentials Committee — Drs. Joshua Herbert, Henry Yoon,
Jack DiTeodoro
• Graduate Medical Education Committee — Drs. Joseph
Connelly, Henry Yoon
Medical Staff
J. Robert Shapiro, MDMember at-Large to Department Executive Committee
Henry Yoon, MDAssociate Chair
Kathleen Nurena, MDMember at-Large to Medical Executive Committee
21 2016 Clinical Annual Report
• Information Technology Leadership Council — Dr. Henry Yoon
• Infection Control Committee — Dr. Clarke Latimer
• Internal Medicine/Family Medicine Performance Improvement
Committee — Drs. Henry Yoon (Co-chair), Anne Brewer
• Medical Executive Committee — Drs. Joshua Herbert (Chair), Rod
Acosta (Outgoing Chair), Joseph Connelly, Kathleen Nurena
• Medical Ethics Committee — Drs. Joseph Connelly, Anne Brewer
• Ancillary Provider Committee — Dr. Jack DiTeodoro (Chair)
• Obesity Task Force — Dr. Anne Brewer
• Palliative Care Committee — Drs. Anne Brewer, Joseph Connelly
• Pediatric Peer Review Committee — Dr. Kathleen Nurena
• Perinatal Infectious Disease Committee — Dr. Anne Brewer
• Pharmacy and Therapeutics Committee — Dr. Shanthi Devaraj
• Planetree Committee (SHMG) — Dr. Lawrence Liebowitz
• Primary Care Committee (SHMG) — Dr. Lawrence Leibowitz
• Primary Care Integration Steering Committee — Dr. Henry Yoon
• Quality Assurance Committee (SHMG) — Dr. Clarke Latimer
• Utilization Management Committee — Dr. Joseph Connelly
• Dr. Anne Brewer served as Medical Director of the Palliative
Medicine service at the Hospital.
• Stamford Hospital Breast Leadership Committee — Dr. Katherine
Takayasu
Departmental Education and Teaching Activities The Family Medicine Residency Program had another successful
year in 2015. For the fourteenth straight year, the program filled
completely in the match with excellent candidates. The additions
to the residency staff include:
• Daniel Bal, MD (joined in PGY-2 year)
• Thomas Collins-Pallett, MD
• Nivi Devaraj, MD
• Paul Frenette, MD
• Lyuba Polinkovsky, MD
• Jimena Repetto, MD
Five physicians graduated from the Residency Program in 2016
and, for the fifth consecutive year, all satisfactorily passed the
American Board of Family Medicine certification exam. Additionally:
• Dr. Henry Yoon succeeded Dr. Joseph Connelly as Program
Director of the Family Medicine Residency Program.
• Dr. Lawrence Liebowitz was re-appointed Clinical
Assistant Professor of Medicine at New York Medical College
• Dr. Alan Falkoff had faculty appointments at NYU, Columbia,
Sacred Heart, Pace University and Quinnipiac University.
• Dr. Clarke Latimer had faculty appointments at UCONN
and Quinnipiac University.
• Dr. Marc Brodsky had a faculty appointment
at Columbia University
• Dr. Joseph Feuerstein had a faculty appointment
at Columbia University.
• Dr. Katie Takayasu had a faculty appointment
at Columbia University.
• Dr. Joseph Connelly had a faculty appointment
at Columbia University.
• Dr. Ann Williams had a faculty appointment
at Quinnipiac University.
Departmental Research and Scholarly Activities High Ridge Family Medicine participated in various research
projects in primary care with PPRNet.
Dr. Joseph Feuerstein published a book in the popular press
entitled Dr. Joe’s Man Diet: Lose 15-20 Pounds, Drop Bad Cholesterol
20% and Watch Your Blood Sugar Free-Fall in 12 Weeks that received
very positive reviews on Amazon.
Dr. Joseph Feuerstein published articles on “Teaching lifestyle
changes to a cohort of local physicians” and “Hypnosis and
acupuncture for anxiety states” in The Journal of Alternative
and Complementary Medicine.
Dr. Joseph Feuerstein did poster presentations on “Teaching
lifestyle changes to a cohort of local physicians” and “Hypnosis and
acupuncture for anxiety states” at the International Congress on
Integrative Medicine & Health (CIMH) 2016 in Las Vegas.
2016 Clinical Annual Report
Department of Family Medicine: Annual Report 2016
22
Dr. Joseph Feuerstein did a poster presentations on “Hypnosis and
acupuncture for anxiety states” at Stamford Hospital Research Day.
Three Family Medicine residents submitted articles and/or
questions to the Core Content Review of Family Medicine.
Dr. Lawrence Leibowitz completed a two-year fellowship in
Integrative Medicine sponsored by the University of Arizona.
Dr. Katherine Takayasu presented several lectures to attending
physicians and residents at Stamford Hospital and Columbia University.
Dr. Kathleen Nurena and two Family Medicine Residents, Lidya Bal
and Jessica Reichbind, presented a research project on “Dog Bite
Prevention” at Stamford Hospital Research Day.
Dr. Marc Brodsky was the principal investigator of a study based
at the Wilton Y comparing a particular stretching exercise program
to self-care for patients with back pain.
Dr. Marc Brodsky did a poster presentation on “Protocol
development and feasibility study of group stretching exercise
program for chronic low back pain” at the International Congress
on Integrative Medicine & Health (CIMH) 2016 in Las Vegas.
Dr. Marc Brodsky published a paper on “Change in health-related
quality-of-life at group and individual levels over time in patients
treated for chronic myofascial neck pain” in the Journal of Evidence-
Based Complementary and Alternative Medicine.
Community Outreach
Dr. Anne Brewer went to the Dominican Republic in January for
a medical mission trip, her eighth to this country.
Dr. Henry Yoon served as School Medical Advisor to the Stamford
Board of Education as well as to the Stamford Department of
Public Health.
Dr. Marc Brodsky coordinated the Athletes and the Arts program
at Chelsea Piers Connecticut.
Dr. Henry Yoon served on the board of directors for Smith House
and the Shelter for the Homeless.
Dr. Henry Yoon was Coordinator of Stamford Hospital’s
Mini-Medical School.
Dr. Joseph Connelly served on the board of directors for
Optimus Health Care.
Dr. Lawrence Leibowitz served as Director of Health of the
Town of Redding.
Drs. Joseph Feuerstein served on the Board of Trustees of
the Fairfield County Medical Association.
Dr. Joseph Feuerstein served as Associate Counselor for
the CSMS governing council. He also served on the CSMS
Charitable Trust Board of Directors.
Dr. Robert Shapiro served as Co-medical Director of the
AmeriCares Stamford mobile van.
Dr. Katherine Takayasu served as Physician Advisor on the
Caring Hospice Professional Advisory Committee.
Dr. Lawrence Leibowitz served as Camp Director for summer
camps in Stamford, Ridgefield and Redding.
Dr. Katherine Takayasu volunteered in the Network of Working
Women group at the YWCA of Darien/Norwalk.
Dr. Alan Falkoff lectured at UCONN about Baseball in Society
while batting .378 in his 28th season with the Stamford Mets
this year.
Dr. Katherine Takayasu made several presentations about
stress management and optimal health to community groups
in Darien, New Canaan and Stamford.
Dr. Joseph Feuerstein served as secretary on the Weston
Newcomers and Neighbors Association.
Dr. Ann Williams continued to inspire everyone to greater
attention to their physical activity level by participating
in (and winning) numerous running and triathlon events
2016 Clinical Annual Report 23
throughout the year, culminating in her qualifying for the
third time for the Kona Ironman World Championship
race in Hawaii.
Dr. Kathleen Nurena, a certified dog trainer, presented classes
on scent detection to the community.
Integrative Medicine
Overview
The Stamford Health Center for Integrative Medicine & Wellness
(CIMW) is comprised of a Hospital-based clinic that offers an
integrative medicine consultation service. It is situated in the
Tully Health Center.
The Center’s model is a high-volume, outpatient, sub-specialty medical
clinic that provides the following Integrative Medicine services:
1. Pain management
2. Nutrition and supplement consultation
3. Mind-body stress reduction
4. Lifestyle medicine
PhilosophyThe philosophy of the CIMW is well-aligned with the Planetree
philosophy that is based on the simple premise that all care should
be organized around the needs of patients. As a result, the CIMW
focuses on its patients as people, how they live and what their
personal goals may be, as well as how their lifestyle affects illnesses,
injury and chronic medical conditions.
The CIMW treats the whole person — body, mind and spirit —
using a safe and evidence-based approach customized for each
individual. Working in collaboration with the patients and their
medical teams, the CIMW offers patient-centered care that blends
conventional and complementary medicine tailored to achieve
the patient’s personal needs and goals for health and wellness.
Patients
The Center treats children, adolescents and adult patients.
Most patients are referred for consultation by physicians and
word of mouth. CIMW practitioners conduct over 9,000 patent
visits per year.
Practitioners
The CIMW employs three full-time board-certified Family Physicians
who provide all treatments. The physicians oversee interdisciplinary
aspects of care by conventional and complementary practitioners,
both Hospital- and community-based. Practitioners who share
common patients with the CIMW physicians are vetted to assure
proper credentialing and are included in a monthly meeting, to
which all Stamford Hospital physicians are welcome, at the Center
to discuss the care of mutual patients, improve communication
among practitioners and optimize patient outcomes.
Services Offered
The Center offers the following Integrative Medicine programs:
Pain Management — The pain management service accounts
for the majority of patient visits and revenue for the CIMW. Most
patients with pain are seen for neck pain and associated symptoms
that include headaches. Other conditions include low back pain,
occupational- and sports-related overuse injuries, osteoarthritis,
neuropathy, fibromyalgia and autoimmune-related and cancer-
related pain conditions.
Nutritional/Supplement Consultation — Weight loss is the most
common condition that is treated in the nutritional consultation
service. The weight loss plan is made up of three components:
a personalized diet, referral to a medical fitness program and
behavioral strategies. Nutrition is an important aspect in the
treatment plan of all patients and includes attention to metabolic
syndrome, digestive symptoms, autoimmune and cancer-related
conditions and attention deficit and hyperactivity disorders
Women’s Health — In addition to issues related to reproductive
health such as pelvic pain, fertility, childbearing, perimenopause
and menopause, the Center complements standard care in the
treatment of female patients with depression, heart disease risk
factors, arthritis and digestive issues. Dr. Katherine Takayasu leads
a multidisciplinary biopsychosocial pelvic pain program that
includes meetings with specialists, community presentations and
presentations at national meetings to improve the quality of life
of patients suffering with this very challenging problem.
Stress Reduction — The CIMW provides patients with the tools
to reduce stress and support lifestyle changes, such as Mindfulness
Meditation. The program also helps patients reduce anxiety and
pain through hypnosis and guided imagery. The signature service
of the Mind-body Stress Reduction service is the Peg Huttleston
24 2016 Clinical Annual Report
Department of Family Medicine: Annual Report 2016
Prepare for Surgery Program to reduce perioperative anxiety.
The Prepare for Surgery program, which is available to all surgical
patients at Stamford Hospital, was featured in a Stamford Health’s
Pulse newsletter published in 2016.
The Athletes and the Arts Program — The Athletes and the Arts
Program was created by the CIMW in conjunction with specialists in
Orthopedics and Sports Medicine to optimize performance in athletes
and performing artists. The focus of the program is to prevent
and treat injuries, inform athletes and performers about optimal
nutrition and hydration and reduce performance anxiety. Treatment
methods may include lifestyle approaches to include instruction
in self-care acupressure and stretching exercises, physician-
administered acupuncture, trigger point injections, non-opioid pain
medication recommendations, nutritional counseling, botanical
and supplement consulting and physician-administered mind-body
stress-reduction therapies.
Education and Research
The clinical stories and patient care outcomes at the Center
offer a rich resource for teaching Integrative Medicine Fellows
at the CIMW as well as for learning activities for medical
students and medical residents.
A full-time, two-year Integrative Medicine Fellowship provides
a unique clinical experience in evidence-based complementary
therapies in pain management, nutrition/supplement consultation
and mind-body stress reduction with guided imagery and mindfulness
meditation. Fellows are funded to complete the 1,000-hour University
of Arizona distance learning and residential Fellowship in Integrative
Medicine curriculum, as well as a 300-hour CME acupuncture program.
Fellows spend 50% time at the CIMW and 50% time at Optimus, a
Federally Qualified Health Care Center that is affiliated with Stamford
Hospital and primarily funded by U.S. Department of Health and
Human Services. Two fellows graduated from the program in June and
a new fellow, Dr. Danielle Greenman, began her fellowship this year.
The Center is a partner in an educational grant from Health Resources
and Services Administration (HRSA) for Integrative Medicine Training
Grant awarded for Griffin Hospital (Yale Teaching Affiliate) Residents.
The CIMW receives no research funding. Center physicians participate
in quality improvement initiatives and frequently present the findings
in peer-reviewed publications and as abstracts at conferences.
Financial Data
Philanthropic funding originally helped open the CIMW
seven years ago, but the clinic is now self-sustaining.
Philanthropy continues to support the education of Center
Fellows at University of Arizona and the acupuncture course.
The number of patient visits in the pain management,
mind-body stress reduction and evidence-based nutrition
services continue to increase each year.
Services at the CIMW are covered by most major medical
insurance plans, including Medicare.
Collaborations
A key strategy of the Center is to build relationships within
the Hospital system and community. As such the CIMW is engaged
in the following collaborative process improvement programs:
1. Breast pain with breast surgeons
2. Pelvic pain with gynecologists
3. Cancer and pain with oncologists
4. Dietary approaches to reducing cardiac risk factors
with primary care physicians and specialist physicians
5. Concussion program with neurologists, neuropsychology
and physical therapy
6. The Athletes and the Arts Program with Orthopedics
7. Reducing perioperative anxiety as part of the standardized
pre-operative process with surgeons throughout the Hospital
Strategy/Future Direction
The members of the Department of Family Medicine are proud
of the many achievements of Stamford Hospital over the past year,
including the opening of the new Hospital, and are gratified to be part
of these successes. We value our relationship with the Hospital as we
collaborate to maintain and improve the health of our patients and the
community in the spirit of Healing: Reimagined.
The presence of a strong Department of Family Medicine will
become even more important as the healthcare system evolves.
We look forward to continuing to work with the Hospital to provide
excellent care to our patients, strengthen our practices, and move
our community’s overall health forward in the face of the changes
taking place around us.
25 2016 Clinical Annual Report
Photograph: © Anton Grassl/Esto
Patient Room
26 2016 Clinical Annual Report
MedicineThe continued vitality of medical practice in the greater Stamford community depends on consistent recruitment of
newer generations of physicians to the staff of our Hospital — this revitalization is essential to the progress of our profession
and our institution, and an effort to which the Department of Medicine remains committed. Emblematic of the clinical
excellence to which we will always strive is the new Stamford Hospital tower, a metaphoric beacon of our departmental
and institutional commitment.
Medicine. Advanced.
27 2016 Clinical Annual Report
Department of Medicine: Annual Report 2016
As a “department of departments,” the Department of Medicine
is involved in a wide range of clinical care, medical education and
research. The achievements of the individual departments that make
up the Department of Medicine are detailed in their respective
annual reports and presented under “Scope of Clinical Services.”
The continued growth of the Department has resulted in the largest
number of physicians on its staff in its history. There are a total of
271 medical practitioners representing 18 primary care and specialty
divisions. A breakout of medical staff specialty representation is
shown in Figure 1. This has been the result of a concerted effort
Figure 1: Medical Staff Specialty Representation in the Department of Medicine
Specialty Active Staff Courtesy Staff
Affiliate Staff
Ancillary Staff
Provisional Active
Provisional Affiliate
Provisional Ancillary Honorary
Internal Medicine 49 – 12 2 2 – 4 5
Allergy and Immunology 3 4 – – – – –
Cardiovascular Disease 19 4 – 3 2 – 1 2
Clinical Cardiac Electrophysiology 3 – – – 1 – –
Dermatology 15 – – – 1 – –
Endocrinology 5 2 1 1 1 – –
Gastroenterology 9 1 2 – – – – 1
Geriatric Medicine 3
Hematology and Oncology 7 – – 4 1 – 1
Hospice & Pallative Medicine 3
Infectious Disease 6 2 – 2 – – –
Interventional Cardiology 6 3 – – 3 – –
Nephrology 4 2 – – 1 – –
Neurology 4 2 – – 4 – –
Pulmonary Medicine 6 – – – 3 – – 2
Rheumatology 5 – – – 1 – –
Physical Medicine and Rehabilitation 9 – 2 – – – –
Hospitalist 25 1 – 5 5 – –
Total 178 21 17 20 25 – 7 10
Noel I. Robin, MD, MACPChair, Department of Medicine and DIO, Stamford Hospital
Professor of Clinical Medicine and Associate Dean at Stamford Health Columbia University College of Physicians & Surgeons
A Message From The Chair The Year in Review
28 2016 Clinical Annual Report
Department of Medicine: Annual Report 2016
by Stamford Hospital to develop primary care centers in adjacent
communities where patients historically might have related to
other hospitals. The growth of hospitalism has also contributed
substantially to these large numbers and second only to general
Internal Medicine, the professional hospitalist staff at 36 is the largest
single specialty within the Department. This represents a 13%
increase compared with 2015. The parallel growth of the Stamford
Health Medical Group (SHMG) and the commitment of new
physicians to be a part of this multidisciplinary organization has been
a catalyst to the vitality of the Department of Medicine. A parallel
increase in the Ancillary Staff took place with 27 members now
serving in that capacity, as compared with 22 in 2015.
The following new members joined the Department of Medicine
since September 2015:
• Erik Beger, MD – Rheumatology
• Meghan Newman, APRN – Internal Medicine
• Donna O’Hara, APRN – Interventional Cardiology
• Maura Sparks, MD – Internal Medicine
• Paul Huang, MD – Hospitalist
• Erin Krajci, APRN – Cardiovascular Disease
• David Hahn, MD – Neurology
• Scott Martin, MD – Interventional Cardiology
• Dmitriy Khodorskiy, MD – Hospitalist
• Joahd Toure, MD – Hospitalist
• Shuaib Latif, MD – Clinical Cardiac Electrophysiology
• Sylvie Rosenbloom, APRN – Internal Medicine
• Susheel Kodali, MD – Interventional Cardiology
• Yumi Koh, DO, MPH – Internal Medicine
• Elizabeth Marsh, MD – Dermatology
• Lindsay Burke Naughton, APRN – Hematology and Oncology
• Christine Couture, PA-C – Gastroenterology
• Marlon Rosenbaum, MD – Cardiovascular Disease
• Daniel Brooks, MD – Neurology
• Rebekah Gospin, MD – Endocrinology
• Sarah Buckingham, MD – Neurology
• Tatjana Gavrancic, MD – Hospitalist
• Anna Monidois, MD – Pulmonary Medicine
• Jamie Stratton, MD – Hematology
• Desh Nandedkar, MD – Pulmonary Medicine
• Danielle Greeman, MD – Internal Medicine
• Arzhang Fallahi, MD – Interventional Cardiology
• Ilnaz Salehi, MD – Hospitalist
• Maryana German, APRN – Cardiovascular Disease
Comparison of the most common DRGs resulting in admission to
the inpatient medical service are noted in Figure 2.
Scope of Clinical Services
Allergy and Immunology
Active Staff:
• Denis A. Bouboulis, MD • Mitchell R. Lester, MD
• Ora Burstein, MD • Paul S. Lindner, MD
• Leslie R. Coleman, MD
Members of the Department of Allergy and Immunology with active
full staff privileges include Denis A. Bouboulis, MD; Ora Burstein, MD;
Leslie R. Coleman, MD; Mitchell R. Lester, MD; and Paul S. Lindner,
MD. The physicians in the Department of Allergy and Immunology
function in an outpatient setting and provide inpatient consultations,
treating patients for a variety of allergic and immunologic conditions.
These include allergic rhinitis, asthma, sinusitis, skin disorders such as
urticaria, contact dermatitis and eczema, food allergy, stinging insect
allergy, drug allergy and immunodeficiency.
In this specialty, specific allergens causing an allergic response are
pinpointed using various techniques that include skin testing, patch
testing, in-vitro analysis of antigen-specific IgE, oral and parenteral
challenges. In addition to avoidance techniques and allergy/asthma
medications, we offer a program of desensitization, which helps
patients develop immunologic tolerance to offending allergens.
Desensitization can be provided for all major environmental
allergens such as dust mites, molds, pollens and cat and dog dander.
Individuals can be desensitized for bees, hornets, wasps and yellow
jackets, antibiotics and other medications including penicillins,
cephalosporins and chemotherapy agents. A major push toward
developing desensitization techniques for food allergens, such as
peanuts, is underway in many academic centers due to the rising
prevalence of food-induced anaphylaxis over the past two decades.
Allergists in our community work closely with other subspecialists
and general practitioners to provide comprehensive care of
the allergic patient. We work with pulmonologists to provide
asthma care; dermatologists can obtain input regarding potential
food allergies as a trigger for eczematous conditions; and
Paul S. Lindner, MD
Director, Allergy and Immunology
Assistant Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons
2016 Clinical Annual Report 29
DRG DRG Description FY16 Rank IP Dc % of All
InptsFY15 Rank IP Dc % of All
InptsFY14 Rank IP Dc
% of All
InptsFY13 Rank IP Dc % of All
Inpts
871 Septicemia or severe sepsis w/o MV 96+ hours w/MCC 1 428 4.58% 1 397 6.8% 1 301 5.1% 1 253 4.4%
392 Esophagitis; gastroent & misc digest disorders w/o MCC 2 236 2.51% 4 133 2.3% 5 138 2.4% 3 141 2.5%
603 Cellulitis w/o MCC 3 170 1.81% 5 125 2.1% 2 158 2.7% 2 191 3.3%
872 Septicemia or severe sepsis w/o MV 96+ hours w/o MCC 4 157 1.68% 3 142 2.4% 8 105 1.8% 12 78 1.4%
291 Heart failure & shock w/MCC 5 155 1.66% 2 157 2.7% 3 146 2.5% 4 126 2.2%
897 Alcohol/drug abuse or dependence w/o rehab therapy w/o MCC 6 150 1.21% 9 103 1.8% 4 141 2.4% 5 126 2.2%
292 Heart failure & shock w/MCC 7 141 1.51% 6 118 2.0% 6 114 1.9% 6 122 2.1%
65 Intracranial hemorrhage or cerebral infarction w/CC 8 126 1.34% 17 70 1.2% 18 81 1.4% 16 73 1.3%
378 G.I. hemorrhage w/CC 9 113 1.21% 7 118 2.0% 9 97 1.7% 10 94 1.6%
812 Red blood cell disorders w/o MCC 10 110 1.16% 8 105 1.8% 7 118 1.9% 7 116 2.0%
641Misc disorders of nutrition; metabolism; fluids/electrolytes w/o MCC
11 103 1.10% 19 67 1.1% 14 89 1.5% 14 76 1.3%
193 Simple pneumonia & pleurisy w/MCC 12 100 1.07% 16 71 1.2% 15 86 1.5% 22 62 1.1%
247 Perc cardiovasc proc w/drug-eluting Stent w/o MCC 13 95 0.95% 13 81 1.4% 16 84 1.4% 23 60 1.1%
309 Cardiac arrhythmia & conduction disorders w/CC 14 90 0.93% 22 60 1.0% 14 88 1.5% 11 91 1.6%
690 Kidney & urinary tract infections w/o MCC 15 88 0.90% 11 86 1.5% 12 90 1.5% 17 71 1.2%
310 Cardiac arrhythmia & conduction disorders w/o CC/MCC 16 84 0.90% 15 74 1.3% 17 83 1.4% 13 77 1.7%
683 Renal failure w CC 84 0.81% 10 101 1.7% 10 97 1.7% 9 106 1.9%
682 Renal failure w/MCC 17 76 0.80% 12 82 1.4% 22 58 1.0% 15 76 1.3%
194 Simple pneumonia & pleurisy w/CC 18 75 0.80% 14 75 1.3% 11 95 1.6% 8 114 2.0%
638 Diabetes w/CC 19 72 0.77% 20 61 1.0% 30 52 0.9% 47 32 0.6%
689 Kidney & urinary tract infections w/MCC 20 66 0.71% 18 69 1.2% 32 49 0.8% 33 49 0.9%
312 Syncope & collapse 21 61 0.65% 27 52 0.9% 19 65 1.1% 25 56 0.9%
918 Poisoning & toxic effects of drugs w/o MCC 22 49 0.37% 41 38 0.6% 20 60 1.0% 40 42 0.7%
313 Chest pain 23 25 0.27% 62 22 0.4% 34 47 .08% 18 70 1.2%
SUBTOTAL 2,854 2,406 41.1% 2,435 40.2% 2,302 40.2%
Total Inpatient Discharges 5,643 5,860 5,855 5,710
Inpatient Days 28,867 31,688 32,418 32,068
Total Observation Discharges 1,733 1,559 1,547 1,160
Observation Days 2,273 2,192 2,103 2,314
Figure 2: Department of Medicine, Comparison of Most Common DRGs
30 2016 Clinical Annual Report
Department of Medicine: Annual Report 2016
otolaryngologists are helped by having the allergist identify and treat
the allergic triggers, which can often complicate a case of chronic
sinusitis and nasal polyposis.
Many of our allergists are involved in clinical research projects.
Dr. Denis A. Bouboulis published two original research articles this
year including, “PANDAS: Baseline Immunoglobulin Levels Predict
Achievement of Remission at One Year Following IVIG Therapy.”
J Neurol Neurosurg 3(2):122 and “Infection-Induced Autoimmune
Encephalopathy: Treatment with IVIG. A Report of Six Patients.”
Int J of Neurology Res 2016 March 2(1):256-258.
Allergists in the Department also diagnose and treat a variety
of primary and secondary immunodeficiencies. The most
prevalent of these is common variable immunodeficiency (CVID),
which responds well to Intravenous Immunoglobulin (IVIG)
therapy. The newest form of gammaglobulin therapy is through
the subcutaneous (SCIG) route. With SCIG, patients no longer
need to spend time at an outpatient infusion center and can
administer their own gammaglobulin therapy at home. The latest
developments in the treatment of allergic disorders are the newly
approved therapies for hereditary angioedema including purified
human C1 esterase inhibitor (Berinert — for acute attacks, Cinryze
for maintenance prevention) and a reversible kallikrein inhibitor,
Kalbitor (ecallantide) for acute attacks. A newly approved selective
bradykinin B2 receptor antagonist, Firazyr (icatibant) has also been
found useful in reversing acute angioedema attacks.
Newer forms of immunotherapy are in current development.
The first monoclonal anti-IgE antibody to be released is Xolair
(omalizumab), which has been shown to improve asthma control
while decreasing the need for systemic and inhaled steroids. Xolair
theoretically will also work for allergic rhinitis and food allergies
by decreasing total IgE on mast cells, however these additional
indications are currently being evaluated. Xolair has just been
approved for treating severe chronic idiopathic urticaria.
Monoclonal antagonists of IL5 have recently been approved for the
treatment of severe asthma. As IL5 stimulates eosinophil activation,
these agents are useful to treat asthma patients with an eosinophilic
phenotype. Nucala is administered SQ monthly and Cinquair is given
monthly by IV. Both medications can be useful as steroid-sparing
agents in treating asthmatics requiring high dose inhaled steroids
or systemic steroids to maintain adequate asthma control.
Studies looking at a variety of future immunotherapy options
include the use of T-cell peptides to stimulate a preferential TH1
vs. TH2 response, the use of adjuvants such as lipopolysaccharide
and immunotherapy with bacterial DNA oligonucleotides containing
an abundance of CPG motifs to enhance a TH1 protective response.
Other monoclonal antibodies on the horizon include anti-IL5 for
hypereosinophilic syndromes and anti-IL4, anti-IL13 for asthma.
The Department of Allergy and Immunology has an active role in
the teaching program for medical students, interns and residents at
Stamford Hospital. Residents spend many weeks with our physicians
in elective rotations. Our Department provides lectures for Grand
Rounds in Medicine as well as lunch conferences for Residents and
Medical Students. This year, Dr. Lindner presented “An Update in the
Field of Allergy & Immunology” as part of the Medical Grand Rounds
series in September.
Our Allergy staff is also active in regional and national allergy
societies. Dr. Lester was recently elected to the Board of Regents of
the American College of Allergy, Asthma and Immunology (ACAAI)
and gave a lecture at the New England Allergy Society this year.
In the coming year, our Department looks forward to providing
excellent care in the field of Allergy and Immunology as clinicians
and educators, and will continue to bring the latest developments
in our specialty to the greater Stamford Hospital community.
Cardiology
Active Staff:
• Charles Augenbraun, MD • Susan Eysmann, MD
• Jeffrey Berman, MD • Arzhang Fallahi, MD
• Samuel Brodsky, MD • John Fisher, MD
• Salvatore Carbonaro, MD • Glenn Gandelman, MD
• Joonun (Chris) Choi, MD • Jeffrey Green, MD
• Evelyn Cusack, MD • Mark Heiman, MD
• Sandhya Dhruvakumar, MD • David H. Hsi, MD
• Gregory D’Onofrio, MD • Steven F. Horowitz
The Cardiology Division is now located on the second floor in the
new Hospital. Within this sophisticated facility, we have state-of-
the-art Cardiac Catheterization and Electrophysiology Laboratories,
nuclear cardiology cameras, 3-D echocardiography and a hybrid
David H. Hsi, MD, FACC, FASE
Chief of Cardiology
Co-Director of the Heart & Vascular Institute, Stamford Hospital
Clinical Professor of Medicine, Columbia University College of Physicians & Surgeons
31 2016 Clinical Annual Report
operating room for special procedures. Stamford Hospital is the
region’s only full-service cardiovascular center in Fairfield County.
We cherish our tradition of the Planetree philosophy and providing
patient-centered care. We are proud to announce the addition of
three new cardiologists joining the team in 2016:
Scott Martin, MD, FACC, FSCAI
Specialty: Cardiovascular Disease and Interventional Cardiology
Medical School: SUNY Downstate Medical Center
Residency: Washington University School of Medicine
Fellowship: University Hospital at SUNY Stony Brook
Board Certifications: Cardiovascular Disease - American Board of Internal Medicine
Shuaib Latif, MD, FACC, FHRA
Specialty: Cardiovascular Disease and Clinical Cardiac Electrophysiology
Medical School: Washington University School of Medicine
Residency: Johns Hopkins University School of Medicine
Fellowship: Hospital of the University of Pennsylvania; University of Texas Southwestern
Board Certifications: Clinical Cardiac Electrophysiology - American Board of Internal Medicine
Arzhang Fallahi, MD, FACC
Specialty: Cardiovascular Disease and Interventional Cardiology
Medical School: University of Washington School of Medicine
Residency: Icahn School of Medicine at Mount Sinai
Fellowship: Icahn School of Medicine at Mount Sinai Beth Israel; New York University School of Medicine
Board Certifications: Cardiovascular Disease - American Board of Internal Medicine
Diplomate - Adult Comprehensive Echocardiography - National Board of Echocardiography
Internal Medicine - American Board of Internal Medicine
Interventional Cardiology - American Board of Internal Medicine
Nuclear Cardiology - Certification Board of Nuclear Cardiology
Registered Physician in Vascular Interpretation - American Registry for Diagnostic Medical Sonography
Diplomate - Adult Comprehensive Echocardiography - National Board of Echocardiography
Dr. Martin is highly skilled in transradial artery-based complex
coronary procedures. Dr. Latif was trained in the top EP program
and specializes in atrial fibrillation ablation and other procedures.
Dr. Fallahi received intense training in TAVR procedures and is
proficient in peripheral vascular interventions.
The Interventional Cardiologists and support staff provide around-
the-clock coverage for the acutely ill patient. They have achieved
98% door-to-balloon times for all eligible ST elevation myocardial
infarction patients admitted to the Hospital in 2016. The procedures
offered include advanced imaging and coronary interventions
and hemodynamic support using percutaneous left ventricular
assist devices.
In addition, our Interventional Cardiologists have significant
experience with TAVR procedures. Some on our team have been
involved in the field of TAVR for over a decade and others have
performed hundreds of cases during a dedicated training program
in structural heart interventions. We work closely and collaborate
with a multidisciplinary team of anesthesiologists and heart
specialists, including the world renowned interventional cardiologist
Dr. Antonio Colombo, at Stamford Health’s Structural Heart Disease
(SHD) Center and Valve Clinic, which is affiliated with Columbia/
NewYork-Presbyterian Hospital to provide comprehensive screening,
evaluation and life-saving treatment to patients with structural
heart and valve disease.
Additional achievements include the following:
• Dr. Wayne Miller, who specializes in 3-D echocardiography and
advanced TAVR imaging, has participated in every TAVR procedure
at Stamford Hospital and provided real-time and accurate
diagnostic information for the TAVR team.
• Dr. Thomas Nero successfully implanted the first CoreValve TAVR
prosthesis at Stamford Hospital with excellent clinical outcome.
• Dr. Thomas Nero, Dr. Scott Martin and Dr. David Hsi have started
an acute pulmonary embolism alert program using ultrasound-
facilitated thrombolysis in patients with massive or sub-massive
pulmonary embolism with appropriate clinical indications.
They worked closely with the ICU team, Dr. Michael Bernstein,
the hospitalists and Dr. Christina Suh.
• Dr. Antonio Colombo was named as the Deputy Editor of the
prestigious Journal of the American College of Cardiology
(JACC) in 2016.
• Stamford Hospital is the first and only hospital in Connecticut to
offer the sophisticated hemodynamic monitoring for patients with
32 2016 Clinical Annual Report
severe congestive heart failure by implanting the CardioMEMS™
in the pulmonary arteries. Dr. Jeffery Green and Dr. Portnay
successfully performed all procedures.
• Dr. Chris Choi led the system-wide effort and received a Gold
Plus Award in Heart Failure care from the American Heart
Association Get With The Guidelines® program in 2016.
Under the leadership of Dr. Sandhya Dhruvakumar, Director of
Electrophysiology, we are the regional leaders in the diagnosis
and treatment of complex arrhythmias including atrial fibrillation,
offering a full spectrum of treatment options including
radiofrequency ablation, cryoablation and hybrid surgical-catheter
ablation procedures. We were the first hospital in Connecticut
to perform cryoballoon ablation, an innovative treatment for
atrial fibrillation, and remain the only hospital in our region to
offer this technology. The Electrophysiology team consists of our
board-certified electrophysiologists and a dedicated, trained
team including full-time nurse practitioners, EP technicians and
EP nurses. Our new Electrophysiology Lab is replete with cutting-
edge equipment in a spacious suite that permits the seamless
integration of technologies in real time, which helps to improve
diagnosis and to better guide treatment.
Dr. Evelyn Cusack, our Director of Community Outreach, has
continued her popular “Walk with the Doc” program, visited many
community physicians and given lectures to the EMS, AHA and
at other public events.
Dr. Edward H. Schuster serves as the Medical Director for Cardiac
Rehabilitation. The program incorporates contemporary concepts
of wellness, fitness, and lifestyle modification for the benefit of
patients with known heart disease. The Cardiac Rehab Program
includes both ECG monitoring and lifetime wellness maintenance
under the leadership of Dr. Murray Low.
The Division provides an educational program combining clinical
discussions and exemplary, formal didactic presentations from
hospital-based cardiologists and many distinguished guest
speakers including: Dr. Paul Thompson from Hartford Hospital,
Dr. Daniel Jacoby from Yale-New Haven, Dr. Valentin Fuster
from Mount Sinai Heart and Dr. Gilbert Tang from Westchester
Medical Center.
We are very proud to be collaborating with Columbia/NewYork-
Presbyterian Hospital, one of the nation’s oldest, largest and
most experienced ACHD programs, to provide the best treatment
possibilities with the goal of improving our patients' longevity
and quality of life. The HVI’s ACHD program is led by Marlon S.
Rosenbaum, MD, Associate Professor of Medicine and Pediatrics
at Columbia University College of Physicians and Surgeons and
Director of the Schneeweiss Adult Congenital Heart Center at
Columbia University Medical Center.
Dermatology
Active Staff:
• Severine Chavel, MD • Rebecca Hall, MD
• Debra Pruzan-Clain, MD • Omar Ibrahimi, MD
• Rhett Drugge, MD • Steven Kolenik, MD
• Robin Evans, MD • Sharon Littzi, MD
• Rena Fortier, MD • Fern Meyer, MD
• Elizabeth Gaines, MD • Ellen Naidorf, MD
• Samuel Gettler, MD • Donald Savitz, MD
Provisional Active Staff
Elizabeth Marsh, MD
The Department also acknowledges the outstanding skill,
educational endeavors, and kindness of Elgida Volpicelli, MD,
Stamford Hospital’s dermatopathologist.
As a specialty, Dermatology focuses on skin cancer prevention
and public education about the perils of sunbathing. Department
members participate in various community forums and events
including corporate skin cancer screenings. We volunteer at the
outpatient clinic at 1351 Washington Boulevard and consult at the
Hospital. The Department's dermatologists also supervise and teach
the medical residents and rotating medical students, and lecture
within the Hospital as well as the outside community.
Great strides are being made in the treatment of many refractory
skin conditions, with the approval of multiple biologics for diseases
such as psoriasis, hidradenitis supporativa and chronic urticaria.
The cosmetic arena also is expanding with newer fillers, heat and
cold generated body sculpting and improved laser treatments.
Department of Medicine: Annual Report 2016
Ellen S. Naidorf, MD
Director of Dermatology
33 2016 Clinical Annual ReportPatient Room
34 2016 Clinical Annual Report
Endocrinology
Active Staff:
• Mary E. Arden-Cordone, MD • Mary M. Kane-Brock, MD
• Maria Asnis, MD • Bismruta Misra, MD
• Anna C. Freitag, MD • Antonio Pantaleo, MD
• Melissa Goldstein, MD • Noel I. Robin, MD
• Rebekah Gospin, MD • Leonard Vinnick, MD
The field of Endocrinology continues to see significant growth in
the understanding of the pathophysiology of disease processes,
and in earlier and more accurate disease detection. There also
has been continued application of newer pharmacologics and
technical skills to address endocrinologic dysfunction.
Type 2 diabetes remains the most prevalent disease seen by
endocrinologists, a result of prevailing patterns of diet and
lifestyle. Balanced glycemic control that matches the physiologic
needs of the individual diabetic patient remains the mainstay of
diabetes management, with new insulin preparations currently
available. In addition, today there are various other categories
of pharmacologics that can play a role in diabetes management.
All of these treatment options are available at Stamford
Hospital and are tailored to the unique needs of each patient.
The optimal management of the diabetic patient underscores
the indispensable necessity of interdisciplinary and collaborative
medical practice. Notwithstanding the nine available categories
(including insulin) of drugs to manage diabetes, nowhere in
clinical practice is personalized medicine more applicable.
The pathophysiology of diabetes is exquisitely elegant, but the
needs of each patient must be individually addressed so that
the blood glucose response is congruent with the therapeutic
goal. Essential to effective management must be patient
enfranchisement in a healthy lifestyle.
Endocrinology has also assumed an even higher level of
commitment to bone health in a structured program that would
comprise preemptive evaluation and screening for potential bone
issues as well as secondary fracture prevention.
This will additionally comprise a dedicated nurse navigator who will
coordinate care and assist the patient along the care continuum.
On the education front, Endocrinology sessions for colleagues,
house staff and students take place throughout the year through
inpatient teaching rounds, The Academic Half Day, student tutorial
and preceptorship sessions, Endocrinology Tumor Board and
Medical Grand Rounds, including the Summer Syllabus. In addition,
residents spend one-on-one time with certified diabetes educators
(CDEs) at the Stamford Hospital Diabetes Education Center, an
American Diabetes Association (ADA)-recognized center for diabetes
education. Endocrinology support through consultation and
clinical involvement takes place on all Hospital units, and a regularly
scheduled and dedicated outpatient clinic at 1351 Washington
Boulevard is staffed by the Department.
Fairfield County Diabetes and Endocrinology has dedicated
endocrinologists and is part of the Stamford Health Medical Group
(SHMG) network. The practice is led by Medical Director Dr. Bismruta
Misra with Drs. Maria Asnis, Melissa Goldstein and Rebekah Gospin
as attending endocrinologists. The practice is now located in a
new facility at 292 Long Ridge Road in Stamford.
The Diabetes Education Program at Stamford Health
Diabetes education programs apply for American Diabetes
Association (ADA) Education Recognition voluntarily. Stamford
Hospital first acquired this Education Program Recognition from
the ADA in 2001 and currently has maintained program recognition
extending through 2019. The application process is rigorous with
participant data collection and interpretation. The ADA’s Diabetes
Education Recognition Program is the process through which
programs that meet the National Standards for Diabetes Self-
Management Training and Support (DSMT) are formally identified
for their performance and quality.
The ADA Education Recognition Program has grown to become
the leading quality assurance mechanism for all diabetes self-
management education programs across the country. To that point
Medicare will cover diabetes education sessions for their beneficiaries
only if provided through an ADA-accredited diabetes education
program. Programs that do receive this recognition are viewed
as having met the criteria for having a staff of knowledgeable health
professionals (registered nurses and registered dieticians) who can
provide state of the art diabetes education. Currently all educators
at the Diabetes and Endocrine Center are CDEs. A multidisciplinary,
interactive and proactive approach to diabetes education has
Department of Medicine: Annual Report 2016
Noel I. Robin, MD
Director of Endocrinology
2016 Clinical Annual Report 35
been created to include a thorough assessment, sound educational
curriculum, diabetes support management planning and follow
up with behavioral outcome measurement. The Stamford Health
Diabetes Education Program is designed to offer outpatient
individual instructional sessions, as well as group self-management
classes. The sessions begin with an individual assessment to
develop a plan of care. Classes are offered on different days and at
different times, and staffing schedules are flexed, when necessary,
to meet participant needs.
Instructional methods include demonstrations, return
demonstrations, audiovisual presentations and interactive
sessions. There is adequate time during each session for questions
and answers. Our teaching approach is interactive, as well as
patient- and family-centered, and supports the evolution of
problem solving skills. Hearing-impaired patients are offered sign
language interpretive services, and TDD devices are also available.
Additionally, we can utilize the ATT Language line, in which
instructors engage interpreters by speakerphone for the many
different languages spoken in the service area. There is no cost to
the patient for these interpretive services.
Follow up is considered an integral part of the educational
experience for the individual with diabetes. Behavioral goals are
formed during the instruction sessions, and are evaluated and/or
modified. Follow-up may also occur in person or on the telephone
as needed. The participants in the Diabetes Education Program
will be seen on an as-needed basis following instruction. Phone
contact is always encouraged to solve self-management problems
that may arise. Diabetes Self- Management Support Planning
(DSMSP) is provided in collaboration with the participant, and is
communicated with other healthcare providers involved in the
patient’s care. The referring Primary Care Physician and /or Specialist
are notified for an urgent health issue needing to be resolved and
on overall education program progress.
The Diabetes Education Program Staff
Debra Milne, BSN, RN, CDE Director, Ambulatory Nursing and Diabetes Education
Sangeeta Ahuja, MS, RD, CDE
Jill Ely, APRN, CDE
Barbara Nadolny, RN, BSN, CDE – Lead RN, CDE
Gavin Pritchard, RDN, CDE
Ann Rupp, RN, BSN, CDE
In 2016, there were 3,180 diabetes education visits (2,700 budgeted).
Diabetes education actively participate in community outreach
through their continued support of Stamford Health-sponsored
wellness and Speakers Bureau events. We also:
• Conducted a half-day academic session for residents related to
delivering comprehensive diabetes care.
• Held full-day quarterly education sessions on diabetes awareness
for GEMS and RN staff.
Additionally, Barbara Nadolny BSN, RN, CDE, serves as the legislative
point person for Connecticut Alliance of Diabetes Educators (CADE).
She is actively involved in the State of Connecticut Department of
Public Health coalition where the goal is to achieve reimbursement
from Connecticut Medicaid for Diabetes Education services.
Gastroenterology
Active Staff:
• Neeraj Anand, MD • William Pintauro, MD
• Henry Grafton Beecher, MD • Robin Forman Rose, MD
• Robert Dettmer, MD • Neil Schamberg, MD
• Sarah Kahn, MD • Amy Smithline, MD
• Darlene Negbenebor, MD • Stuart Waldstreicher, MD
The Department of Gastroenterology has enjoyed another
successful year. Our Division continues to diversify the services
it offers to patients and the healthcare community. Over the
past year, we performed over 6,000 endoscopic procedures at
both the Hospital and the Tully Health Center. In addition, under
the direction of Dr. Amy Smithline, we are currently providing
esophageal motility and impedance studies along with 24-hour
pH monitoring. This has enhanced our ability to evaluate and
treat patients with problematic gastroesophageal reflux and
esophageal motility disorders. We are currently working with
our Colorectal Surgery colleagues in coordinating pelvic floor
physiology dysfunction testing. This includes high-resolution
anorectal manometry and pudendal nerve testing methodologies
used for evaluation of function and coordination of anal sphincter
and pelvic floor muscles. The Endoscopy Center at the Tully
Stuart Waldstreicher, MDDirector of Gastroenterology
Assistant Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons
36 2016 Clinical Annual Report
Health Center received designation as an American Society of
Gastrointestinal Endoscopy Center of Excellence. Our Division
acquired the Fuse® full spectrum endoscopy system designed to
enhance colorectal polyp detection. We have also incorporated
the ProVation® dictation system to provide improved
documentation for our endoscopic reports. Our new endoscopy
suite located on the first floor of the new Hospital is equipped
with full anesthesia capabilities and fluoroscopy, allowing us to
perform all of our procedures, including ERCP, in our new suite.
We are appreciative for all the support of our colleagues and
administration that allows us to provide state-of-the-art care for
our patients and community.
Geriatrics
Active Staff:
• Rodrigo Acosta, MD • Allison B. Ostroff, MD
• Rohit Bhalla, MD • Santi Neuberger, MD
• Anne Brewer, MD • Meghan Newman, APRN
• Doreen Chimblo, APRN • Noel Robin, MD
• Tzivia Moreen, MD • Monika Tello, APRN
This has been a very busy and productive year for the Division of
Geriatrics. Our geriatrics task force, which includes representation
from nursing, nursing education, discharge planning, case
management, Planetree, chaplaincy and the departments of
Psychiatry, Neurology and Internal Medicine, has finalized a
protocol for the identification and management of patients
with delirium and our pilot began on the 8th floor of the new
Hospital on November 1. We are partnering with the Alzheimer’s
Association in training a dedicated group of volunteers who will
work one-on-one with this patient population. These volunteers
will be obtaining information about the patients from their
family/caregivers to best target interventions for the individual.
The Alzheimer’s Association has also provided us with tool kits
containing everything from information for family and caregivers
to a deck of cards and coloring pads to provide stimulation to this
patient population.
A new Delirium Policy has been approved by the Medical
Executive Committee and is being implemented for the entire
Hospital. Only 17% of delirium cases are currently identified
in hospitals nationwide and early identification will help both
patient and hospital outcomes. We have also created new patient
education materials on delirium to better educate families to
the condition and to manage their expectations.
We are working with the hospitalists to develop an inpatient
geriatric consultative service and are actively recruiting to
fill this role.
The Connecticut Chapter of the Alzheimer’s Association has also
elected Dr. Allison Ostroff to its board of directors. We are working
on creating a “dementia-friendly community” and Stamford was
selected as the pilot city for this initiative. While it is still in its early
stages, this initiative includes collaboration from the Hospital, City
leadership and area businesses to identify ways to best manage
our elderly population with cognitive deficits. Currently there is
only one of these communities in the United States in Minnesota.
These communities exist and flourish in Belgium, Holland and
Great Britain. Once again, we hope to present our pilot data at
the Connecticut Annual Meeting of the Alzheimer’s Association
in April 2017.
We are hoping to expand the division of Geriatric Medicine soon
so that we can provide the most comprehensive and fluid care to
our patients and make transitions of care as seamless as possible.
We greatly look forward to working with everyone in caring for
our older population.
Department of Medicine: Annual Report 2016
Allison B. Ostroff, MDDirector of Geriatric Medicine
37 2016 Clinical Annual ReportMain Lobby
38 2016 Clinical Annual Report
Hospitalist Medicine Active Staff:
• Jennifer Bendl, DO • Michael Marchese, MD
• Iulian Benetato, MD • Santy Mathew, MD
• MaryAnne Bhojwani, MD • Hiren Mody, MD
• Alfred Bircaj, MD • Girija Narayanaswamy, MD
• Sasha Cobotic, MD • Aye Omoruyi, PA
• Resul Dalipi, MD • Chinyelu Oraedu, MD
• Satish Deshpande, MD • Kwen Ortega, MD
• Jenifer Drummond, MD • Miroslav Radulovic, MD
• Joseph Elassal, MD • Praveen Reddy, MD
• Betty Exume, PA • Rolando Santos, MD
• Christiana Famodimu, MD • Ilnaz Salehi, MD
• Mary Fedor, MD • Asha Shah, MD
• Tatjana Gavrancic, MD • Danielle Sry, PA
• Kakra Gyambibi, MD • Christina Suh, MD
• Paul Huang, MD • Peter Tenicki, MD
• Clive Johnson, DO • Joahd Toure, MD
• Chinenye Kalu, APRN • Phi Tran, DO
• Dmitriy Khodorskiy, MD • Marcos Valerio, MD
• Maher Madhoun, MD
Since July 2003, when the program of full-time hospital-based
physicians (Hospitalists) was formally inaugurated, Hospitalist
Medicine has developed into a strong and relevant in-hospital
Department of Medicine: Annual Report 2016
presence of trained medical professionals who serve the institution and
the medical community in a variety of ways. At Stamford Hospital, it has
evolved to fulfill important institutional needs and to set a standard of
care in the oversight of inpatients seen in our hospital. Hospitalists have
also meaningfully complemented the role of practicing physicians, as
the need for seamless and effective care of their inpatients has grown.
Notably, the Stamford Hospital Hospitalists group treats approximately
90% of the Medicine inpatient census. Hospitalist Medicine remains
the fastest-growing specialty in clinical practice.
The Hospitalists continue to have a preeminent role in resident
education. This has been both a natural and an evolutionary trend
in medical education, promulgated by changing requirements
mandated by the Accreditation Council for Graduate Medical
Education (ACGME), as well as the reality of the intensive involvement
of Hospitalists in the care of patients also managed by medical house
staff. Hospitalists’ importance in resident education is underscored
by the appointments of Dr. Maher Madhoun, Dr. Paul Huang and
Dr. Hiren Mody as Assistant Program Directors in Inpatient Medicine
for the Residency Program in Internal Medicine. The Hospitalist
group also provides clinical education to Quinnipiac University
students for their Internal Medicine rotation.
Hospitalists continue to play a leadership role in developing and
implementing the MediTech inpatient EMR; improving accountability;
and collaboration between various Hospital departments, particularly
among the medical staff and ED. Over the last year, we identified a
need to have a Hospitalist Census Surge Alert/Policy. This has been
created and has been used on numerous occasions. This is activated
during times of high census, high acuity, severe weather, mass influx
in ED and or lack of surge capacity. Our organizational goal is to avoid
diversion, prevent ED overcrowding and prevent delays in discharging
by activating all available resources. This has aided in floor and
ED efficiency throughout.
We are also always working to improve the patient experience.
We have teamed up with the Patient Satisfaction team to assist in
improving our patient satisfaction metrics. We have instituted a
direct observation tool when engaging the patient and family in
efforts to improve the patient experience, and work on this feedback
metric remains in progress. In addition, our group continues to
work on improving care of sepsis patients and we have formed a
multidisciplinary task force to work on this. All cases of severe sepsis are
identified and reviewed, and any areas of opportunity of improvement
identified and discussed with the team members. This continues to be
a work in progress.
In conjunction with Neurology, Hospitalists play a major role in the
neurologic care at Stamford Hospital. The entire Division is an active
Maher Madhoun, MD
Hospitalist Director
Infectious Disease Specialist Assistant Clinical Professor, Columbia University College of Physicians & Surgeons
Assistant Program Director for Inpatient Teaching, Internal Medicine Residency Program
Peter J. Tenicki, MD
Associate Director
Assistant Clinical Professor, Columbia University College of Physicians & Surgeons
Assistant Program Director for Inpatient Teaching, Internal Medicine Residency Program
39 2016 Clinical Annual Report
participant in the Stroke Program, which was recertified by the Joint
Commission in 2015. The Hospitalist team is available around the
clock to expedite the treatment of patients with stroke, working
collaboratively with Neurology.
With an aging population, limitations on medical residents’ hours
and increased daily physician responsibilities, mid-level providers
are delivering care not only in the outpatient setting but also in
the Hospital. Currently, we have five full-time and per diem mid-
level providers. Mid-levels are improving quality and safety with
quality-improvement projects by sitting on various committees in
the Hospital and by using evidence-based best practice protocols.
In addition, by informing patients and patients’ families about what
is to happen and future treatment steps to take, patient satisfaction
for our Division has increased and avoidable readmissions reduced.
Physicians can delegate care to mid-level providers, within their
scope of practice, which frees up physicians for more complex
cases. They are a crucial part of our Division and are accessible to
answer nurses’ questions, complete histories and physicals, aid
in ED throughput times, assist in minor procedures, respond to
emergencies, complete discharge summaries, facilitate discharges
earlier in the day and provide other care when needed.
Members of the Hospitalist Medicine group continue to serve on
many Hospital committees, including ED Leadership Throughput
Committee, Pharmacy and Therapeutics Committee, Graduate
Medical Education Committee, IT Leadership Committee,
Resuscitation Committee, Sepsis Committee, Clinical Competence
Committee Meeting for Internal Medicine, Infection Control
Committee, Patient Satisfaction Committee, Medicine Peer Review,
Medical Executive Committee, Core Measures work group, Infection
Prevention and Patient Safety and Quality Committee.
The top 10 admitting diagnoses include:
1. Unspecified Chest Pain 6. Atrial fibrillation, unspecified type
2. Syncope & Collapse 7. Seizure
3. Sepsis 8. TIA
4. Acute Respiratory Failure 9. AKI
5. CVA 10. COPD exacerbation
Some of our quality, productivity and strategy metrics are included
below. Figure 1 shows Stamford Hospital’s payor mix; Figure 2
highlights ED hold to admit status for FY16 vs. FY15; Figure 3 shows
the trend for readmission rates for 2014-2016; Figure 4 demonstrates
the average length of stay for patients from 2014-2016; Figure 5
shows the percentage of discharge orders by 10 a.m.; and Figure 6
highlights the e-prescribing rate for June, July and August 2015.
Hospitalist Medicine’s goals for 2017 include continued growth and
expansion in developing Hospital protocols and efficiency-related
projects such as LOS reduction, SNF utilization, reducing re-
admissions from both home and SNFs, improved case mix index and
medical record documentation, improved early discharge metrics,
improved PCP satisfaction, improved sepsis bundle performance
and ED throughput. Due to the climate of the new healthcare law,
Hospitalists have been called upon to participate in a bundle savings
program and revenue-sharing with multiple entities during the
patient’s continuum of care. We consistently strive to provide a higher
quality of patient care. Therefore, we aim to increase our Medicare
core measure metrics by giving patients the best-possible care,
exceeding their expectations and preventing readmissions. We have
ongoing initiatives to increase patient satisfaction scores with regards
to physician communication.
Figure 1: FY 2016 Payor Mix
Payor Mix
40 2016 Clinical Annual Report
Department of Medicine: Annual Report 2016
Figure 2: Highlights ED hold to admit status for FY16 vs. FY15
E-Prescribing Rate
2016
Jun
65.7
Jul
64.7Jul
Aug
Aug
October 2015 to present
All Cause Re-admission Rate All Cause Re-admission Rate
FY 2015FY 2014 FY 2016
9.69% 9.80% 9.07%
FY 2016
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
8.79% 10.30% 8.62% 10.23% 9.44% 8.79% 10.55% 8.73% 9.45%8.32%
7.33%8.17%
Avg LOS: (excludes > 30 day stays) Avg LOS: (excludes > 30 day stays)
FY 2015FY 2014 FY 2016
4.64 4.82 4.75
FY 2016
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
5.10 5.10 4.90 4.73 4.77 4.91 5.06 4.59 4.763.92
4.754.28
a) Includes all inpatient accounts, except Account Types – 'IPHOBPIC', 'IPPSYCH', 'IPREHAB', 'OPOBSERV', and 'OPSOC-H'.b) Data reported as of patient's 'Discharge Date'.c) Data excludes patients with Diaschrge Disposition Name – '02 XFER TO ACUTECARE HOSPITAL', '07 AGAINST MEDICAL ADVICE, and '20 EXPIRED'.d) Data excludes outliers (i.e., patients with LOB>30).e) Hospitalists acting as 'Physician of Record'.
%D/C Ordered by 10 a.m.
FY 2016No
Yes 42.1%
Oct
57.9%
Nov
47.7%
52.3%
Dec
42.4%
57.6%
Jan
42.0%
58.0%
Feb
42.6%
57.4%
Mar
44.8%
55.2%
Apr
48.0%
52.0%
May
41.1%
58.9%
Jun
42.5%
57.5%
Jul
46.7%
53.3%
Aug
51.5%
48.5%
Sep
41.7%
58.3%
No Yesa) Data reported as of patient's 'Discharge Date'b) Hospitalists acting as 'Physician of Record'
ED Hold to Admit Status
FY 2015
Volu
me
Min
utes
FY 2016
OctOct AprApr JanJan JulJul NovNov MayMay FebFeb AugAug DecDec JunJun MarMar SepSep
334
27
345
24
318
24
307
31
311
22
336
21
355
30
322
30
328
22
302
23
381
29
318
23
314
28
410
31
283
20
335
27
348
23
234
19
306
23
378
24
226
21
332
24
347
24
224
23
41 2016 Clinical Annual Report
Figure 3: Trend for readmission rates for 2014-2016
a) Data reported as of patient's 'Admit Month'b) Hospitalists acting as 'Admitting Provider'
a) Data reported as of patient's 'Discharge Date'b) Hospitalists acting as 'Physician of Record'
a) Source: Ingenious Med.
a) New Consults – H&P Bills Volume reported by Ingenious Med - New Admissions as per Meditech a) NBounce: Ingenious Med.b) Only Hospitalists data
a) Data reported as of patient's 'Discharge Date'b) Hospitalists acting as 'Physician of Record'
a) Data reported as of patient's 'Admit Month'b) Hospitalists acting as 'Admitting Provider'
New Admissions
Discharges - Hospitalist: Physician of Record
New Consults
New Admissions (Daily Average)
Discharges - Hospitalist: Physician of Record (Daily Average)
H&P Bills
FY 2015FY 2015
FY 2016 FY 2016
FY 2016 FY 2016
Oct Nov Dec MayJan JunFeb JulMar AugApr Sep
Oct
Oct
Nov
Nov
Dec
Dec
May
May
Jan
Jan
Jun
Jun
Feb
Feb
Jul
Jul
Mar
Mar
Aug
Aug
Apr
Apr
Sep
Sep
53
16.8
692
19.7
49
19.7
648
20.4
38
18.2
673
19.9
90
17.3
615
17.8
21
16.2
561
17.1
40
17.5
640
18.1
43
17.6
640
19.5
111
17.0
607
17.5
62
18.1
642
17.9
54
19.6
594
18.5
50
16.5
657
19.1
206
19.3
632
610 612616552514 560566 544556 555591 528 17.6
Oct Nov Dec MayJan JunFeb JulMar AugApr Sep
522 590563 536485 543499 528561 589513 578
FY 2015
FY 2016 FY 2016
FY 2015
Oct Nov Dec MayJan JunFeb JulMar AugApr Sep Oct Nov Dec MayJan JunFeb JulMar AugApr Sep
548 17.7
639 20.6
578 19.7
599 20.0
562 18.1
635 20.5
539 17.4
525 16.9
509 17.0
540 18.0
544 17.5
600 19.4
508 18.0
597 20.6
557 18.0
496 16.0
589 19.0
580 18.7
613 20.4
540 18.0
559 19.3
607 19.6
613 20.4
426 14.2
Average Daily Cenus
FY 2016
FY 2015
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep
105.2
114.1
97.2
106.9
110.4
107.8
110.5
113.5
106.3
112.3
108.8
114.5
115.6
116.9
99.7
104.3
107.3
100.3
98.3
94.2
101.6
100.2
110.4
100.6
42 2016 Clinical Annual Report
Infectious Diseases
Active Staff:
• Ralph Cipriani, MD • Ariana Kuehne, NP
• Maher Madhoun, MD • Asha Shah, MD
• Michael Parry, MD • Lynda Streett, MD
The Infectious Diseases Department is a Division of the Department
of Medicine and provides multiple services to patients and clinicians.
The Division is responsible for infection prevention and Hospital
epidemiology, microbiology laboratory direction, Employee Health
Service direction, the antibiotic stewardship program in conjunction
with Pharmacy, the HIV program, clinical consult service, emergency
management (for infectious diseases) and staff education at all
levels. Scheduled and ad hoc educational programs are provided
for students, residents, attending staff, nursing staff, other Hospital
employees and the community. The Department is also actively
involved in numerous medical staff and Hospital committees:
• Infection Prevention Committee – Dr. Michael Parry (Chair),
Dr. Lynda Streett, Dr. Asha Shah
• IT Leadership & Emergency Management
Committee – Dr. Michael Parry
• Regs & Accreditation Committee – Dr. Michael Parry
• Pharmacy & Therapeutics Committee – Dr. Michael Parry
• Perinatal Infection Committee – Dr. Lynda Streett, Dr. Asha Shah
• ICU Committee – Dr. Lynda Streett
Dr. Streett recently completed certification in Wound Care
Management and Dr. Shah attained her Master’s Degree in Medical
Epidemiology at Columbia University Mailman School of Public
Health. Two part-time Division members, Dr. Maher Madhoun
(full-time Hospitalist) and Dr. Ralph Cipriani (full-time Internist), also
participate in committee and educational programs.
The most active subspecialty areas of clinical work are hospital-
acquired infections and HIV/AIDS. Ariana Kuehne, NP, Director of
Outpatient HIV Services, coordinates HIV clinic services and the
bimonthly adult immunology clinic. She expertly supervises the
care for a client base of up to 100 individuals, working both at
Optimus Healthcare and Stamford Hospital. The Department was
again successful in its reapplication for three federal Ryan White
Grants in support of the Infectious Disease Nurse Practitioner,
Adherence Nurse Rheajeanne Britt, RN, and Nutritional Counselor
Lisa Lasorsa, RD. They provide dedicated service to our clients and
make the Stamford Hospital HIV Program a unique and highly
acclaimed program in the state. Private practice outpatient referral
diagnoses in addition to HIV infection, include tick-borne diseases,
skin/soft tissue, wound and bone/joint infections, immunization
services and travel medicine.
Research activities, Hospital epidemiology, environmental
infection control and antibiotic stewardship are ongoing. The
Department, together with Environmental Services, continues
to be involved in a multi-medical center environmental study
to evaluate the effectiveness of terminal room cleaning in the
prevention of hospital-acquired infections. The Department is
involved in three pharmaceutical research studies: A randomized,
double blind study of Omadacycline versus Moxifloxacin for the
treatment of Community Acquired Bacterial Pneumonia; Treatment
of Candidemia with CD101, a new long-acting Echinocandin;
and Treatment of Severe Influenza in Hospitalized Patients with
Oseltamivir, with or without Danirixin, a CXCR2 inhibitor.
Infection prevention represents the most important departmental
activity at Stamford Hospital. Infection Prevention Nurses Brenda
Grant, Merima Sestovic and Paula Castellano-Flynn function out
of the Department’s offices on the Terrace level of the Physicians’
Office Building. They perform critical roles in infection surveillance,
outbreak investigation and control, education, policy development
and regulatory compliance. Ms. Grant continues her appointment to
the State of Connecticut Healthcare-Associated Infections Advisory
Committee. She was also elected to a three-year term on the National
Board of Directors of the Association for Professionals in Infection
Control and Epidemiology (APIC). Ms. Sestovic has been involved in
regional APIC activities. Dr. Parry is also a member of the Connecticut
Department of Public Health (CT DPH) Committee on Reportable
Diseases and CT DPH Advisory Committee on Infectious Diseases.
The Department’s quality improvement initiatives are ongoing and
showed good performance in several collaborative areas for FY16.
The Department was an active participant in two collaborative
projects in this regard: the PAICAP (Preventing Avoidable Infectious
Complications by Adjusting Payment) study with Harvard Medical
School; and the Sentinel Laboratory RSV and Influenza Surveillance
Program through CDC. Infection prevention targets include
Department of Medicine: Annual Report 2016
Michael Parry, MDThomas Jay Bradsell Chair of Infectious Diseases, Stamford Hospital
Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons
43 2016 Clinical Annual Report
reduction in all device-related infections including hospital-wide
central line-associated bacteremia (CLABSI), hospital-wide catheter
associated urinary tract infections (CAUTI) and colon surgical
infections (with surgery). Increasing demands for surveillance and
public reporting have taxed our resources as 2016 saw an increase
in monthly requirements for reporting for CLABSI and CAUTIs, C.
diff cases and MRSA bacteremia from all Med-Surg units, Pediatrics,
Rehab and the ICU. Urinary catheter utilization rates remain 50%
lower than CDC benchmarks. Hand hygiene monitoring is an
integral part of our hospital-acquired infection (HAI) reduction
effort but it has been a challenge to reach the 95% target.
Nevertheless, HAI rates for 2015 reached all all-time low, falling
to 0.8% and surgical site infections were 0.61%.
Nephrology
Active Staff:
• Revekka Babayev, MD • William Hines, MD
• Eric Brown, MD • Nazanine Khairkhah, MD
• Brenda Chan, MD • Francis Walsh, MD
• John Fitzgibbons, MD
The Division of Nephrology continues to offer acute inpatient
hemodialysis, acute inpatient peritoneal dialysis, and CRRT
(continuous renal replacement therapy). For the period
October 1, 2015 to September 30, 2016, we performed 843
inpatient hemodialysis treatments and 71 days of CRRT. Our
glomerulonephritis practice remains active and has benefited
immensely from the cooperation of Interventional Radiology (for
biopsies), Stamford Pathology (which performs an immediate
assessment of the adequacy of the biopsy and sends the tissue
to Columbia) and the world-class renal pathologists at Columbia
University. We actively recruit patients for the CureGN Study in
cooperation with Columbia and host the study staff quarterly for
the convenience of our subjects.
The Stamford DaVita dialysis center currently has 160 in-center
hemodialysis patients, seven home hemodialysis patients (who use
the NxStage machine), and 44 peritoneal dialysis patients. We have
been designated a Five-Star Clinic by CMS (its top rating) and have
won a Fistula First Award from the ESRD Network of New England.
Our clinic serves the greater Stamford area with patients residing in
towns stretching from Norwalk to Port Chester and South Salem.
The principal modality for peritoneal dialysis is CCPD, which is dialysis
done overnight using a simple machine. Daily home hemodialysis
is an important modality due to the greater degree of rehabilitation
that it affords as well as superior phosphate and blood pressure
control, we plan to offer nocturnal hemodialysis immininently.
We continue to aggressively refer patients for renal transplant
and retain affiliations with the programs at Columbia and Yale.
DaVita continues to provide outpatient dialysis services and, since
March, 2014, supplies inpatient hemodialysis and CRRT.
The Division of Nephrology supports the teaching program of
the Hospital. All members of the Division participate in clinical
teaching, morning report, formal lectures and renal conferences.
Two members participate in third-year medical student
preceptorship for four weeks each year. One member supervises
the Department of Medicine Journal Club, an important
educational vehicle that teaches house staff analytic reading,
interpretative skills, statistical analysis and critical thinking. One
member is an active participant in the outpatient Medicine Clinic
at Optimus. Two physicians are active members of the Department
of Medicine Clinical Competence Committee. We collaborate
with the Department of Medicine in arranging outside nephrology
speakers regularly and last year hosted Dr. Andrew Bomback and
Dr. Jai Radhakrishnan from Columbia and Drs. Peter Aronson,
Mark Perazella and Aldo Peixoto from Yale.
The Division continues to participate in clinical research. We are
actively recruiting for the SONAR Study, an endothelin agonist to
slow the progression of diabetic nephropathy, and are participating
in a study providing external defibrillators ro new dialysis patients
and four different studies of Vadadustat, a novel medication to treat
the anemia of kidney disease.
Dr. Revekka Babayev joined our practice a year ago after completing
her training at Columbia and has already won the Specialist of the
Year Award from the house staff, an honor which barely touches
her contributions to our practice and community. In addtion
to the Stamford practice, clinical services are performed by Drs.
John Fitzgibbons, Nazanine Khairkhah and Francis Walsh, whose
dedication continues to expand the clinical and academic services
that the Division provides.
Eric Brown, MD Director of Nephrology Assoc. Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons
44 2016 Clinical Annual Report
Neurology
Active Staff:
• Daniel Brooks, MD • Charisse Litchman, MD
• Sarah Buckingham, MD • Sarah Mulukutla, MD
• David Hahn, MD • Louise D. Resor, MD
• Eric Kung, MD • Evangelos Xistris, MD
Drs. Charisse Litchman and Eric Kung received special
certification from the American Academy of Neurology in the
management of headaches. Dr. Louise Resor completed training
in electroencephalography. Dr. Evangelos Xistris has extensive
experience in the diagnosis of neuromuscular problems and
performs EMGs.
In 2015, Dr. Sarah Mulukutla joined the staff as a neuro-hospitalist
devoting her full time to the care of hospitalized patients. She
provides urgent and intensive management to patients with
neurologic problems. She was joined in that endeavor in November
by Dr. David Hahn, a stroke-trained neurologist, who spends half-time
in the office, and more recently by Dr. Daniel Brooks. Dr. Brooks, also a
graduate of the Yale Neurology program, completed a neurovascular
fellowship at the Albert Einstein College of Medicine. Dr. Sarah
Buckingham, another Yale-trained neurologist with sub-specialty
training in movement disorders, was the most recent addition to
the Department. Her expertise in the management of patients with
Parkinson’s disease and tremor is a major asset to the community.
The members of the Department continue to staff the stroke
program at Stamford Hospital. They are on call around-the-clock to
respond to “stroke alerts.” Intravenous TPA, a “clot busting” medicine
aimed at improving stroke outcomes, must be given within four-
and-a-half hours of the onset of symptoms. Our stroke protocol is
designed to provide rapid assessment of stroke patients in the ER and
in the Hospital to ensure the medication is administered in a safe and
timely manner. In September 2015, we received recertification by The
Joint Commission, having already achieved Gold Award status from
the American Heart Association’s Get With The Guidelines® program.
The three neuro-hospitalists have enhanced inpatient neurologic
care immeasurably. Their immediate availability has served to
improve our care of stroke patients in particular. As a result, over
the past year the number of patients who received TPA rose to an
all-time high and our door-to-needle times for the administration
of IV-TPA decreased dramatically.
Dr. Kung continues to supervise the neurologic care of brain-
injured patients as he leads the concussion program, a multi-
disciplinary group of neurosurgeons, neurologists, orthopedists,
neuropsychologists, speech, occupational and physical therapists.
Neurologists supervise electrodiagnostic services at Stamford
Hospital. In addition to routine outpatient EEG and evoked potential
exams, 24-hour ambulatory EEG testing is available. In the Hospital,
the Department provides prolonged video EEG monitoring for
the evaluation of undiagnosed episodes of altered consciousness
and monitoring of critically ill ICU patients. With the acquisition
of new equipment this fall, real-time remote monitoring of the
EEG will be available.
The addition of four recently trained neurologists has added
to the depth and breadth of neurologic care in Stamford.
The neuro-hospitalists have enabled us to provide superior
care for inpatients with neurologic problems.
Department of Medicine: Annual Report 2016
Louise D. Resor, MDDirector of Neurology
45 2016 Clinical Annual Report
Oncology and Hematology
Active Staff:
• Anne Angevine, MD • Steve Lo, MD
• Michael Bar, MD • Jamie Stratton, MD
• Salvatore Del Prete, MD • Isidore Tepler, MD
• Anthony Gulati, MD • Paul Weinstein, MD
The Divisions of Hematology and Oncology are composed of the
eight physicians practicing as Hematology Oncology PC (HOA),
administratively named Medical Oncology and Hematology
(MOH), as part of the cancer service line within the Bennett Cancer
Center (BCC). Dr. Jamie Stratton joined HOA in August 2016, after
completing her medical training at New York Medical College and
a fellowship at Yale-New Haven Hospital. Skilled medical colleagues
including Radiation Oncologists, cancer-oriented Surgeons,
Pathologists, Diagnostic Radiologists and other medical staff
provide dedicated support. We are greatly aided by subspecialty
Nurse Navigators Dominique Srdanovic (GU, Supervisor), Melissa
Ronk (Thoracic) and Katharine Radziewicz (GI). We serve the needs
of patients with oncologic and hematologic (both benign and
malignant) disorders in the Hospital’s primary catchment area and,
increasingly, secondary, tertiary and even more distant markets.
We are very often involved in the care of the nearly 900 patients
diagnosed with cancer in Stamford Hospital each year. More than
100 patients typically are seen daily, accounting for more than
20,000 visits to the Bennett Cancer Center annually.
The Divisions of Hematology and Oncology at the Bennett Cancer
Center offers a comprehensive range of treatments for adult
malignant blood diseases. During the first nine months of 2016,
over 600 unique patients with primary hematologic malignancies
were seen and managed by the physicians of the BCC. Additionally,
the benign hematology program remained equally robust, as the
majority of new consultations for hematologic disorders related to
helping patients with benign abnormalities of their blood counts,
metabolic disorders such as Gaucher disease, autoimmune diseases,
bleeding disorders such as hemophilia and von Willebrand disease
and disturbances of the coagulation system predisposing to
thromboembolic disease, including those afflicting women with
infertility or maternal-fetal issues related to hypercoagulability. There
is also an active inpatient consultation service focused on providing
guidance on the management of the frequent transient hematologic
complications of acute illnesses. Dedicated full-time genetic
counseling for inheritable disorders is available to all patients and
their families.
Hematologists at the BCC continue to work closely with two
dedicated hematopathologists, who utilize the most sophisticated
and ever evolving cytogenetic, molecular and immunologic tools
available for state-of-the-art molecularly-defined pathology. These
tools include: fluorescence-activated cell sorting (FACS) for the
rapid diagnosis of malignant hematologic disorders; qualitative
and quantitative polymerase chain reaction (PCR) studies of both
DNA and RNA, which have the ability to detect one malignant
cell/1,000,000 cells; and fluorescent in situ hybridization (FISH),
a technology that provides information on multiple genetic
abnormalities (“molecular signature”) critical to the treatment of
acute and chronic leukemias, lymphomas and multiple myeloma.
During 2016, the Department increasingly adopted direct deep
sequencing technologies, including next generation sequencing
(NGS), to help identify mutations amenable to targeted drug therapy.
This technology has proven particularly useful in patients with
poorly classified hematologic malignancies or advanced relapsed/
refractory disease without available standard treatment options.
Continued rapid adaptation of an increasingly broad menu of new
assays are made in real time to both provide patients with the most
precise diagnostic and monitoring tools, and to allow patients to
access the increasing array of targeted agents available to patients
with hematologic disorders as part of the momentous change to
“personalized” medicine.
A burgeoning array of sophisticated therapies are available to
patients and include traditional systemic chemotherapy; small
molecule targeted therapies, such as the recently approved
and revolutionary Bruton kinase inhibitors, BCL-2 inhibitors
and phosphatidylinositol 3-kinase inhibitors for low-grade
non-Hodgkin’s lymphomas and chronic lymphocytic leukemia;
Paul Weinstein, MDDirector of Oncology
Michael Bar, MDDirector of Hematology
46 2016 Clinical Annual Report
traditional monoclonal antibodies as well as both radio-conjugated
and toxin-conjugated monoclonal antibodies for malignant
lymphoproliferative disorders and leukemias; anti-CD38 and natural
killer cell activating antibodies to treat multiple myeloma; epigenetic
hypomethylating agents for myelodysplastic syndromes and
acute myelogenous leukemia of the elderly; immune modulation
therapy for lymphoproliferative disorders, plasma cell dyscrasias
and aplastic anemia; enzyme replacement therapy for metabolic
disorders, such as Gaucher disease; complement inhibition therapy
for rare disorders, such as paroxysmal nocturnal hemoglobinuria
and atypical hemolytic uremic syndrome; and recombinant factor
replacement therapy for congenital and acquired bleeding disorders.
Plasmapheresis, apheresis and exchange transfusions are available
to both inpatients and outpatients.
Our latest accomplishment was being selected as the newest
member of the Dana-Farber/Brigham and Women’s Cancer Care
Collaborative. The relationship will provide our medical staff with
increased educational opportunities, and the ability to consult
with internationally recognized specialists in all aspects of cancer
care. Our patients may not have to travel to Boston to receive
these benefits because virtual tumor boards will allow for case
presentations and recommendations. Our patients will have
greater access to the latest cancer research and clinical trials.
The Divisions’ clinical research program for both Oncology and
Hematology remains robust, under the leadership of Dr. Salvatore
Del Prete and supervisor Molly Daley. In 2015, 91 of our patients were
newly enrolled into studies here or at external sites (Dana-Farber,
for example), encompassing a wide variety of solid tumors and
hematologic malignancies. Currently, there are 155 patients actively
enrolled in 52 studies at the BCC and hundreds of patients are in
long-term follow-up The numbers for 2016 (YTD) are even more
impressive. Examples of the importance of our activities include our
participation in trials leading to the approval of imbruvica (Ibrutinib)
for chronic lymphatic leukemia and ado-trastuzumab emtansine
(Kadcyla) for Her-2 neu positive advanced breast cancer. This is also
a very exciting time because of the rapid advances in immune-
oncology. Here too, we are enrolling patients in studies investigating
the role of these agents in lung and triple negative breast cancers.
The Genetic Counseling Program, directed by Drs. Isidore Tepler and
Paul Weinstein, and supervised by Erin Ash, MS, CGC, is increasingly
active, serving the needs of those affected with cancer, their families
and healthy but concerned individuals. The Program has advised
persons with, or worried about, their personal risk for breast and
ovarian cancer, as well as increasing numbers of persons having
or concerned about gastrointestinal cancers (in collaboration
with our Gastrointestinal Cancer Family Tumor Registry) and other
malignancies. To that end, multigene mutation panel assays are being
used more frequently. In 2015, we counseled 276 new persons, and
discovered high-risk genetic mutations in 14 of them, undoubtedly
fulfilling the maxim that knowledge is power.
Our Survivorship Program, championed by Drs. Anne Angevine
and Steve Lo, and under the direction of Deanna Xistris, RN, MSN,
and Fran Becker, LCSW, is ready to accept persons completing
their treatment for early-stage cancer. A summary of their therapy
and recommendations for future follow-up is supplied to patients,
their families and their physicians via a formal report with updates
as appropriate.
The Center for Medicare and Medicaid Innovation has developed
the Oncology Care Model in an effort to provide high- quality
care with cost savings achieved by care delivery in less expensive
settings. We are one of the select practices in the country to
participate in this pilot program. We are charged with providing
outpatient services designed to keep patients from needing
referrals to the Emergency Department and/or hospitalization.
The Hospital is underwriting the cost of the support staff needed
to educate providers, and to track, and analyze the results
of our effort. If successful, the model will likely be expanded
to all oncology practices in America.
Pain and Pallative Care Service
The Pain and Palliative Care Service provides an extra layer of
support for patients from all departments who face a serious
or life-threatening illness.
The Service continues to provide both assistance in transitioning
to hospice and ongoing symptom management for those who
are enrolled in inpatient hospice. The Service is staffed by nurse
practitioners with physician collaboration. Monika Tello, MS, ANPBC,
ACHPN and Doreen B. Chimblo, MS, APRN, FNP-BC, joined us in 2012,
and Maria Rivera, APRN, joined us in February 2015. This transition has
enabled the provision of a higher level of consultation for patients,
Department of Medicine: Annual Report 2016
Anne Brewer, MD, MPH, FAAFPMedical Director of Palliative Care
47 2016 Clinical Annual Report
including more immediate improvement in pain and symptoms.
The ability to recover billable services from the NPs’ care, in
addition to a conversion to an electronic billing process, has
improved efficiency.
Because of the national shortage of specialty-trained Palliative Care
clinicians, a major focus has been improving the primary palliative
care skills of frontline clinicians.
Accomplishments in this regard include:
• Participation in Internal Medicine, Family Medicine and Surgical
lecture series programs for residents
• Participation in Grand Rounds and the Pastoral Care Lecture Series
for attendings and chaplains
• Weekly precepting in the Family Medicine Clinic, which facilitates
discussions of primary palliative care
• Participation in the Pastoral Care Advisory Committee
• Active planning and participation in the Third Annual “SHARE”
curricula for house staff, an interdepartmentally sponsored
program that gives residents an opportunity to learn about
patient/physician relationships from cancer survivors
• Core rotation for Family Medicine and Internal Medicine residents
• Participation in the Magnet presentation
• Daily ICU rounds by nurse practitioners with the ICU team
• Pain lectures for nursing orientation and Bennett Cancer
Center staff
This year the Pain and Palliative Care Service worked with the Bennett
Cancer Center in the training of several Social Work interns. Through
this innovative interdisciplinary and interdepartmental effort, we
were joined this year by two master’s-level Social Work interns. It
has been a true win-win to partner in their education while they are
active participants in providing mental health services to our patients.
The time they have been able to spend with patients and families
has been instrumental in supporting those families along their grief
pathways, and facilitates better communication between the families
and everyone on the Palliative Care team.
Pulmonary, Critical Care and Sleep Medicine Pulmonary Medicine
Active Staff:
• Michael Bernstein, MD • Alex Ortega, MD
• Caroline Gulati, MD • Dominic Roca, MD
• James S. Krinsley, MD • Paul Sachs, MD
• Anna Moniodis, MD • Steven Thau, MD
• Desh S. Nandedkar, MD
In 2016, Pulmonary Medicine was intricately involved in the
equipment evaluation, purchasing, preparation, training, planning
and implementation steps needed for the seamless flow of patients
into the new Hospital. The Division continued to report a high
utilization of its varied services. Both inpatient and ambulatory
services remained active over the past year. Over 170,000
procedures/interventions were performed by Respiratory Therapy
(RT) in 2016. The volume of ventilator days remains very high.
The average daily ventilator census was 6.8 ventilators in use per
day. The Pulmonary section remained committed to preventing
ventilator-associated events (VAE), soft tissue injuries due to
endotracheal tube pressures and self-extubations. Among the
interventions are a ventilator-associated event committee, VAE
prevention bundles, oral care protocols, specialized endotracheal
tubes and probiotic use.
The Division continued to perform outpatient pulmonary services
on both campuses. Tests performed at the Pulmonary Function
Lab on the fourth floor of the Tully Health Center predominantly
consisted of pediatric cases, but the Lab was available to adult
outpatients as well. A new PFT lab will be located in the Integrated
Care Pavilion. Overall, over 5,000 studies PFTs were performed by
the Department at the hospital campuses. The turnaround time for
PFT interpretations was improved to less than four days.
Arterial blood gas utilization remained high. Over 8,100 ABGs
were analyzed in 2016. The Pulmonary Laboratory passed its Joint
Commission inspection and re-certification process. It also passed
the on-site College of Pathologists Laboratory inspection.
Paul Sachs, MDDirector of Pulmonary Medicine
Associate Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons
48 2016 Clinical Annual Report
The RT Department remained committed to education. In October,
in honor of Respiratory Care Week, they organized their 3rd Annual
Stamford Hospital Respiratory Care Symposium. This was a CME/CEU
event attended by respiratory therapists and nurses from
throughout Connecticut and was once again highly successful.
Our RTs continued to supervise students from the Norwalk
Community College Respiratory Therapy Program. Two new
students rotated through the Intensive Care Unit and the
Intermediate Care Unit every six weeks. This continues to generate
energy and enthusiasm among our RT staff. It has also helped with
Stamford Hospital’s recruitment of the finest of the new respiratory
therapy graduates. Some students enjoyed their experience so
much that they have stayed on to work here. The Department
also participated in new nursing orientations. Twice monthly
nurse educators and nurse managers scheduled one- to two-hour
sessions for their staff to review respiratory procedures, policies and
equipment with the Respiratory Therapist Supervisor or Clinical
Coordinator. Two of our therapists are certified as BLS/ACLS/PALS
instructors, and one of our therapists is now a neonatal ALS
instructor. 100% of our RTs are ACLS certified and over 65% of our
therapists are now certified in Pediatric Advanced Life Support as
well. Our Respiratory Therapists remain involved in multidisciplinary
committees to improve care at Stamford Hospital including
committees on Magnet Skin Breakdown, Transition of Care, Bariatric
Accreditation, Ventilator Associated Events, Resuscitation, Quiet at
Night, Reusable Scopes, Regulations and Accreditation, Misuse of
Vials, Ethics, ID, Disaster Preparedness, Nursing Coordinating Council
and Self-Staffing. RT is also an active participant in the monthly
ICU committee meetings. Diane Major-Olivant, RRT is the Facilitator
of the Pediatric Neonatal Committee. The Department is now
participating in a statewide CHA initiative for pediatric asthma
and three have completed certification courses.
The entire RT staff is proficient in utilizing high-flow nasal cannula
therapy. This new technology has allowed patients to tolerate high
concentrations of oxygen via nasal cannula at flow. High flow rates
of up to 60 LPM are tolerated because the delivered gas is humidified
and heated to body temperature. They were useful in avoiding the
need for bulky high flow masks and, in some cases, intubations.
The outpatient Pulmonary Rehabilitation Program continued to
thrive on the second floor of the Tully Health Center. To date, 979
participants have graduated from the program since its inception.
The program remained busy, graduating about 50 patients every
year, with anywhere from six to 12 participants in the program
at any one time. The variety of patient diagnoses in the program
has increased as well. Patients with COPD as well as those with
pulmonary fibrosis, sarcoidosis, asthma and s/p lung transplantation
continued to take advantage of this multidisciplinary program.
Participants continued to praise the program, documenting
improved quality of life and exercise capacity. Many continued to
exercise in the Post-Rehab Fitness Program at the Sarner Health
& Fitness Institute, specifically designed for Pulmonary Rehab
graduates. The program proudly achieved national re-certification
from the American Academy of Cardiovascular and Pulmonary
Rehabilitation.
The Pulmonary Rehabilitation team hosted its 12th Annual COPD
Day Health Fair, a patient education program that was the first of
its kind in the Northeast region when it was initially developed in
2005, and remains unique to this area. About 60 patients and family
members from the greater Stamford area attended the event and
the feedback was overwhelmingly positive.
Kathryn Sullivan, RRT, the Pulmonary Rehab Coordinator, continued
her new role as our COPD Patient Liaison. She met with patients
admitted to the Hospital with a diagnosis of COPD exacerbation. She
assisted with coordinating Hospital discharge to provide continuity
with outpatient care and to try to prevent unnecessary readmissions.
The entire Respiratory Department assisted by completing COPD
worksheet/education forms on over 80% of inpatients admitted with
a diagnosis of COPD exacerbation. Thanks in part to these efforts, the
Hospital COPD readmission rate fell to 17%.
The Pulmonary Department, in conjunction with Thoracic Surgery
and the Bennett Cancer Center, continued our initiative to assist our
patients and staff with tobacco cessation with the “Commit to Quit”
Program. We now have four Association for the Treatment of Tobacco
Use and Dependence-certified counselors who are available to see
our patients. Carbon monoxide testing and spirometry screening are
available for participants of the program, as needed. The Stamford
Hospital’s tobacco Quit Line can be reached by dialing (203) 276-
QUIT, or ext. 7848 from any Hospital phone.
The Interventional Pulmonary and Advanced Bronchoscopy
service, led by Dr. Michael Bernstein, continues to see growth
in our program. Stamford Hospital offers a wide array of
interventional and advanced diagnostic bronchoscopy procedures,
including endobronchial ultrasound capabilities, both convex
and radial probe imaging, navigational bronchoscopy using the
superDimension™ System, fiducial placement for CyberKnife®
radiation, cryobiopsy/cryoablation as well as APC ablation. In
2016, we had a significant increase in cryo-based biopsies, which
have allowed for better diagnostic yield during bronchoscopy.
We continued to perform a wide array of both diagnostic and
Department of Medicine: Annual Report 2016
49 2016 Clinical Annual Report
therapeutic pleural procedures including PleurX catheters,
ultrasound guided thoracenteses, percutaneous and conventional
chest tubes, and closed pleural biopsies. With the move to the
new Hospital, the program falls administratively within the scope
of the OR facilities, which has allowed us flexibility to offer easier
scheduling for our patients. Our Interventional Pulmonary and
Advanced Bronchoscopy team is a core part of the Hospital’s
multidisciplinary Lung Cancer Program working with Thoracic
Surgery, Medical Oncology, Radiation Oncology, Pathology and
Diagnostic Radiology and participating in our bi-weekly lung
cancer tumor boards. This year, the Bennett Cancer Center joined
the Dana-Farber/Brigham and Woman’s Cancer Care Collaborative.
This collaborative provides our lung cancer patients access to new
trials and therapeutics and our physicians with opportunities to
discuss lung cancer management with a multidisciplinary tumor
board based at one the premier oncology centers in the world.
The Pulmonary Division plays a key role Stamford Hospital’s Lung
Cancer Screening Program. Dr. Michael Bernstein serves as the
Co-Clinical Director of the program along with Dr. Michael Ebright
of Thoracic Surgery. Our multidisciplinary program is accredited by
the American College of Radiology. Over the last year we have seen
a 25% growth in the number of patients screened.
The Interventional Pulmonary and Advanced Bronchoscopy team
also has partnered with the Stamford Hospital Office of Research to
participate in two industry sponsored trials and registries. We are
part of the Percepta registry (Veracyte) that offers an ability to
risk stratify patients for lung cancer based on genomic analysis of
material obtained at bronchoscopy. Moreover, we are one of five
sites for Aminoindex Trial looking to stratify lung cancer probability
based on a blood test.
The Pulmonary Department remained active in providing CME
opportunities for the Stamford community. The 34th Annual
Pulmonary Symposium was held in May. Stamford Hospital
Radiologist Dr. Gregory Pearson spoke on the topic “Guidelines for
Management of Pulmonary Nodules.” This was followed by a lively
discussion of associated issues by a panel of experts that included
Drs. Ebright, Bernstein, Robert Babkowski and Thoracic Nurse
Navigator Melissa Ronk. This format was well-received and will be
considered for future Pulmonary symposiums. Pulmonary Grand
Rounds was given in July by our newest Stamford pulmonologist,
Dr. Ann Moniodis. She spoke on “Understanding Upper Airway
Obstruction.” In addition, the Division gave numerous talks
throughout the Stamford community about pulmonary topics such
as lung cancer screening, smoking cessation and sleep apnea.
We are pleased with the quantity and the quality of services that
the Pulmonary Division provided, but we are particularly proud of
the individuals who make up our staff. They participated in other
community events such as performing screening spirometries
at the Women’s Expo, COPD Day, Employee Health Fair and
Health, Wellness & Sports Expo at Chelsea Piers Connecticut. The
Pulmonary Rehab staff volunteered their time and skills to make ID
badge holders that were then sold to pay for light hand weights to
be presented to Pulmonary Rehab participants upon graduation.
We were proud to learn that Dr. Alex Ortega was the Medical
Residents’ choice for the “Rookie of the Year” award and Dr. James
Krinsley received the “Teacher of the Year” award at the Department
of Medicine graduation dinner.
Critical Care
In FY16 there were 1,174 admissions to the Intensive Care Unit
(ICU), seven fewer than in FY15. Median length of stay of patients
admitted to the ICU remained unchanged at 1.7 days.
65 patients were admitted to the ICU following cardiovascular
surgery during this fiscal year, 19 fewer than in the previous fiscal
year. The distribution of cases was: 49% “isolated” coronary artery
bypass surgery, 28% “isolated” valvular surgery, 9% combined
coronary artery bypass and valvular surgery and 13% with other
procedures (predominantly complicated aortic root repair,
including repair of emergency ruptures). Notably, for the third
year in a row (227 cases), hospital mortality was 0%.
The year was marked by revision and development of numerous
multidisciplinary patient care protocols as well as creation of
new ones.
• Active mobilization of the critically ill patient was the major
initiative during the year. This required intensive involvement
of Nursing, Respiratory Therapy and Physical Therapy, as well
as physician and pharmacy involvement to modify sedation
practices and orders. The culture of the unit regarding this issue
has changed. Over the course of the year patients undergoing
mechanical ventilation have been routinely taken out of bed
and several of them have walked around the ICU while
undergoing mechanical ventilation via endotracheal tube.
• Glucose control evolved, based on interpretation of medical
literature. Two blood glucose targets were used, based on
preadmission glycemic control, reflected by the HbA1c level.
Rates of hypoglycemia were extremely low.
50 2016 Clinical Annual Report
• The multidisciplinary effort to manage severe alcohol withdrawal
has been associated with a significant reduction in ICU and
hospital length of stay of this difficult-to-treat population.
In addition, the team’s success using the protocol was reflected
by a 0% rate of patients who required intubation for respiratory
failure after being admitted to the ICU. Historic annual rates for
this metric ranged from 15%-30%.
• The multidisciplinary committee on infection control met regularly
and monitored infection control practices and protocol adherence,
especially relating to the prevention of ventilator-associated
pneumonia (VAP), catheter-associated urinary tract infections
(CAUTI) and central line-associated bacteremia (CLAB). Foley
catheter utilization rate remained at approximately 50% of
the national standard and the rate of the sentinel infections
remained low. In fact, there has been an 80% reduction in
the overall rate of ICU-acquired infections regularly monitored
by the nurse epidemiologists since 2008.
During the year the Director of Critical Care, James Krinsley, MD,
delivered presentations relating to intensive glucose management
of critically ill patients, based on the work completed at the Stamford
Hospital ICU, 2014 Congress of the European Society of Intensive
Care Medicine in Barcelona, 2015 Congress of the Society of
Critical Care Medicine in Phoenix, 2015 Congress on Advanced
Technologies and Treatments of Diabetes in Paris and 2015 Congress
of the International Society of Intensive Care and Emergency
Medicine, in Brussels.
In addition, the following manuscripts were published:
Krinsley JS, Bruns D, Boyd J. The impact of monitoring frequency on
the domains of glycemic control – a Monte Carlo Simulation. J Diab
Sci Tech. 2015 9(2):1-9.
Krinsley JS, Preiser JC. Time in blood glucose range 70-140 mg/dL >
80% is strongly associated with increased survival in critically ill non-
diabetic patients. Crit Care 2015; 19:179.
Wenerman J, Desaive T, Finfer S, Foubert L, Furnary A, Holzinger U,
Hovorka R, Joseph J, Kosiborod M, Krinsley JS, Mesotten D, Nasraway
S, Rooyackers O, Schulz M, Van Herpe T, Vigersky R, Preiser JC.
Continuous glucose control in the ICU: Report of a 2013 roundtable
meeting. Crit Care 2014; 18:226.
Krinsley JS. Is glycemic control in the critically ill cost effective? Hosp
Prac. 2014, 42(4):53-58.
Krinsley JS. Glycemic control in the critically ill: What have we learned
since NICE-SUGAR? Hosp Prac. 2015; 43(3):191-197.
Finally, following the replacement of the local Institutional Review
Board (IRB) by a centralized IRB, Quorum, a group of clinical
investigations was initiated by Dr. Krinsley with medical and surgical
residents, for presentation at national and regional conferences.
These included:
• Diabetes is associated with increased dysglycemia and mortality
in patients with sepsis
• The relationship of the severity of sepsis to insulin resistance
and dysglycemia
• Time in BG range 70-140 mg/dL is associated with survival in
non-diabetic medical ICU patients
• The impact of vital sign measurement frequency on APACHE II
and IV severity scoring
• In an ICU with a high-intensity staffing model, is a nocturnal
intensivist necessary?
• Time in BG range 70-140 is associated with survival in non-diabetic
critically ill patients admitted with trauma
Sleep Medicine
2016 was another busy year for Stamford Health’s Connecticut
Center for Sleep Medicine (CCSM). For the fourth year in a row we
increased the number of patients being evaluated for sleep disorders
and the number of home and in-center sleep studies performed
despite the current climate of numerous challenges presented by
federal regulations and private insurance companies. We continue
to strive meet the increasing demands of our patients and referring
physicians by adding Dr. Desh Nandekhar our third board-certified
sleep specialist to the team that currently includes Dr. Dominic Roca,
Dr. Steven Thau, Dr. Michael Bernstein, Dr. Caroline Gulati, Diana
Bernal Messinger, APRN, Lance Dougherty, RN, RT, RSPGT, Dr. Alex
Ortega and Karolyn Chang PA-C. We also added Dr. Anna Moniodis,
who joined us from Brigham & Women’s Pulmonary/Critical Care
fellowship. Our goal remains to continue to provide outstanding
care for our sleep patients while decreasing the wait time for doctor
visits and for studies. Dr. Hossein Sadeghi is board-certified in
Sleep Medicine and, as a part the CCSM, makes us poised to treat our
potential pediatric population. In addition to those achievements,
PAS and the Sleep Centerventured into Greenwich in the second
half of the year, working with the Stamford Health Medical Group
(SHMG) practice there to provide state-of-the-art sleep services for
patients in Greenwich. This could not have happened without
our close working relationship with Dr. Rod Acosta and
Department of Medicine: Annual Report 2016
51 2016 Clinical Annual Report
Dr. Gail Fennell, who spearheaded this endeavor. We are looking
forward to solidifying this relationship to a permanent one that will
benefit SHMG, the Sleep Center and the patients in Fairfield County.
The program is a Stamford Hospital Center of Excellence and
accredited by the American Academy of Sleep Medicine as a
sleep center to diagnose and treat all sleep disorders including
but not limited to sleep apnea, insomnia, restless legs, narcolepsy,
delayed/advanced sleep phase, jet lag and all other conditions
that cause sleepiness or difficulty sleeping. In FY16, we performed
over 1,400 sleep studies; 571 in-center studies, up from 454 last year,
and 867 home studies, up from 615, making us one of the largest
providers of home studies in Fairfield County. We are on pace to
exceed those numbers next year with over 1,800 studies projected,
which is a very exciting challenge. We also welcome our new
scorers, Maggie Quintero and Ernestine Tillman. With their help,
patients will get their tests and results more quickly.
New data continues to strengthen the link between sleep
apnea and cardiovascular disease, atrial fibrillation, other rhythm
disturbances, stroke, thromboembolic events, psychological
disorders, cognitive deficits, diabetes and other metabolic disorders,
which can not only lead to obesity, but an increased risk of cancer
as well. The literature also continued to demonstrate that treatment
with CPAP reduces that risk. There is even more data suggesting
that obstructive sleep apnea contributes to cognitive decline in
dementia patients and CPAP can ameliorate those symptoms.
CPAP remains the most effective treatment for obstructive sleep
apnea. For some patients, the adjustment period can be difficult
and education has been shown to be the largest factor in improving
patient adherence. To further facilitate the goal of CPAP compliance,
the CCSM continued to offer CPAP Management. For those who
ultimately could not tolerate CPAP or did not wish to continue with
CPAP therapy we helped patients explore other options such as oral
appliances, positional therapy devices and/or surgery. The FDA has
approved Inspire a hypoglossal nerve pulse generator controlled
by a small handheld sleep remote. This provides another treatment
available to help our patients maintain compliance.
Our 14th Annual Sleep Symposium featured Dr. Ana C. Krieger,
Associate Professor of Clinical Medicine, Associate Professor of
Medicine in Neurology and in Genetic Medicine, who spoke on
“OSA and Hypoventilation: Review and Treatment.” This is currently
a “hot topic” in the field of medicine, as different modalities are
being used to treat different breathing patterns as a way to
improve outcomes and quality of life.
The technical aspects of the CCSM have always been outsourced
and we have been with our current company Persante, formerly
known as Sleep Care of New Jersey, for the past five-and-a-half
years. They provided the CCSM flexibility in managing IT and Federal
guideline challenges throughout the year. All of the technicians
were supervised by lead sleep technicians and our board-certified
sleep physicians, 24-hours-a-day.
While sleep apnea was the most common diagnosis seen at our
center, the CCSM also had significant experience in treating all
childhood and adult sleep disorders such as restless legs, insomnia,
narcolepsy and REM behavior disorders.
The Connecticut Center for Sleep Medicine remained one of
the premier sleep centers in the tri-state area and will continue
to provide state-of-the-art sleep medicine to the region.
Rehabilitation Medicine
Active Staff:
• Aris Barbadimos, MD • Daniel Southern, MD
• Carolyn Casino, MD • David Walshin, MD
• Andrew Illig, DO • Jun Xu, MD
• Stephen Massimi, MD • Po Priscilla Xu, MD
• Edwin F. Richter, MD
The physiatrists (doctors specializing in Physical Medicine and
Rehabilitation) of the Division of Rehabilitation Medicine provide
a broad range of services including musculoskeletal care, pain
management, electrodiagnostic testing and rehabilitative services for
patients with a wide variety of disabling conditions. Patient services
are provided in the physicians’ offices as well as at the Optimus Clinic.
Inpatient services are provided in the Van Munching Rehabilitation
Unit as well as other areas of Stamford Hospital.
The Van Munching Rehabilitation Unit had an exceptionally busy
year with over 365 discharges, and patient satisfaction ratings
remain high. We continue to look for new opportunities to enhance
Edwin F. Richter, MDDirector of Rehabilitation Medicine
52 2016 Clinical Annual Report
care such as the expansion of neuropsychological services for Van
Munching inpatients over the past year. Education programming for
inpatients has also been enhanced.
Outpatient rehabilitation services are provided at the Tully Health
Center and its Darien satellite and at Chelsea Piers Connecticut.
Services provided at various locations within the system include
physical therapy, occupational therapy, speech therapy and
neurophysiology. Rehabilitation services are an important
component of the new Balance Center that was developed by
Stamford Health this year. Specialized rehabilitation services are
provided for cancer survivors. Ongoing support groups are designed
to help patients with history of amputation as well as those with
history of stroke or brain injury.
With our new facilities, we are looking forward to expanding
opportunities for collaboration with colleagues across the
health system.
Rheumatology
Active Staff:
• Erik Beger, MD • Shikha Mehta, MD
• Hana Hulinska, MD • Donald Stangler, MD
• Sharon Karp, MD • Tomas Vietorisz, MD
The Department of Rheumatology is currently comprised of six
members: Drs. Erik Beger, Hanna Hulinska, Sharon Karp, Shikha
Mehta, Donald Stangler and Tomas Vietorisz. As Chairman of the
Department, Dr. Vietorisz continues to practice full-time as a member
of Stamford Health Medical Group. He received his medical
degree from the Mount Sinai School of Medicine in 1988. After a
residency in Internal Medicine at Boston University, he completed
his fellowship in rheumatology at The Albert Einstein College of
Medicine in 1994. He is board certified in both internal medicine
and rheumatology.
Dr. Karp is a graduate of Brown University and the Brown University
School of Medicine seven-year medical program. She completed her
residency at Stamford Hospital and her fellowship in rheumatology at
New York University (NYU) School of Medicine. She is board certified
in both internal medicine and rheumatology. Dr. Karp is a member
of the Shoreline Medical Group division of Westchester Health. She is
a member of the Women’s Health Research at Yale Advisory Council,
a non-profit affiliate of the Yale School of Medicine dedicated to
advancing knowledge about women’s health and medical gender
differences, training researchers, and translating findings into practice
and national public policy. Dr. Karp serves on the Advisory Council
of the Warren Alpert Medical School of Brown University and as a
member of Brown’s Advisory Council on Biology and Medicine.
Dr. Hulinska is a full-time rheumatologist with private practice
offices in both Stamford and Westport. She received her medical
degree from the University of Connecticut School of Medicine
and completed her residency and rheumatology fellowship at
North Shore University Hospital in Manhasset and Long Island
Jewish Hospital. She is board certified in internal medicine
and rheumatology.
Dr. Mehta practices full-time rheumatology as a member of the
Stamford Health Medical Group. She joined Stamford Health
in 2015 and works in partnership with Drs. Vietorisz and Beger.
Dr. Mehta received her medical degree from Maulana Azad College
of Medicine in New Delhi, India. She completed her residency in
internal medicine at Maimonides Medical Center in New York City
and went on to complete a rheumatology fellowship at Westchester
Medical Center in Valhalla, New York. She is board certified in
internal medicine and rheumatology.
Dr. Beger received his medical degree at the Georg-August University
in Goettingen, Germany. He subsequently completed his residency
in internal medicine at Boston University and went on to complete
a fellowship in rheumatology at Albert Einstein College of Medicine.
Since 2000 he has served as attending rheumatologist in a variety
of hospitals including Nassau University Medical Center, Queens
Hospital Center, Catholic Medical Center, Flushing Hospital Center
and most recently has been practicing locally as a member of
Soundview Medical Associates in Norwalk, Connecticut. He joined
Stamford Health Medical Group in September 2015 and is in
practice with Drs. Vietorisz and Mehta. Dr. Beger is board certified
in both internal medicine and rheumatology.
The Department is proud to announce that three of its members,
Dr. Karp, Dr. Vietorisz and Dr. Beger, have all been selected as
“Top Docs” in Connecticut magazine.
Department of Medicine: Annual Report 2016
Tomas Vietorisz, MD
Director of Rheumatology
53 2016 Clinical Annual Report
In addition to providing rheumatological care in the private
practice setting, the Drs. Vietorisz, Beger and Mehta continue
to provide indigent care for members of the community suffering
with rheumatological illnesses through the Optimus Clinic
system. The rheumatology clinic meets once a month, s staffed
by house officers of the Stamford Hospital and is supervised by
Dr. Vietorisz, Dr. Mehta and Dr. Beger. These physicians also
provide indigent care to medical inpatients requiring more
urgent rheumatological interventions.
The field of rheumatology continues to be exciting and rapidly
developing. The use of biologic therapies has now become
firmly established as safe and effective, and has greatly expanded
the number of patients with rheumatic diseases who can be
successfully treated. Biologic therapies currently approved for use
include agents targeting TNF, IL-1, IL-6, T-cell receptor molecules
CD-80/86, B-cell receptor CD-20, IL-12/23 as well as the newest
biologic agent to be approved, sekukinumab (an IL-17a inhibitor).
Studies looking at biologic agents targeting IL-12, IL-23, CD-19
among others are currently in phase 2 and 3 studies and show
promise as potential future options in treatment of autoimmune
disease. In addition, the use of kinase inhibitors has become a
reality in the treatment of rheumatic disease with the approval of
Tofacitinib for use in patients with rheumatoid arthritis.
However, the cost of these agents continues to be prohibitive
for many patients particularly the uninsured and underinsured.
With the expiration of patent protection for biologic agents
etanercept and infliximab, the era of biosimilars is nearly upon
us. How these agents are to be regulated, priced and approved
by the FDA are questions that are yet to be answered. Hopefully,
these products will reduce the cost of biologic therapies and
make these highly effective treatments available to a wider
number of individuals.
Hospital Committee Participation
In addition to the broad participation of members of
various departments and divisions within the Department
of Medicine (referred to in each department’s individual report),
acknowledgment goes to Steven Thau, MD, who was elected by
his peers to be the at-large Department of Medicine representative
to Stamford Hospital’s Medical Executive Committee, a position
he has held, and ably served since January 1, 2016.
Departmental Safety and Quality
Under the leadership of Rohit Bhalla, MD, Vice President, Quality
& Chief Quality Officer, the Department of Medicine actively
participates in Stamford Hospital’s many safety and quality initiatives.
The following are year-to-date statistics (as of October 5, 2016) for
the measures in which the Department is actively involved
(numbers in parentheses represent the target values):
Clinical Effectiveness:
• VTE Prophylaxis – All Inpatients 99% (97%)
• Stroke Education 98% (97%)
• Early Elective Deliveries <39 Weeks 2.7% (0.8%) (Elective deliveries<39 Weeks Gestation)
• Outpatient Surgery Antibiotic Use Composite 100% (99%)
• Surgical — SCIP — Appropriate Care 97% (97%)
• Venous Thromboembolism – Appropriate Care 98% (95%)
• Stroke – Appropriate Care 96% (94%)
Hospital-Acquired Infections:
• Hand Hygiene 95% (95%)
• Central Line-Associated Bloodstream 0.91 (0.70) Infections (Med/Surg + ICU) per 1,000 line days
• Central Line-Associated Bloodstream 7 (8) Infections (Med/Surg + ICU Actual #)
• Central Line-Associated Bloodstream 0 (1) Infections (NICU Actual #)
• Catheter-Associated Urinary Tract 6 (9) Infections (ICU, CAUTI per 1,000 catheter days)
• Catheter-Associated Urinary 6 (9) Tract Infections (ICU, Actual # of CAUTIs)
• All Surgical Site Infections (per 100 Surgical Cases) 0.62 (0.7)
• All Surgical Site Infections (Actual # of SSI) 34 (44)
• Colon Surgical Site Infections (Actual #, all classes) 7 (8)
• MRSA (per 1,000 patient days) 0.06 (0.08)
• VRE (per 1,000 patient days) 0.000 (0.06)
• C. Difficile (per 1,000 patient days) 0.708 (1.0)
• Resistant Infection Rate 0.768 (0.95) (MRSA, VRE, C. Diff per 1,000 patient days)
54 2016 Clinical Annual Report
Teaching Activities
Medical Student Education
Stamford Hospital’s affiliation with Columbia University College of
Physicians and Surgeons (Columbia P&S) is now in its eighteenth
year. Currently, 98 physicians at Stamford Hospital hold major faculty
appointments at Columbia University P&S, 83 within the Department
of Medicine as follows:
• Instructor in Clinical Medicine 34
• Assistant Clinical Professor of Medicine 36
• Associate Clinical Professor of Medicine 7
• Clinical Professor of Medicine 3
• Professor of Clinical Medicine 3
Columbia P&S students are assigned to our Department of Medicine
in both the Inpatient Clinical Clerkship and in Primary Care Medicine,
as well as in Family Medicine, Surgery, Obstetrics and Gynecology
and Pediatrics. At any given time there are as many as 24 Columbia
students throughout all rotations. Stamford Hospital numerically
teaches the entire student body of Columbia P&S.
Within the Department, seven or eight third-year students are
assigned to Inpatient Medicine and one or two to Primary Care/
Ambulatory Medicine at any one time. The Department also regularly
accommodates students who seek clinical electives at Stamford
Hospital. Since Critical Care Medicine is not a dedicated rotation
during the third year at Columbia, this is an especially attractive and
vital elective experience we can offer. Other clinical electives include
Cardiology, Pulmonary Medicine, Infectious Disease Medicine,
Hematology and Oncology and a fourth-year sub-internship in
Internal Medicine and Emergency Medicine. Columbia P&S medical
students consistently laud the quality of their educational experience
at Stamford Hospital and the personalized, role model education
they receive. These physicians are recognized as preceptors for the
10 clinical clerkship sessions of the academic year:
• Maria Asnis, MD • Ted Listokin, MD
• Revekka Babayev, MD • Scott Martin, MD
• Salvatore Carbonaro, MD • Shikha Mehta, MD
• Joonun Choi, MD • Wayne Miller, MD
• Deena Ebright, MD • Bismruta Misra, MD
• Melissa Goldstein, MD • Craig Olin, MD
• Rebekah Gospin, MD • Noel Robin, MD
• Anthony Gulati, MD • Paul Sachs, MD
• William Hines, MD • Asha Shah, MD
• Sarah Kahn, MD • Brianna Siegel, MD
The Fifth Annual “Residents as Teachers Day,” jointly sponsored by
Columbia P&S and Stamford Hospital, was held on October 27, 2016.
The keynote presentation was given by Lisa Mellman, MD, Senior
Associate Dean for Student Affairs and Clinical Professor of Psychiatry
at Columbia University College of Physicians and Surgeons. This was
followed by additional presentations along with individual meetings
with department chairs, clerkship site directors, and Columbia P&S
residency program directors.
The Department of Medicine also provides a comprehensive course
in the Foundations of Medicine; it is the first major experience in
clinical medicine for medical students. This course is under the
exemplary leadership of Neil Boside, MD, with Drs. Peggy Geimer,
Alfred Wolfsohn and Richard Sheinbaum ably serving as educators.
Residency Program in Internal Medicine
Stamford Hospital’s Residency Program in Internal Medicine had
another productive and successful year, which was notable for
a number of programmatic changes.
1. Residents: The program welcomed the addition of six new
Categorical Interns in July 2016 (Drs. Brett Carroll, Pankil Desai,
Claire McCutcheon, Lovin Pappy, Theodora Vamvouris and Niurka
Visconti) and two Preliminary Interns, Dr. Marco Russo (who will
be completing a residency in Neurology) and Dr. Krutika Parasar
(who will be completing a residency in Physical Medicine and
Rehabilitation). We proudly acknowledge the achievements
of our recent graduates who have gone on to pursue competitive
fellowships in Cardiology, Gastroenterology, Pulmonary/Critical
Care and Endocrinology, as well as hospitalist positions at
respected academic institutions. We have already begun our
recruitment season for the 2017 intern class, and have received
more than 2,000 applications for our eight resident positions
in the 2017 NRMP match.
Department of Medicine: Annual Report 2016
Kirsten Hohmann, MD
Interim Program Director, Internal Medicine Residency Program
Medical Director of Ambulatory Education, Optimus HealthCare
Associate Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons
55 2016 Clinical Annual Report
2. Faculty: Regrettably, Dr. Maria Maldonado left the Internal
Medicine Program in July 2016 to pursue primary care practice
in Yonkers. During her seven-year tenure as program director,
there were numerous programmatic improvements and
initiatives that have ensured an excellent education for our
residents. Dr. Kirsten Hohmann has assumed the role of Interim
Program Director in addition to her continued role as Director
of Ambulatory Education, while a search is underway for a
permanent replacement.
The inpatient teaching experience remains under the able
leadership of Drs. Maher Madhoun and Paul Huang, Co-Assistant
Program Directors. In the ambulatory setting, Dr. Celeste Cox
has joined Optimus Health Care where she will be an Internal
Medicine preceptor as well as an independent practitioner as
part of a collaborative position between Optimus and
Stamford Hospital
3. Curriculum Development/Program Evaluation: The Clinical
Competence Committee meets monthly for continued
oversight of resident competency assessment. The Program
Evaluation Committee meets annually for program evaluation
and improvement, and this year the focus has been on inpatient
education with the consequent development of longer floor
rotations and inpatient portfolios. A new required one-week
rotation in Quality Improvement and in Primary Care offices has
been instituted for the 2016-17 academic year. A comprehensive
internal review of the Internal Medicine Residency program was
conducted from April through June 2016 by Drs. Frances
Ginsburg and Setul Pardanani, and their review noted adequate
resident supervision in inpatient and ambulatory venues.
Second- and third-year residents continue to participate in a
two week rotation in Neurology at the renowned Neurologic
Institute at Columbia University, as well as in Geriatrics at
the Dorothy Adler Geriatric Assessment center at Yale-New
Haven Hospital.
Dr. Maldonado along with the collaborative efforts of Dr. Steve
Horowitz, Marc Brodsky, Joonun Choi, Joseph Connelly and
Tzivia Moreen have developed a Planetree Curriculum for
residents that focuses on our core value of patient-centered
care as well as physician wellness.
4. Research/Scholarly Activity: All six senior Internal Medicine
residents and two junior residents presented abstracts at the
annual Connecticut Chapter Meeting Scientific Session of
the American College of Physicians on October 28, 2016.
Six residents presented either research abstracts or clinical
vignette posters at the Stamford Hospital’s first Annual
Research Day in May. Four residents working under the direction
of Dr. James Krinsley also presented abstracts or delivered an
oral presentation at the Society of Critical Care Medicine
Meeting this year.
5. Clinical Learning Environment Review (CLER): The ACGME
now ensures that residents are meaningfully engaged in their
institution’s quality strategy and patient safety initiatives through
the Clinical Learning Environment Review process that occurs
every 18 months, and ours took place on November 1-2. Internal
Medicine residents are given multiple opportunities to work with
Hospital leadership and interprofessional teams to improve the
quality of patient care, and several sit on institutional committees
such as Sepsis, ED Throughput and Information Technology.
All residents are required to engage in a longitudinal Quality
Improvement project in either the inpatient or ambulatory
setting with the purpose of implementing a lasting intervention
to improve care.
Medical Student Education: Within the Department of
Medicine, seven to eight third-year medical students are
assigned to Inpatient Medicine and two are assigned to
Primary Care Ambulatory Medicine for four- and five-week
blocks. The Department continues to accommodate
students for other clinical electives and a fourth-year medicine
sub-internship in Internal Medicine and Emergency Medicine.
Our ICU faculty have also supported a dedicated Critical
Care Medicine rotation for students. Columbia P&S students
consistently laud the quality of their educational experience
at Stamford Hospital and the personalize role model
education they receive.
56 2016 Clinical Annual Report
Continuing Education Reflective of its commitment to continuing medical education,
Stamford Hospital was awarded in its most recent site visit in 2013
an unprecedented six years of accreditation, with commendation,
by the Committee on Continuing Medical Education (CME) of the
Connecticut State Medical Society.
The breadth of CME programs offered in 2016 illustrates
this commitment:
• Medical Grand Rounds — Weekly diverse, educational
presentations, many emphasizing an integrative and
multidisciplinary approach to care. Themes in 2016 included
“Biologic Bases for Human Obesity,” “Immunotherapy in Cancer
Management,” “Screening for Lipopathies,” “Breast Care for
the Primary Care Provider” and “Domestic Violence.”
• Dedicated lectures in Nephrology included “Classification
and Diagnosis of Renal Tubular Acidosis,” Pathophysiology and
Treatment of Metabolic Alkalosis” and “Resistant Hypertension.”
• Comprehensive Clinical Case Conference — This monthly
conference draws on the rich array of relevant clinical cases
requiring multidisciplinary involvement.
• Yale University Seminars in Geriatric Medicine — Four timely,
topical presentations regarding the care of older adults.
Themes this year included “Medication Use in the Elderly”
and “Optimizing Medication in Older Adults with Multiple
Chronic Conditions.” A related Medical Grand Rounds was
titled “Is it Parkinson’s Disease?”
• The 8th Annual Keith Landesman Memorial Lectureship — A
lasting tribute to a beloved colleague and the values that
defined his life. This year’s lecture was given by Dr. Steven F.
Horowitz, Clinical Professor of Medicine at Columbia University
College of Physicians and Surgeons. The title of Dr. Horowitz’s
presentation was “Nutrigenomics, Epigenetics and the Future
of Integrative Medicine.”
• The Annual William F. Buckley, Jr. Memorial Lecture — Given
in memory of Mr. Buckley, whose gracious bequest allowed for
the creation of an ongoing lectureship in Infectious Diseases.
This year’s lecture was given by Michael F. Simms, MD, Director
of Infectious Diseases at Waterbury Hospital, on “Healthcare
Associated Infections.”
• The 38th Annual William H. Resnik Memorial Lecture — This
year’s distinguished speaker was Lee Goldman, MD, Harold and
Margaret Hatch Professor, Executive Vice President and Dean
of the Faculties of Health Sciences and Medicine at Columbia
University Medical Center, who spoke on “Too Much of a Bad
Thing.” The program was followed by a Town Hall Meeting
with all engaged participants in Medical Education.
• A special lecture provided by John Fitzgibbons, MD, Professor
of Clinical Medicine at Columbia University College of Physicians
and Surgeons, on “Presidential Health Maladies: Mistakes
and Cover-ups.”
• Senior Resident Presentations — Seven senior resident
presentations addressed a wide range of clinical topics.
• Schwartz Rounds — Although in the domain of all of Stamford
Hospital, these important, reflective and poignant teaching
experiences, held every two months, are meaningful and
inspirational to our Department.
• The 12th Annual Sleep Medicine Symposium — Sponsored by
the Connecticut Center for Sleep Medicine, under the leadership
of Drs. Dominic Roca and Steven Thau. This year’s presentation
was given by Ana C. Krieger, MD, Medical Director of the
Weill-Cornell Center for Sleep Medicine, on “Obstructive
Sleep Apnea and Hypoventilation.”
• The 34th Annual Pulmonary, Critical Care and Sleep Medicine
Symposium — Sponsored annually by the Department of
Pulmonary Medicine to enlighten physicians on current issues
in Pulmonary Medicine, their pathophysiologic mechanisms
and their clinical management. This year’s presentation
was given by Gregory Pearson, MD, PhD, Cardiac and
Thoracic Radiologist at Stamford Hospital, and Associate
Professor of Radiology at Columbia University College of
Physicians and Surgeons.
• The 23rd Annual Oncology Symposium —sponsored by the
Carl and Dorothy Bennett Cancer Center to provide physicians
with the most current knowledge and understanding of cancer.
This year’s theme was “Immune Checkpoint Inhibition and
Beyond” and was presented by Patrick A. Ott, MD, Clinical
Director of the Center for Immuno-Oncology at Dana-Farber
Cancer Institute.
Department of Medicine: Annual Report 2016
57 2016 Clinical Annual Report
• Dedicated Summer Syllabus in Medicine — A comprehensive,
12-week compendium aimed at new house staff and
medical students.
• Medical Grand Rounds during the Summer Syllabus — 12 weekly
sessions led by Department staff on clinical, medico-legal, and
quality and safety topics.
• Annual Medical Grand Rounds Lecture in Podiatry — The 2016
Speaker was Robert Fridman, MD, who spoke on “Common
Pediatric Problems Faced by Primary Care Physicians.”
• “Art in Medicine” — a dedicated annual interactive program
given by Anna Willieme, MFA, on “The Development of
Medical Observational Skills Through Fine Works of Art.”
• Stamford Hospital and the Fairfield County Medical Association
co-sponsored two special programs on “Medical Issues Relevant
to Returning Service-People in U.S. Armed Forces” and “Opiate
Addiction.” These programs were relevant for Connecticut-
required CME, but also covered two exceedingly important
medical and social issues of our times.
Community Outreach
As part of the Department’s commitment to promoting a healthier
community through education, physician members participate in
an array of forums and programs including the Mini Medical School,
health fairs, lectures, symposia and awareness days focused on
specific health conditions.
Strategy/Future Direction
The continued vitality of medical practice in the greater Stamford
community depends on consistent recruitment of newer generations
of physicians to the staff of our Hospital — this revitalization is
essential to the progress of our profession and our institution, and
an effort to which the Department of Medicine remains committed.
Emblematic of the clinical excellence to which we will always strive
is the new Stamford Hospital tower, a metaphoric beacon of our
departmental and institutional commitment.
Stamford Hospital has been an integral part of the evolution of
Hospitalist Medicine, which has freed primary care physicians to
tend to their office-based patients and improved the efficiency of
inpatient care. It is imperative that Hospitalist Medicine continue
to be represented in all components of medical education, and
that community physicians feel a part of the clinical and intellectual
stimulation that is part of their association with Stamford Hospital.
An important corollary is the need to maintain and foster
Stamford Hospital’s role as a major teaching campus. The Hospital
has established a special relationship with Columbia University
College of Physicians and Surgeons and is privileged to have the
responsibility of educating so many future physicians. This privilege
is cherished with pride, humility and unwavering commitment.
We are also very proud of our selection as the campus site for
the Sacred Heart University Physician Assistant Program and the
educational vibrancy that this contributes.
The responsibilities of the Department of Medicine are large and
are shared by many. No single individual or group of individuals
can possibly perform all the clinical, service and educational
responsibilities. This annual report gives formal recognition to those
members who have generously given of their time, energy, and
above all, themselves. Our medical community is surely better as a
result of their kindness and good deeds. They have enriched all and
have made our community and profession all the better. We may
be very fortunate as a community to have facilities and technology,
present and future, of extraordinary design and sophisticated
capability. Nothing, however, is more important than the worth
of our staff. They deserve our highest respect and appreciation.
Their beneficiaries and generosity must never be taken for granted.
It is my deep hope that their generous and selfless contributions
ennoble them and augment their pride and esteem in our
beautiful profession.
To those good physicians who exemplify these ideals, who continue
to make ours a profession of meaning and worth — for their
dedication, kindness, friendship and collegiality, the Department
of Medicine extends its heartfelt gratitude.
58 2016 Clinical Annual Report
Obstetrics & GynecologyCollaboration among multidisciplinary team members continues to be an asset to our program, particularly in terms
of achievements related to patient safety. The Department’s commitment to quality and patient-centered care resonates with
patients and this is evidenced in our increasing volume of births and strong patient satisfaction scores.
Care. Delivered.
59 2016 Clinical Annual Report
The Hugh K. Miller, MD, Department of Obstetrics & Gynecology
works in collaboration with our obstetricians and gynecologists and
strives to provide the highest level of quality care to patients in our
community by offering the most up-to-date diagnostic testing and
novel treatment modalities in a safe and nurturing atmosphere.
The Department is proud to share its accomplishments and highlight
the areas in which we continue to work to assure that we are setting
the highest standards for providing excellent patient care.
This was a productive year for the Department:
• Stamford Hospital was recognized for its outstanding
obstetric care and received the 2016 Women’s Choice
Award in Obstetrics for the third year in a row.
• We are pleased to announce that many of our attendings
have received local, regional and national recognition,
including Fairfield Magazine Top Doctors, Connecticut
Magazine Top Doctors, Castle Connolly’s New York Metro
Area Top Doctors in Obstetrics and Gynecology and the
Path to Parenthood Family Building Award.
• We would also like to congratulate our PGY III Resident,
Andrew Rausch, MD, for being awarded the Gold Humanism
Award from Columbia University.
• Additionally, the collaboration among multidisciplinary
team members continues to be an asset to our program,
particularly in terms of achievements related to patient
safety. The Department’s commitment to quality and patient-
centered care resonates with patients and this is evidenced
in our increasing volume of births and strong patient
satisfaction scores.
I am proud to serve as Interim Chair of this Department and look
forward to continued growth in the Women’s Health service line
over the next fiscal year.
Scope of Clinical Activities
The Department is pleased to report volume growth in Obstetrics,
Gynecology and Gynecologic Oncology (with data provided in
Figures 1 and 2). In addition, our global quality program continued
to achieve results, demonstrating a Departmental focus on quality
and value. All Department members continue their commitment
to put patients first, and patient feedback affirms the success of
these efforts.
We are cognizant of the constantly evolving medical landscape
and remain poised to change quickly to meet regulatory
requirements as well as implement cutting-edge technologies.
The Department is comprised of many members across several
disciplines. This multidisciplinary approach to patient care and
our commitment to continually strive to improve that care
position us well for the future.
Department of Obstetrics & Gynecology: Annual Report 2016
Carol Fucigna, MDInterim Chair, Department of Obstetrics & GynecologyVice Chair, Department of Obstetrics & Gynecology
A Message From The Chair The Year in ReviewA Message From The Chair The Year in Review
60 2016 Clinical Annual Report
Included below are some of the highlights of the Department’s
activities in 2016:
• As shown in Figure 1, our Obstetricians performed a total
of 2,227 deliveries including 1,230 vaginal deliveries and
997 Cesarean sections.
• As shown in Figure 2, there were a total of 1,492 gynecologic
surgeries performed, which has increased from 1,429
performed during FY 2015.
• The Minimally Invasive Surgery/Robotics Program is now in its
eighth year, and recently received a three-year reaccreditation
as a Center of Excellence for Minimally Invasive Gynecologic
Surgery. Gary Besser, MD, and Stephen Gallousis, MD, are
Co-Directors of Minimally Invasive Gynecologic Surgery.
• Our Minimally Invasive Gynecology (MIG) numbers continue
to be affected by the loss of uterine power morcellation
in hysterectomy and myomectomy (April 17, 2014). Stamford
Hospital hasproactively prohibited the use of the morcellator
in all gynecologiccases and we are constantly re-evaluating
the literature on morcellation.
• The Gynecologic Oncology program, led by Elena Ratner, MD,
and comprised of three Gynecologic Oncologic surgeons,
grew by 40% from 2015 to 2016.
• The Hospital’s Cesarean rate remained a focus for analysis
during fiscal year 2016. Data regarding the Cesarean rate
in nulliparous patients presenting at term with a single fetus
in vertex presentation was collected through the course of
the year and submitted to The Joint Commission as part
of the Perinatal Care Core Measures Project. During FY16,
the NSTV Cesarean rate at Stamford Hospital was 40%, an
increase from the 37% rate recorded in FY15. Efforts during
the most recent fiscal year to address this measure included:
– Transition of physician documentation of perinatal
care from GE Centricity to MediTech. This required the
development of documentation templates that would
permit effective. documentation of the indications
for Cesarean in individual cases to that quality data
may be effectively collected.
– Collaboration with IT to develop a perinatal quality
“dashboard” using data extracted from these templates.
– Collaboration with the Departmental Peer Review
Committee to develop triggers for peer review in
selected cases of Cesarean birth in this population.
• “One of the most highly effective preventive measures
a mother can take to protect the health of her infant is to
breastfeed. However, in the United States, although most
mothers hope to breastfeed and 79% of babies start out
being breastfed, only 19% are exclusively breastfed six
months later. Additionally, rates are significantly lower
for Afican-American infants” (www.CDC.gov).
According to the CDC 2013 Breastfeeding Report Card,
76.9 % of new mothers in Connecticut ever breastfed
(76.5% national average), 35.8 % were exclusively
breastfeeding at three months (37.7 % national average)
and 15.5% were exclusively breastfeeding at six months
(16.6 % national average). These rates fall woefully short
of the AAP’s recommendation that new mothers provide
exclusive breast milk for the first six months of a baby’s life.
We recognize and support each mother’s individual feeding
choice, while ensuring that each patient has the necessary
information and knowledge about their feeding decision.
Our Hospital exclusive breastfeeding rates have gradually
Department of Obstetrics & Gynecology: Annual Report 2016
Figure 1. Number of Babies Delivered
Number of Babies Delivered 2013-2016
2450
2400
2350
2300
2250
2200FY13
2285
FY14 FY15 FY16
2288
2363 2367
Figure 2. Gynecologic Volume
Gynecologic Volume 2015 vs 2016
1800160014001200
800600400200
00FY15 FY16
1429 1492
61 2016 Clinical Annual Report
increased toward the 53% national benchmark. We recognize
that there are instances when it is medically appropriate to
support infant feeding with formula. Our goal is to provide
optimum care to moms and babies, encourage and facilitate
breastfeeding as a best practice for both mom and baby,
and when necessary, intervene in a way that continues to
support breastfeeding rather than interfere with it.
• Under the direction of Tracy Shevell, MD, the Maternal Fetal
Medicine Department has been working collaboratively
with the Postpartum Support International’s CT Chapter to
bring educational resources and training on mood and anxiety
disorders to the Department.
• In conjunction with the Connecticut Department of Public
Health, Stamford Hospital and Optimus Health Center under
the direction of Setul Pardanani, MD are now able to offer the
CT Early Detection Program for breast and cervical cancer
screenings to women who are uninsured/underinsured.
Additionally, the program offers women access to the Wise
Women Program, which promotes additional preventative
healthcare measures.
• The Department conducted an interdisciplinary campaign
to promote teaching and awareness on the Zika Virus to
physicians, clinical staff and patients.
• In an effort to streamline our EMR systems and to be in line
with other Departments, we have transitioned from using
GE Centricity to MediTech on Labor and Delivery.
• Planetree tenets continued to be integrated into daily
patient care operations.
• The Department published a quarterly newsletter
highlighting clinical and programmatic updates for the
system, including information on our residency program
and recognition of physicians.
The Department’s gynecologic procedure numbers continue
to be robust, however, we continue to be impacted by the ban
on morcellation. The FDA ban on intraabdominal morcellation
in April 2014 has led to a decrease in minimally invasive procedures.
The Gynecologic Oncology program experienced a 40% growth
in surgical volume in 2016. Our patients are cared for by three
board-certified Gynecologic Oncologists: Drs. Elena Ratner,
Karen Nishida and Babak Litkouhi. Community physicians
continue to support the program with an increase in referrals
from all catchment areas.
Medical StaffThe Department is comprised of 14 full-time physicians, 41 voluntary attending physicians, 12 resident physicians, four nurse practitioners and one physician assistant.
Paul Bobby, MD
Director, Perinatology
Co-Director, OB Safety & Quality Committee
Medical Student Clerkship Director
At-Large Member, Medical Executive Committee
Frances Ginsburg, MD
Director, Reproductive Endocrinology & Infertility & Residency Program Director
Setul Pardanani, MD
Director of Ambulatory Care & Associate Residency Program Director
Tracy Shevell, MD Director, Perinatal Ultrasound
Brian Hines, MD Director, Urogynecology & Pelvic
Reconstructive Surgery
62 2016 Clinical Annual Report
New Staff:
• Barry Whitt, MD Reproductive Endocrinology
Transitions:
The following Department members resigned in 2016:
• Mariel Focseneanu, MD
• Emre Seli, MD
Departmental Education and Teaching Activities
The Department serves as a clinical training site for a second- and
third-year core clerkship in Obstetrics & Gynecology for medical
students from Columbia University College of Physicians and
Surgeons. The OB/GYN residency program received a three-year
accreditation from the RRC/ACGME. The Maternal-Fetal Medicine
Division is approved by the American Board of Genetic Counseling
as a teaching site for senior genetic counseling students from
Sarah Lawrence College. Additionally, the Department continues
its relationship with Planned Parenthood of New England as a
second- and third-year resident rotation site for outpatient practice.
The Residency Program in Obstetrics & Gynecology is under the
supervision of Director Frances Ginsburg, MD, and assisted by Setul
Pardanani, MD. The program has a full complement of residents,
which consists of three residents in each of the four years.
The current first-year residents are:
• Valerie Curro, DO, Nova Southeastern University College
of Osteopathic Medicine
• Laura Gilroy, MD, Royal College of Surgeons in Ireland
School of Medicine
• Jessica Li, MD, University of Miami Leonard M. Miller
School of Medicine
The recent graduate residents are:
• Oluwakemi Adegoke, MD, Fellowship in Global Health,
Massachusetts General Hospital
• Daniel Cibulsky, MD, Private Practice,
Stamford, Connecticut
• Elizabeth Rodriguez, MD, Private Practice,
Boston, Massachusetts
Department of Obstetrics & Gynecology: Annual Report 2016
Elena Ratner, MD Director, Gynecologic Oncology
Gary Besser, MD
Co-Director, GYN Minimally Invasive Surgery
Stephen Gallousis, MD
Co-Director, GYN Minimally Invasive Surgery
Kathy LiVolsi, RN, MHA
Clinical Operations Director, Maternal & Child Health Services
Donna Bowman, APRN
Co-Director, OB Safety & Quality Committee
Mary L. Henwood Director, Women’s Health & Pediatric Service Line
Janine Popot, MD Chair, Peer Review Committee
63 2016 Clinical Annual Report
The Department also provides an active program
of Continuing Medical Education:
• Faculty and Departmental Meeting
• Multidisciplinary M&M Conference
• Multidisciplinary OB/PEDS Conference
• Grand Rounds
• CoreCases for OB/GYN — Co-Developed by
ACOG & CaseNetwork
In addition, the Department sponsored the 22nd Annual Morton
A. Schiffer Day Resident Research Symposium on June 3, 2016.
Departmental Research and Scholarly Activities
Department members gave several presentations at regional and
national meetings in the past year:
• Retrospective Analysis of Transvaginal Hysterectomy
vs. Supracervical Hysterectomy with Associated Sacrocolpopexy
— Oluwakemi Adegoke, MD; Brian Hines, MD; Katherine
Sandhu, MD. ACOG Annual Clinical and Scientific Conference,
Washington DC. May 2016. Poster Presentation.
• Intrahepatic Cholestasis of Pregnancy in Stamford, Ana
Pantel, MD. Annual State of Connecticut Resident Research
Day, Hartford Hospital. September 2016. Oral Presentation.
• An Observational Study of Paternal Weight Gain During
Pregnancy, Courtney Noonan, MD; Paul Bobby, MD. State
of Connecticut Resident Research Day, Hartford Hospital.
September 2016. Poster Presentation.
• Immediate Postpartum LARC in a Community Setting: Patient
Desires and Effectiveness, Kelly Fellows, MD, Setul Pardanani,
MD. State of Connecticut Resident Research Day, Hartford
Hospital. September 2016. Poster Presentation.
• Implementation of a Universal Perinatal Depression Screening
and Treatment Program in a Community Health Care Setting,
Kiger Lau, MD, MPH; Setul Pardanani, MD. State of Connecticut
Resident Research Day, Hartford Hospital. September 2016.
Poster Presentation.
• An Observational Study of Paternal Weight Gain During
Pregnancy, Courtney Noonan, MD; Paul Bobby, MD. State
of Connecticut Resident Research Day, Hartford Hospital.
September 2016. Poster Presentation.
• First Trimester Detection of the EEC Syndrome, Andrew C.
Rausch, MD; Paul Bobby, MD. State of Connecticut Resident
Research Day, Hartford Hospital. September 2016. Poster
Presentation.
• An Observational Study of Obstetrics and Gynecological
Graduate Medical Education in Nepal and the United States,
Kiger Lau, MD, MPH; Setul Pardanani, MD. State of Connecticut
Resident Research Day, Hartford Hospital. September 2016.
Poster Presentation.
• Spontaneous Orgasm with Movement after TOT Placement:
A Case Report, Sarah Elliott, MD; Brian Hines MD. State of
Connecticut Resident Research Day, Hartford Hospital.
September 2016. Poster Presentation.
• Prolapse Recurrence after Partial Removal of Transvaginal
Mesh, Xibei Jia, MD; Katherine Sandhu, MD; Brian Hines, MD.
State of Connecticut Resident Research Day, Hartford Hospital.
September 2016. Poster Presentation.
• Prolapse Recurrence after Partial Removal of Transvaginal Mesh,
Xibei Jia, MD; Katherine Sandhu, MD; Brian Hines, MD. ACOG
District 1 Annual Meeting. Toronto Canada. August 2016.
Poster Presentation.
• Intrahepatic Cholestasis of Pregnancy in Stamford, Ana Pantel,
MD. ACOG District 1 Annual Meeting. Toronto Canada.
August 2016. Poster Presentation.
Strategy/Future Direction
The Department of Obstetrics & Gynecology had a strong year
focused on collaborating with our Physician Relations leader,
Lisa Rosato, to ensure that we visit most of our physicians at their
offices and work together to strengthen and improve our clinical,
nursing and administrative relationships. Over 30 physician office
visits were conducted this year. We continue to refine plans to
improve physician and patient satisfaction for both our inpatient
and outpatient care. We have also worked on increasing our
obstetric volume by increasing the number of obstetricians on
our staff. The new daVinci robot was installed this past year and
all our gynecologic physicians were delighted to be trained to
utilize the new technology and enable us to provide the latest
robotic technology for our gynecologic patients.
The Women’s Health service line continues to focus on developing
comprehensive services for women in the community.
64 2016 Clinical Annual Report
Our Marketing team has collaborated with many of our physicians
to write and publish blogs on issues from breast-feeding to
ovarian cancer. The use of social media is an important channel
of communication with women in our market 25-65 years of
age. Physicians who post blogs receive significant increased
volume to their Hospital listing on our website and visits to their
own web pages. We will continue to work with our Marketing
team to enhance our efforts to reach women who are thinking
of becoming pregnant or are newly pregnant to introduce them
to the excellent physicians on staff and promote the wonderful
services offered at Stamford Hospital.
Current and future projects for research include:
• Prevalence of Intrahepatic Cholestasis in Pregnancy is SW Connecticut — Ana Pantel, MD
• An Observational Study of Paternal Weight Gain during Pregnancy — Courtney Noonan, MD; Paul Bobby, MD
• Has Use of Non-invasive Prenatal Testing Changed Practice in the Community Hospital Setting: A Retrospective Chart Review— Tracy Shevell, MD
• Safely Decreasing the Primary Cesarean Section Rate in a Community Hospital — Kezia Spence, MD
• Impact of a Quality Improvement Initiative on the Episiotomy Rate at a Community Hospital — Andrew C. Rausch, MD; Maureen Burke, MD; Donna Bowman, DNP, FNP-BC, RNC-OB; Paul Bobby, MD; Daryl Wieland, MD, MSMI
• Resection of Vaginal Mesh and Recurrent Pelvic Organ Prolapse: A Retrospective Study — Xibei Jia, MD; Oluwakemi Adegoke- PGY 4; MD, Brian J. Hines, MD; Katherine S. Sandhu, MD
• Transvaginal Resection of Sacrocolpopexy Mesh to Relieve Pelvic Pain — Xibei Jia, MD; Oluwakemi Adegoke, MD; Brian J. Hines, MD; Katherine S. Sandhu, MD
• Spontaneous Orgasm with Movement after TOT Placement: A Case Report, Sarah Elliott, MD; Brian Hines MD
• Implementation of a Universal Perinatal Depression Screening and Treatment Program in a Community Health Care Setting, Kiger Lau, MD, MPH; Setul Pardanani, MD
• First Trimester Detection of the EEC Syndrome, Andrew C. Rausch, MD; Paul Bobby, MD
• An Observational Study of Obstetrics and Gynecological Graduate Medical Education in Nepal and the United States, Kiger Lau, MD, MPH; Setul Pardanani, MD
• Prolapse Recurrence after Partial Removal of Transvaginal Mesh, Xibei Jia, MD; Katherine Sandhu, MD; Brian Hines, MD
• Retrospective Analysis of Toxicity, Treatment Delays and Recurrence-free Intervals for High-risk Endometrial Adenocarcinoma of the Uterus Treated with Chemotherapy vs. Combined Modality Therapy — Elena Ratner, MD.
Outcomes in the Department of OBGYN Departmental Safety and Quality
Led by Co-Directors Paul Bobby, MD, and Donna Bowman, APRN, the primary mission of the OB Safety and Quality Committee is to develop evidence-based protocols for delivering obstetrical care at the highest level of safety and quality. Compliance with these protocols, along with the Department’s collaborative, multidisciplinary approach to care, has produced favorable results on a variety of quality and safety measures.
Quality Metrics/Core Measures 201
• Joint Commission (year-to-date FY16)
» Elective deliveries <39 weeks — 2% (Leapfrog & CMS benchmark <5%)
» Cesarean in NSTV (Nullip, Term Singleton, Vertex) 39% (no benchmark) Most are for labor arrests and NRFH. We have referred select indications for peer review. These include “arrest of dilation diagnosed prior to 6cm” and “failed induction.”
• Antenatal steroid administration — 100% (no benchmark)
• Exclusive breastfeeding has increased from 37% to 47% (no benchmark)
• Leapfrog (publicly reported)
» Episiotomy 17% (benchmark <12%)
» DVT prophylaxis for Cesarean — 97% (benchmark 80%)
Safety Program
• 100% eligible residents passed Electronic Fetal Heart Monitoring Exam
• 100% eligible nursing staff passed Electronic Fetal Heart Monitoring Exam
• Preeclampsia DTR compliance 95 % (internal target 90%)
Department of Obstetrics & Gynecology: Annual Report 2016
65 2016 Clinical Annual ReportMain Concourse
66 2016 Clinical Annual Report
PathologyWe continue to expand our level of sophisticated testing by bringing in advanced clinical chemistry platforms and
automation. We expanded our molecular diagnostics capability in microbiology — enabling us to identify a vast array
of major human pathogens within hours. We continue to expand our ability to identify common molecular alterations
in hematologic malignancies and solid tumors that can serve as targets for novel therapeutics.
Testing. Expedited.
67 2016 Clinical Annual Report
In 2016, the Laboratory focused on enterprise growth and cost
containment. Following an intensive process we identified Abbott
as the manufacturer/vendor to install a new, fully automated clinical
chemistry system to further upgrade our capabilities and achieve
significant annual savings. Our Siemens system was dismantled,
temporary Abbott equipment brought on-line and construction
of our new Abbott Architect Full-Line Automation is in progress.
This type of line conversion is a highly disruptive process for any
laboratory and has significant impact on operations. This conversion
will be complete by Q3 2017.
The Lab now has 2 Roche/Ventana H600 automated histology single-
slide strainers, which allow for production of “best-in-class” histology
slides and maximize patient safety. At Stamford Health, it is impossible
to have tissue contamination during the H&E staining process. These
instruments replaced our Symphony single-slide histology staining
process. They eliminated Xylene (a known carcinogen), are cheaper to
operate, have improved coverslipping and produce high-definition
histology slides that increase our diagnostic accuracy.
We have also upgraded all our Ventana Immunostainers to improve
our turnaround time (TAT) and IHC results, and in anticipation of
expanding our in-house capability to identify tumor markers that
dictate therapy (such as ALK, PD1 and PDL1) in 2017.
We now have a Frozen Section Room in the new hospital with
a complete pathologist workstation. This will improve our frozen
section TAT and assure best communication with surgeons during
surgery. We are poised to deliver live video of tumor and surgical
margin evaluation into the operating rooms, as well as live video
of histologic evaluation. We will be the first hospital in Connecticut
to have this capability.
The Lab underwent a CAP inspection by a team from Montefiore
Medical Center, and we have received full 2 accreditation.
We continue to participate in the College of American Pathologists
Laboratory Accreditation program, and CAP Performance
Improvement Programs in Surgical Pathology, Cytopathology
and Dermatopathology.
Scope of Clinical Activities
Division of Clinical Chemistry
We continue to review and enhance our daily workflow processes
to ensure accurate test results and optimal TAT of patient results.
In 2015, we implemented Nova whole blood instruments for BMPs
to reduce TATs in the Emergency Department and maintained our
60-minute goal throughout FY16.
In 2016, we submitted a RFP for a full laboratory automation system
and after extensive research, we decided on the Abbott integrated
clinical chemistry and immunoassay platform. We are in the first
phase of the Lab renovation and instrument implementation
process. This five-phase project will take approximately 10 months
to complete. Once fully operational, this system will perform front-
end processing, centrifugation, tests analysis and sample storage
for the majority of chemistry and routine coagulation. Abbott
immunochemistry offers the highest quality testing for HIV and
hepatitis that can be performed 24/7 for improved patient care.
We continue to offer vitamin D testing and procalcitonin testing
24-hours-a-day, seven-days-a-week. These new instruments and
Department of Pathology & Laboratory Medicine: Annual Report 2016
Robert C. Babkowski, MD, MMM, FCAPChair, Pathology & Laboratory Medical Director
A Message From The Chair The Year in Review
68 2016 Clinical Annual Report
Department of Pathology & Laboratory Medicine: Annual Report 2016
automation will improve our quality of results, specimen handling
and overall satisfaction.
The Lab will be bringing Hgb, Serum Proteins and Immunofixation
Electrophoresis in-house. This will improve TAT, increase patient and
physician satisfaction and decrease our reference testing costs.
The Department remains focused on the cost-efficiency of our
reference testing, and we continue to review these tests with the
intent of bringing more assays in-house as the criteria of order
frequency and cost are met.
We were successful in recruiting a new highly qualified and
experienced Clinical Chemistry Supervisor to complete our roster of
section supervisors. Patricia Linquist joined our team in October 2016.
Division of Hematology, Coagulation and Urinalysis
Hematology/CBC Analysis:We acquired and implemented new Sysmex XN technology
for both the Bennett Cancer Center (BCC) as well as the main
Laboratory. This technology upgrade to the BCC resulted in offering
a six-part differential (as opposed to previous 3-part diff ), nRBC
enumeration (previously not available) and Immature Granulocyte
(IG) enumeration (also previously not available). For the main
hospital Laboratory, this upgrade results in automatic repeat testing
when questionable results arise (thus improving quality of results),
decreased TAT, a smaller footprint and reduced reagent consumption
(and therefore decreased cost of operation). Having the same
platforms at the BCC and main Lab allow for a complete patient chart
in MediTech, which means previous result history from either testing
location is integrated into a uniform patient record.
Coagulation:The Laboratory will be upgrading to a new coagulation analyzer,
the ACL Top 750 by Instrumentation Laboratory, which is
compatible with the new Abbott track system. This new model of
coagulation analyzer has the capability to check for pre-analytical
factors such as short sampling, clotted samples and excessive
hemolysis and lipemia. Adding the ACL Top 750 to the track will
provide a consistent TAT for all routine coagulation tests (PT/INR,
aPTT, D-dimer, and Fibrinogen) by automating the processing,
centrifugation and sampling of each tube.
The Laboratory is in the process of validating the VerifyNow®
analyzer by Accumetrics. This system allows for a quick analysis of
patient responsiveness to antiplatelet medications such as aspirin,
Plavix® (clopidogrel) and Brilinta® (ticagrelor). A memo will circulate
to all physicians once the test system is live for patient evaluation.
Urinalysis:We acquired and implemented a new Arkray AU4050, which
automates both dipstick and sediment analysis. Analyzer flags for
pathogenic components including yeast, casts, crystals and flags
for manual microscopic review for confirmation.
Fertility:Semen analysis, post-vasectomy semen analysis and sperm wash
procedures have been transitioned from the Chemistry section
to the Hematology section, as these technologists have better
competency to accurately perform such analyses. These tests will
continue to be offered by appointment only, Monday through
Friday, from 8:00 a.m. to 2:00 p.m. Please call Hematology at
ext. 7600 to make appointments.
Stamford Hospital Coagulation Clinic
The Lab continues to closely support the Coagulation Clinic, which
is administered by Isabelle Millet, PharmD, PhD, and is under the
medical directorship of Raymond Baer, MD. The site successfully
passed all CAP survey samples during this past year with 100%
accuracy. The Clinic accepts patients by physician referral only
for those who wish to use it for anticoagulation initiation and/or
maintenance of their anticoagulated patients.
Blood Bank
The Blood Bank transitioned to the New York Blood Center (NYBC)
services this year. The NYBC collects 2,000 blood product units per
day and distributes to more than 20 million people in New York
City, Long Island, Hudson Valley, NY, New Jersey, Connecticut and
Pennsylvania. It has a web-based ordering system to expedite blood
deliveries. The NYBC reference laboratories, under the direction
of Connie Westhoff, utilize state-of- the-art methods in serological
investigation and DNA blood group analysis to resolve complex
cases, determine clinical significance and provide consultation for
the selection of proper blood for transfusion. The NYBC also performs
RHD genotyping testing for cases where routine laboratory testing
for RHD results in discordant or weaker than expected results for
pregnant women or potential transfusion recipients. This allows for
fewer unnecessary injections of Rh immune globulin and increased
availability of Rh-negative red blood cells.
69 2016 Clinical Annual Report
To allow for faster delivery, prothrombin complex Kcentra, for the
rapid reversal of Coumadin, is now being stored and distributed
by the Pharmacy. The Blood Bank continues to provide activated
factor VII (Novo 7) for treatment of patients with life-threatening
bleeding. Both of these products still require consultation and
dose calculation by Blood Bank Director Raymond Baer, MD.
The Blood Bank maintains sufficient blood products for the
cardiac and trauma services, and has protocols to provide multiple
blood products quickly. These protocols are continually being
updated and modified to reflect the most current scientific data
available. The Blood Bank Director also serves as consultant for
difficult patient coagulation issues.
It is anticipated that as soon as the pneumatic tube system
is validated, blood and blood products will be delivered from
the blood bank by pneumatic tube, decreasing transit time.
BloodTrack® is also in the process of being implemented.
This is a blood management system from Haemonetics that
combines software and hardware components to allow blood
to be remotely stored and distributed. A dedicated smart
refrigerator will be located in the ED for quick dispensing of
emergency blood products. A smart refrigerator will also be
located in the OR to allow for blood to be stored and
distributed to the proper patients.
The Transfusion Administration Record (TAR) computer module
was implemented by the Nursing Department and Blood Bank.
This allows for transfusion documentation to be directly entered
in the computer, which increases transfusion safety. We continue
to review and update policies with the Nursing Department.
Blood transfusion audits are reviewed and documented at the
Transfusion Committee and recorded by Nursing for National
Patient Safety Goals.
In order to reduce data and clinical entry errors, the Blood Bank
is in the process of interfacing the automated analyzer (Tango)
with the MediTech computer.
Due to the collaborative efforts of the Blood Bank, Transfusion
Committee and clinical departments, Stamford Hospital continues
to have one of the lowest crossmatch-to-transfusion ratios in the
state. The Blood Bank continues to monitor transfusion practices,
resulting in decreased utilization of blood and blood products
throughout the Hospital.
Division of Microbiology
Cepheid continues to be our PCR platform of choice. We continue
to perform PCR testing for Enterovirus in CSF, Nasal MRSA, Nasal
MRSA/ MSSA, C. difficile (including the virulent NAP1 strain) and
Mycobacteria tuberculosis complex with gene mutations associated
with Rifampin resistance. Our newest additions to the platform
include Influenzae A, B and RSV, and PCR capability to detect
carbapenamase activity. The carbapenamase assay will enable
us to determine the specific plasmid associated with resistance
for these highly resistant organisms. Now that our facility has all
private rooms, the improved Influenza/RSV PCR assay will enable
us to provide this highly sensitive testing methodology to all of
our ED and inpatients. All of these assays provide real-time testing,
improving TAT of results so that our patients can be treated as
quickly as possible.
The Lab uses the Hologic Panther system for amplified RNA detection
for chlamydia and gonorrhea testing, and HPV. The E6 and E7 genes
of high-risk HPV genotypes are known oncogenes. Fourteen HPV
genotypes are considered pathogenic or high-risk for cervical
disease. Multiple studies have linked genotypes 16, 18, 31, 33, 35, 39,
45, 51, 52, 56, 58, 59, 66 and 68 to disease progression. Women with
a persistent infection with one of these types have an increased risk
for developing severe dysplasia or cervical carcinoma.
We have expanded our capability to identify respiratory pathogens
with the introduction of the BioFire Microarray, an automated
in-vitro diagnostic system that utilizes nested multiplex PCR and
high-resolution melting analysis to detect and identify multiple
nucleic acid targets from clinical specimens. The assay is capable
of identifying 20 of the most common viruses and bacteria
associated with infectious respiratory diseases. BioFire testing
is now available 24/7/365 with an approval/order by Infectious
Diseases physicians or Pulmonary specialists. TAT for this assay
is approximately one hour.
In addition to the respiratory panel, we have added the BioFire
meningitis panel. This panel enables us to detect the most
common viral agents associated with Viral meningitis, as well
as the most common bacterial agents.
Working with our Infectious Diseases physicians, we continue to
perform 100% daily clinical follow-up on all positive blood cultures.
We generate drug-bug mismatch alerts that allow for the early
detection of inappropriate drug selection, and we monitor BC growth
24/7 to enable early notification of positive results to the clinicians.
70 2016 Clinical Annual Report
Department of Pathology & Laboratory Medicine: Annual Report 2016
In 2015, we implemented the Bruker MALDI-TOF to improve our
capability for microorganism identification. This mass spectrometry
instrumentation enables us to perform same-day identification of
most organisms, drastically reducing our TAT. We have incorporated
the MALDI-TOF into our routine workflow and are looking forward
to the implementation of the MALDI-TOF/MicroScan interface.
The interface will allow us to report the identification of organisms
more quickly while waiting for the MIC to isolate.
The Lab also implemented Alere™ isothermic PCR for rapid
molecular detection of influenza. This platform is more accurate
than the classic immunoassay technology. We continue to offer
this PCR technology for all of our outpatient influenza testing.
Division of Point-of-Care Testing
The advent of the new hospital resulted in significant growth in
Point-of-Care Testing, and the program was expanded to include
additional glucose and urine devices to support the opening of
several new patient testing sites within the new building. As one
example, the ED doubled the number of urine testing devices to
support its new footprint.
Activated Clotting Time (ACT) testing performed in CVOR and
Cardiac Cath Lab areas was standardized prior to the opening of
the new building. All patients will now have this testing performed
on the ITC Hemochron Signature Elite device. Elimination of a
secondary device previously used in CVOR also achieved requiring
less blood sampling from our patients.
Anatomic Pathology Laboratory Molecular Pathology Testing
GYN: We utilize the Hologic Panther for HPV testing. This automated
PCR DNA-detection method identifies 14 high-risk HPV types and
specifically identifies the most oncogenic types, HPV 16 and HPV 18.
Coagulation: The Lab utilizes the Cepheid GeneXpert platform to detect Factor II
and Factor V abnormalities.
Bladder Cancer: For the detection of bladder cancer (urothelial neoplasia),
Fluorescent In Situ Hybridization (FISH) interpretation of the
UroVysion test is performed by Bo Xu, MD, PhD. We have successfully
implemented reflex UroVysion testing on those urine cytology
specimens where determination of urothelial neoplasia is difficult
and where the additional molecular testing can better identify
a neoplastic process.
Thyroid, Colon & Lung Cancer
Dr. Xu also evaluates EGFR, KRAS, BRAF, ROS, ALK and PDL1 mutations
in lung, colon and thyroid cancers. The Lab continues to evaluate
colon cancers for mismatch repair proteins (MMRP) using IHC with
reflex positives to full-sequence analysis (microsatellite instability
evaluation) is to identify patients with Lynch syndrome (hereditary
non-polyposis cancer). We also continue to augment thyroid FNA
cytology evaluation with molecular pathology testing, and promote
a collaborative process to our referring endocrinologists and
radiologists whereby indeterminate/suspicious category thyroid FNA
biopsy specimens are evaluated with molecular testing for various
KRAS, NRAS and BRAF mutations. This process allows for judicious
and cost-effective molecular testing.
We successfully evaluated three platforms for thyroid molecular tests:
Thyroseq, ThyraMIR and Vericyte. We are currently using ThyraMIR
platform which combines DNA mutational analysis with microRNA
testing to achieve a highly sensitive and specific result.
With cooperation from our Colorectal Surgeons and Medical
Oncologists, we established that all Stage II and III colorectal cancer
tumors will be evaluated for Recurrence Score using Oncotype Colon
RX assay. This independent variable, when combined with T stage
and MMRP status, allows for optimal patient selection for adjuvant
chemotherapy and benefit of Oxyplatin (at Stage III CRC).
Leukemia/Lymphoma
In conjunction with Neogenomics Laboratories, we continue to
offer our clinicians an array of ancillary testing, the equivalent
of which would be offered at any large academic institution or
specialty cancer hospital. All hematopathology cases are evaluated
by either Raymond Baer, MD, or Tal Oren, MD, both board-certified
Hematopathologists. In close collaboration with the treating
Hematologists and/or Oncologists, Drs. Baer and Oren select
the most appropriate battery of ancillary tests to supplement
conventional morphologic evaluation and to ensure appropriate
utilization in line with the most current guidelines.
Ongoing advances in molecular diagnostics enabled us to
bring these advancements to Stamford Hospital. FISH panels
for myelodysplastic syndrome have been expanded to better
capture the growing number of abnormalities that were recently
incorporated into the revised IPSS scoring system. FISH panels for
71 2016 Clinical Annual Report
acute myeloid leukemia have also been expanded to reflect the
growing number of distinct subtypes recognized in the latest World
Health Organization classification schema. FISH panels for multiple
myeloma can now be performed by enriching plasma cells, thereby
improving the sensitivity of this assay to identify prognostically
significant abnormalities in the neoplastic plasma cells.
We continue to re-evaluate and to expand our offerings in the
growing arena of Next Generation Sequencing (NGS) in an
effort to identify common molecular alterations in hematologic
malignancies that can serve as targets for novel therapeutics,
particularly in those patients who are either too old to receive
standard therapies or who have already failed conventional therapy.
These expanding NGS offerings enable oncologists to better
understand the exact biologic underpinnings of a given patient’s
malignancy and tailor a treatment plan accordingly, permitting
Stamford Hospital to remain at the forefront of this exciting and
emerging technology. An additional development in the field of
NGS is the ability to detect abnormalities in the patient’s peripheral
blood, a technique often referred to as a “liquid biopsy.” We have just
begun to offer liquid biopsies to our patients, enabling our oncologists
the potential to follow molecular abnormalities in a patient’s blood
without patients having to undergo a repeat biopsy. To stay at
the forefront of these technologies, we recently partnered with
Foundation One, an industry leader in this field, to become the
exclusive provider for NGS and Liquid Biopsies at Stamford Hospital.
In summer 2016, Stamford Hospital oncologists began to
request that most of their bone marrow biopsies be performed
by interventional radiologists. In response to this, the Laboratory
mandated that a cytotechnologist be present at all bone marrow
biopsies to ensure the appropriate procurement of material for
morphologic review and ancillary studies. At the beginning of this
transition, a subset of the biopsies were below the quality necessary
for optimal review, necessitating a joint meeting between Pathology,
Medical Oncology and Interventional Radiology to discuss strategies
for quality improvement. After this meeting, changes were
made to the process, the result of which has been a noticeable
improvement in the diagnostic yield for patients undergoing bone
marrow biopsy and a significant drop in the number of “marginally
adequate” and “inadequate” specimens.
We continue to provide the professional interpretation for
many of these tests, which allows us to better integrate all of
the available data and generate a single, cohesive, comprehensive
final diagnostic report for our clinicians. We feel that this approach
not only improves patient care and but is also of significant
value to our clinical colleagues.
Melanoma
We continue to offer BRAF testing for metastatic melanoma.
BRAF mutation positive melanoma patients derive significant
benefit from medications targeting BRAF. As the panel of
medications targeting key players of important molecular pathways
has expanded, we now offer testing for N-RAS and C-KIT. In
addition, a recent and exciting advance in the field of melanoma
therapy has been the use of drugs to modulate the immune system
in fighting cancer cells. To this end, we are now offering PDL-1
testing in the setting of metastatic melanoma.
Melanoma FISH testing is also available through Neogenomics
Laboratories for those lesions that fall under the provisional
category of “MELTUMP” (melanocytic tumor of unknown malignant
potential) or borderline lesions such as is the case with Atypical
Spitz tumors. Elgida Volpicelli, MD, coordinates the ordering of this
test and correlates results with the morphology of these difficult
melanocytic lesions in order to predict behavior.
Division of Cytology
We continue our “push-cart service” with microscope and staining
equipment placed on a mobile cart. We provide on-site immediate
assessment for deep-organ CT-guided biopsies, ultrasound-guided
transbronchial biopsies of the lungs and mediastinum performed
in the OR and endoscopic ultrasound-guided fine needle aspirations
(FNA) of the pancreas/stomach/duodenum performed in the special
procedure room. We work closely with Interventional Radiologists,
Pulmonologists, Thoracic Surgeons and Gastroenterologists to make
sure diagnostic material is obtained and appropriate triage of each
specimen takes place.
We now have five years of experience with the Celient cell
block technology for creation of cell blocks from cytology material.
This technology enables us to create superior, concentrated
samples from body fluids and FNA specimens for subsequent
immunohistochemical testing to classify malignancies.
The direct patient benefit is that we can do more with less.
In our community we are fortunate to have a number of
Endocrinologists who are also skilled ultrasonographers and
perform ultrasound-guided FNAs in their office. Thyroid lesions
that are difficult to sample and require Interventional Radiology
with immediate cytopathology assessment are performed at
Stamford Hospital. Our skilled Interventional Radiologists work
hand-in-hand with our Cytopathologists in sampling
difficult lesions.
72 2016 Clinical Annual Report
Department of Pathology & Laboratory Medicine: Annual Report 2016
Due to the Hospital’s growing expertise, we have seen a significant
amount of thyroid pathology, more than most academic medical
centers. Stamford Hospital is the only institution in Connecticut
with two MD Anderson fellowship-trained Cytopathologists
(Dr. Babkowski and Dr. Xu). At this point, we handle the majority
of thyroid FNA cytology specimens in Fairfield County.
2015 was our first year of completely insourced gynecologic cytology.
We hired three experienced Cytotechnologists and implemented
Hologic computer-assisted screening. This has decreased our cost
of gynecologic cytology and improved our result TAT. Our first
CAP inspection took place 2016 and we passed inspection with
no deficiencies. Given the brand new nature of this Laboratory
expansion, we are very proud of that achievement.
Division of Surgical Pathology
The Division of Anatomic/Surgical Pathology and the Histology
Laboratory at Stamford Hospital has remained very active with
over 22,000 surgical specimens processed during the fiscal year.
Our case complexity has also grown with increasing volume in
dermatology/melanoma, breast and thoracic pathology.
One of our three pathology assistants, Grace Valenzano, MHS, PA,
serves as Anatomical Pathology Supervisor, and is responsible
for overseeing the day-to-day operations of Anatomic and
Cytopathology sections of the Lab.
The TAT for Surgical Pathology reports for 2015 remains at
an average of 24 to 48 hours for 95% of reports.
After serving as the beta test site for the HE600, the Histology
lab welcomed its own HE600 in the spring of 2016 and a second
unit in the summer.
The Pathology and Histology Department have started the
build and implementation of Vantage, a barcoded specimen
tracking system that will go live in January 2017. This fully
automated system will allow the user to track a specimen’s
location at any time and will eliminate specimen labeling errors.
A Frozen Section Room was opened in the new hospital,
providing crucial service just steps away from the OR. This suite
is fully automated with state-of-the-art audio-visual equipment,
allowing the Surgeon and Pathologist to view gross and
microscopic images in real-time.
Departmental Physician Activities
Department members continue to actively participate in
institutional tumor boards and conferences as follows:
• Weekly Breast Tumor Board — Dr. Robert Babkowski,
Dr. Elgida Volpicelli
• Weekly Radiology-Pathology Breast Biopsy Correlation
Conference — Dr. Robert Babkowski, Dr. Elgida Volpicelli
• Monthly GYN Oncology Tumor Board — Dr. Bo Xu
• Monthly Genito-Urinary Tumor Board — Dr. Bo Xu
• Bi-Weekly Chest Tumor Board — Dr. Augusto Podesta
• Monthly General Tumor Board — Dr. Augusto Podesta,
Dr. Tal Oren
• Monthly Hematology Tumor Board — Dr. Tal Oren
• Monthly GI Tumor Conference — Dr. Augusto Podesta
• Bi-Weekly Complex Surgical Case
Conference —Dr. Robert Babkowski
73 2016 Clinical Annual Report
Medical Staff Hospital Committee Participation
Department members participate in various Hospital
committees, including:
• Transfusion Committee — Dr. Raymond Baer
• Breast Center Steering Committee — Dr. Robert Babkowski
• Cancer Coordinating Committee — Dr. Robert Babkowski
• GI Tumor Steering Committee — Dr. Robert Babkowski
• Infectious Disease Committee — Dr. Raymond Baer
• Lung Cancer Steering Committee — Dr. Robert Babkowski
• Medical Executive Committee — Dr. Robert Babkowski
• Patient Safety & Quality Committee — Dr. Robert Babkowski
Laboratory Outreach
The Lab expanded our in-office phlebotomy service to
Glenville Medical Group in Greenwich. We also established
relationships with several Urgent Care Centers, including
those on Frost Road in Waterbury, Chase Street in Waterbury
and East Main Street in Stratford.
Additionally, we completed interfaces to Practice Fusion
(Dr. Mayzlor); Athena (Pulmonary Associates, Gastroenterology
Associates and Stamford Gastroenterology); Healthtronics
(Drs. Nurzia and Santarosa); and Lab Soft (Dr. Goldberg).
Raymond A. Baer, MD, FCAP Director of Clinical Pathology and
Transfusion Services
Tal Oren, MD, PhD, FCAP
Director of Hematopathology
Augusto H. Podesta, MD, FCAPDirector of Surgical Pathology
Elgida Volpicelli, MD, FCAPDirector of Dermatopathology
Bo Xu, MD, PhD, FCAP
Director of Cytopathology and
Molecular Pathology
74 2016 Clinical Annual Report
PediatricsThe new Steven and Alexandra Cohen Pediatric Emergency Department opened late in the year, fulfilling a dream of
this Department. As the only specialized Pediatric Emergency Department in lower Fairfield County, it represents a significant
enhancement in the delivery of healthcare to our youngest most vulnerable patients.
Dream. Realized.
75 2016 Clinical Annual Report
This past year was nothing short of historic for all of Stamford
Health and 2017 looks to be equally notable for the Department
of Pediatrics and the Cohen Children’s Institute. The new Steven
and Alexandra Cohen Pediatric Emergency Department opened
late in the year, fulfilling a dream of this Department. For over
a decade, members of the Department recognized the need
for such a facility and worked collaboratively with many others
at Stamford Health to make it a reality. As the only specialized
Pediatric Emergency Department in lower Fairfield County,
it represents a significant enhancement in the delivery of
healthcare to our youngest and most vulnerable patients. The next
major project for the Department will be construction of our new
inpatient facility, the Cohen Children’s Unit in the Whittingham
Pavilion. The design and development phase is finished and work
is set to begin early in the new fiscal year with completion by spring
2017. Whittingham will become a complete Mother–Child pavilion
when this unit opens.
We continue to strive for strong alignment with our pediatric
colleagues in Stamford Health’s primary and secondary service
areas. Towards this end a workgroup has begun to reach out to
practitioners who are not interested in an employment model
but may want to explore other areas of strategic partnerships.
Kids’ FANS (Fitness and Nutrition Services) programs have taken
a major step forward this past year as our nutritional education
has successfully been incorporated into the curriculum for all
third grade students throughout the Stamford Public Schools.
Additional programs continue to run in many sites including
schools, daycare centers and community centers in both
Stamford and Norwalk.
The Department continues to operate the Medical Home Initiative
of Southwest Connecticut, a program that has received grant funding
from the Department of Public Health since 2005. The program,
which is in the last year of a three-year grant and covers Greenwich
through Bridgeport, strives to help coordinate the complex care
often required for children and youth with special healthcare needs.
With construction of the new hospital complete, next year
promises to be both busy and exciting as we further develop
the Cohen Pediatric Emergency Department and begin to
build our new inpatient facility, the Cohen Children’s Unit.
Scope of Clinical Services
Cardiology
Pediatric cardiology at Stamford Hospital has been a well-utilized
area of subspecialty care over the year, providing inpatient and
outpatient evaluations and treatment to referring physicians and to
the community. There are three full-time pediatric cardiologists on
staff. Drs. Allison Levey, Michael Monaco and Michael Snyder all
hold academic appointments at Columbia University with admitting
privileges at Morgan Stanley Children’s Hospital of New York,
facilitating the local delivery of academic-based subspecialty care.
Hospital-based cardiology imaging and testing has continued to be
active. During the past year, we performed an average of 20 pediatric
and neonatal echocardiograms each month. Figure 1 details the
non-invasive studies and pediatric stress tests performed over
Department of Pediatrics: Annual Report 2016
Gerald B. Rakos, MD, FAAPChair, Department of PediatricsDirector, Division of NeonatologyMedical Director, Cohen Children’s Institute
A Message From The Chair The Year in Review
76 2016 Clinical Annual Report
Department of Pediatrics: Annual Report 2016
the course of the year. Both ECGs and echocardiograms are now
available for rapid review online, facilitating timely reporting.
Fetal imaging continues to be an important component of
our service. Working in close collaboration with the Division
of Maternal-Fetal Medicine and community obstetrical practices,
we have performed a significant number of fetal consultations
and echocardiographic studies over the past year. All fetal studies
are now integrated with the hospital EMR. Finalized reports are
available for review by OB staff and referring physicians shortly
after the studies have been completed. All three physicians are
part of the Cohen Children’s Specialty Center and evaluate clinic
patients in their office as well.
Figure 1: Diagnostic Pediatric Cardiology Volume
Cohen Children’s Specialty Center at Tully Health Center
The Steven & Alexandra Cohen Children’s Specialty Center
continues its vital role as a center of highly specialized outpatient
pediatric care for our region. In total, there are 27 providers in
18 specialties. Growing volume at the Cohen Children’s Specialty
Center is highlighted in Figure 2.
Figure 2: Cohen Children’s Specialty Center Volume
Gastroenterology
During the past year, the Division of Pediatric Gastroenterology
has continued to support the pediatric inpatient service, NICU
and Emergency Department, as well as providing specialty care to
patients of the area’s primary care pediatricians and Family Medicine
physicians. Dr. Sarah Lusman remains part of the Cohen Children’s
Specialty Center.
General Pediatrics
Pediatric hospitalists continue to expertly care for the vast majority
of hospitalized children as nearly all of our community pediatricians
have elected to utilize their service. The entire staff is eagerly
awaiting the spring 2017 opening of the new Cohen Children’s Unit
in the Whittingham Pavilion. This past year saw a slight decrease in
the number of admissions to the Pediatric Unit as shown in Figure 3.
Connecticut Medical Home Initiative
Madhu Mathur, MD, directs the Connecticut Medical Home Initiative
for Children and Youth with Special Health Care Needs – Southwest.
The program, which began in 2005, is in the last year of a three-year
grant from the State of Connecticut’s Department of Public Health.
Emphasis continues to be on care coordination for un- and under-
insured children with highly complex special healthcare needs.
Figure 4 showcases patient volume for 2016 vs. 2015.
Figure 4: Connecticut Medical Home Initiative for Children
and Youth with Special Healthcare Needs — Southwest:
2015 2016 Change
Patients Served for Special Healthcare Needs 934 856 -8.4%
Patients Served With High Complexity Needs 466 537 +15.2%
2015 2016 Change
Echocardiograms 254 234 -7.9%
Electrocardiograms 418 428 +2.4%
24 Hour ECGs 43 49 +14%
Pediatric Stress tests 24 22 -83%
Fetal Echocardiograms 213 228 +7%2015 2016 Change
Inpatient 377 372 -1.3%
Observation 57 51 -10.5 %
Total 434 423 -2.5%
Figure 3: Inpatient Pediatrics — Discharges
5000
4000
3000
2000
1000
02009 2010 2011 2012 2013 2014 2015 2016
2016 Clinical Annual Report 77
Kids’ FANS
Stamford Health’s Kids’ FANS (Fitness and Nutrition Services)
program promotes childhood wellness, obesity prevention and
physical activity using a hands-on curriculum that is designed
to make learning about healthy eating and regular exercise
engaging and interactive.
Under the leadership of Ilaria St. Florian MS, RD, the program has
significantly grown since its inception in 2004 and has expanded
its reach in the last two years from about 13 participating sites
and 300 children enrolled to approximately 35 sites and over
2,200 children estimated for the 2016 – 2017 school year. This
initiative includes a community-wide program now being taught
in schools from pre-K to high school, as well as in summer camps,
after-school programs, childcare centers and health fairs. Kids’
FANS also provides one-on-one nutrition counseling to students
at two School-Based Health Clinics in Stamford.
In March 2016, Kids’ FANS, along with the Stamford Obesity Task
Force (since renamed Stamford Children’s Health Collaborative),
spearheaded the first city-wide nutrition awareness initiative for
National Nutrition Month.
Neonatology
The NICU continues its long tradition of providing outstanding
care to neonates. Our team of neonatologists provides
personalized care that not only includes high-quality technical
care but also Planetree patient-centered components like
kangaroo care, infant massage and mentoring from the Tiny
Miracles Foundation. The NICU’s outstanding Press Ganey patient
satisfaction scores support the success of these initiatives.
We continue to maintain membership in the Vermont Oxford
Network, a voluntary collaboration of health professionals
throughout the world working together to improve neonatal
care. Please note our outcomes in the Department Safety and
Quality section.
This coming year, Drs. Jennifer Bragg and John Ciannella are
planning to join the Division of Neonatology at Yale-New Haven
Hospital in an effort to further enhance communication and
relationships with our colleagues there. They intend to work as
attendings several weeks per year in their busy Level IV NICU and
also participate in educational conferences.
The newborn service saw a modest decline in FY16 as shown
in Figure 5, while the NICU saw growth of just over two percent,
as shown in Figure 6.
Neurology
Drs. Murray Engel and Robert Fryer and Margot Laedlein, APRN,
as well as the non-clinical staff at Stamford Health Medical Group
(Pediatric Neurology), have continued their mission to be the regional
center for Pediatric Neurology care. Their referral base remains quite
broad drawing from Westchester and from both lower and upper
Fairfield County. While currently located at the Cohen Children’s
Specialty Center in shared space, they are hoping to move to
dedicated space, which will allow further expansion of the practice.
There is also hope to add anotherpart-time Child Neurologist who
will help with coverage and allow for an increase in sessions to
ensure that the community’s needs are met. Drs. Engel and Fryer
continue their involvement at the Concussion Center at Chelsea
Piers Connecticut as well.
The Division continues its strong academic affiliation with
NewYork-Presbyterian at both the Cornell campus, where
Dr. Engel is Professor of Clinical Pediatrics and Clinical Neurology,
and Director of the Clinical Service, and at the Columbia campus,
where Dr. Fryer is Assistant Professor of Clinical Neurology.
Figure 7 highlights the Division’s EEG volume in 2016 vs. 2015.
2015 2016 Change
EEGs 174 161 -7%
Long-term EEGs 70 66 -6%
2015 2016 Change
Births 2,426 2,377 -2%
Figure 5: Stamford Hospital Newborn Service
2015 2016 Change
Admissions 308 315 +2.3%
Figure 6: Neonatal Intensive Care Unit
Figure 7: Pediatric Neurology EEG Volume
78 2016 Clinical Annual Report
Department of Pediatrics: Annual Report 2016
Pulmonology
Pediatric Pulmonology at Stamford Hospital continues to
provide inpatient and outpatient consultations, RSV prophylaxis
treatment and cystic fibrosis care. Pediatric sleep evaluation
and management is also available at the Stamford Health Sleep
Center. Hossein Sadeghi, MD, holds an academic appointment at
Columbia University as its Director of the Pediatric Cystic Fibrosis
Program. Pediatric Pulmonary function test volumes are listed
below in Figure 8.
Figure 8: The Pediatric Pulmonary Function Laboratory
at Tully Health Center
Medical Staff
Michael Snyder, MDDirector, Division of Cardiology
Murray Engel, MDDirector, Division of Child Neurology
Mark Glassman, MDDirector, Division of Gastroenterology
Gerald B. Rakos, MDDirector, Division of Neonatology
Hossein Sadeghi, MDDirector, Division of Pulmonology
2014 2016 Change
Spirometry 240 285 +18.8%
Plethysmography 353 372 +5%
Diffusion Capacity 12 6 -50%
Bronchodilator Evaluations 175 166 -5.4%
Pulmonary Exercise Testing 68 18 -74%
Sweat Tests 68 23 - 66%
79 2016 Clinical Annual Report
New Staff:
The Department of Pediatrics welcomed the following
members this year:
• Elisabeth Fishbein, MD (General Pediatrics)
• Beth Rosenberg, MD (General Pediatrics)
• Alejandro Mones, MD (General Pediatrics)
• Meltem Seli, MD (Neonatology)
• Shravani Vundavalli, MD (General Pediatrics)
Transitions:
The following members resigned this year:
• Amy Cram, MD (General Pediatrics)
• Catherine Ford, MD (General Pediatrics)
• Nicholas Matarazzo, MD (General Pediatrics)
• Michael Schessel, MD (General Pediatrics)
Honors and Recognition
Top Doctor Awards
• Alison Cass, MD – New York Metro Area and Fairfield County
• Karen Beckman, MD – New York Metro Area and Fairfield County
• Ora Burstein, MD – New York Metro Area and Fairfield County
• Murray Engel, MD – New York Metro Area and Fairfield County
• Robert Fryer, MD – New York Metro Area and Fairfield County
• Mark Glassman, MD – New York Metro Area and Fairfield County
• Jennifer Henkind, MD – New York Metro Area, Fairfield County
and Connecticut
• Timothy Kenefick, MD – Connecticut
• Rosemary Klenk , MD – New York Metro Area and Fairfield County
• Arnold Korval, MD –New York Metro Area, Fairfield County,
and Connecticut
• Susan Lasky, DO – Connecticut
• Allison Levey, MD – New York Metro Area and Fairfield County
• Alan Morelli, MD – New York Metro Area and Fairfield County
• Todd Palker, MD – New York Metro Area and Fairfield County
• Gerald B. Rakos, MD – New York Metro Area and Fairfield County
• Henry Rascoff, MD – New York Metro Area and Fairfield County
• Hossein Sadeghi, MD – New York Metro Area and Fairfield County
• Michael Snyder, MD – New York Metro Area and Fairfield County
• Sanford Swidler, MD – Connecticut
• George Tsimoyanis, MD – New York Metro Area and
Fairfield County
Honors• Sarah Lusman, MD was named to the editorial advisory board
of PREP GI, an online self-assessment tool from the American
Academy of Pediatrics, and served as a peer reviewer for
UpToDate and JAMA.
• Jenifer Henkind, MD received the Outstanding Commitment
Volunteer Award from St. Joseph’s Parenting Center.
• Paule Couture, MD received recognition from New York Medical
College for 20 years of teaching and serving as a preceptor for
medical students.
Letitia Borras, MD
Co-Director, Hospitalist Medicine
Shahrzad Mohammadi, MDCo-Director, Hospitalist Medicine
Madhu Mathur, MD, MPHDirector, Medical Home Initiative
80 2016 Clinical Annual Report
Figure 9: Stamford Hospital Vermont Oxford Network NICU
Outcomes in Top 25th Percentile
1 Very Low Birth Weight (<1500 grams) 2 Includes all NICU admissions beginning in 2015
Patient Satisfaction
The NICU once again achieved outstanding Press Ganey results
and this is highlighted in Figure 10.
Figure 10: NICU Press Ganey Satisfaction FY16
Figure 11 outlines the Hospital performance for Maternal-Child
Health. Core measures include: elective delivery; Cesarean section;
antenatal steroids; Healthcare-associated bloodstream infections in
newborns; and exclusive breast milk feeding.
Department of Pediatrics: Annual Report 2016
Honors (continued)
• Center for Advanced Pediatrics received the International
Board Certified Lactation Consultant (IBCLC) Care Award and
the Pinnacle Award from Cigna for highest quality pediatric
care in Connecticut.
• Hossein Sadeghi, MD was honored by the CT chapter of the
Cystic Fibrosis Foundation as a community champion. He was
also promoted to the rank of Associate Professor of Pediatrics
at Columbia University and named a Samberg Scholar at
NewYork-Presbyterian Hospital.
Grants
• Madhu Mathur, MD, and Gerald B. Rakos, MD received a
three-year grant (2015-2017) from the Connecticut Department
of Public Health for the Connecticut Medical Home Initiative for
Children and Youth with Special Health Care Needs — Southwest
in the amount of $808,000.
• Jennifer Bragg, MD received a grant from the March of Dimes
for a study entitled “The impact of infant massage in the
Neonatal Intensive Care Unit” in the amount of $5,000.
• Hossein Sadeghi, MD - CF learning and leadership
collaboration; Studies: CTBM100C2407 Novartis CF TOBI
Podhaler study; OPTIMIZE study (effect of Azithromycin
on Tobramycin on children with CF newly diagnosed with
Psuedomonas aeruginosa; TEACH study (effect of Azithromycin
on Tobramycin in children with CF who have chronic
Pseudomonas aeruginosa in their sputum). SENTINEL
(RSV) study was completed.
Departmental Safety and Quality
Stamford Hospital’s NICU has been a member of the Vermont
Oxford Network (VON) since 1997. In 2015, the NICU joined the
expanded VON database which includes all admissions, not just
those whose birth weights are <1,500 grams. It is now possible
to benchmark outcomes of all infants admitted to the Stamford
Hospital NICU with almost 1,000 NICUs worldwide. Over 185,000
infants are included in this database. Outcomes analysis is by the
calendar year and the most recent data available is from 2015.
Our goal is to be in the top 25th percentile for 10 major outcomes
and results are shown in Figure 9.
VLBW 1
2015VLBW 1
2015
All Infants2
2015
Pneumothorax Yes No Yes
Periventricular Leukomalacia Yes Yes Yes
Chronic Lung Disease Yes Yes Yes
Necrotizing Enterocolitis No No No
Severe Intraventricular Hemorrhage Yes No No
Severe Retinopathy of Prematurity Yes Yes Yes
Late Infections No Yes Yes
Mortality Excluding Early Deaths No Yes Yes
Mortality Yes No No
Death or Morbidity Yes Yes Yes
Raw ScoreAll Facility Database Percentile
AHA Region 2 Percentile
NICU Overall 94.8 98 99
NICU Nurses 97 98 99
NICU Physicians 92.6 91 93
NICU Overall Assessment 97.8 99 99
81 2016 Clinical Annual Report
Departmental Education and Testing
The Department continues to offer weekly continuing medical
education conferences that are regularly attended by many
pediatricians, Family Medicine physicians and residents, nurse
practitioners and school nurses. In addition to our staff, speakers
come from academic medical centers such as Columbia University
College of Physicians and Surgeons, Albert Einstein College of
Medicine, Yale-New Haven Children’s Hospital and community
and state agencies. As part of our ongoing efforts to connect with
our primary as well as secondary community of health providers,
we began to live stream our Grand Rounds lectures this past year.
Figure 11: Maternal Child Health Quality Scorecard Including Joint Commission’s Perinatal Care Core Measures:
NSTV: Nulliparous singleton term vaginal, PIV: Peripheral Intravenous, NB: Newborn, CLABSI: Central Line Associated Blood Stream Infection, LF Leapfrog, JC: Joint Commission VON: Vermont Oxford Network, NDNQI: National Database of Nursing Quality Indicators
This has received very positive feedback from practitioners who
otherwise would not have been able to attend.
Family Medicine residents continue to rotate through Pediatrics.
Columbia University College of Physicians and Surgeons medical
students as well as Stamford Hospital OB/GYN residents rotate
through the NICU. Formal educational and multidisciplinary rounds
are held daily on the Pediatric inpatient unit. Teaching is also
provided by Dr. Sadeghi to Family Medicine residents and genetic
counselors, and Dietary Department students who participate
in the Cystic Fibrosis program. All Pediatrics division directors
hold teaching appointments at major academic medical centers.
Maternal Child Health Scorecard FY 2016
Indicator Threshold Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep YTD
JC-PC01- Elective Delivery <39 wks (All Cases)
LF & JC1% 0/18 0/21 0/19 1/15 0/18 0/14 0/21 0/27 0/20 1/17 1/31 0/12 0.4%
JC-PC01- Elective Delivery <39 wks (CMS Sample) 1% 0/5 0/5 0/10 1/4 1/11 0/5 0/7 0/6 0/4 0/7 0/10 0/10 2%
JC-PC 2 - NSTV Cesarean (All Cases) Ntl 3% 35/7348%
22/5739%
20/4643%
26/6639%
21/4943%
28/6949%
20/6332%
24/6636%
25/6638%
36/8443%
32/7741%
21/6234% 40%
JC-PC-02 NSTV Cesarean (CMS cample) 16/3348.5%
20/3655.6%
11/2544%
12/3138.7%
12/3633%
14/3837%
11/3432.4%
15/3641%
14/3244%
15/4137%
12/3238%
9/3625% 39%
JC-PC 3 - Antenatal Steroids Ntl <95% 5/5 NoCases 4/4 4/4 5/5 4/4 4/4 6/6 3/3 5/5 8/8 2/2 100%
JC-PC 4 - Newborn Blood Stream Infections Ntl <5 0 0 0 1 0 0 0 0 0 0 0 0 1
JC-PC 5- Excl. Breastfeeding (CMS) Ntl 50% 16/3743.2%
13/4032.5%
12/3237%
41/8548.2%
11/3234%
15/3050%
21/3658.6%
21/3953.8%
21/3560%
20/3951%
16/3941%
17/3450% 47%
Skin to skin within 30 minutes of Del. NSI 90% 19/19100%
12/1392%
20/20100%
20/20100%
20/20100%
20/20100%
17/2085%
18/2090%
17/2085%
10/2090%
20/20100%
19/2095% 95%
BF - Attempt/ Latch 1hour NSI 80% 13/1968%
13/1969%
14/4069%
15/2075%
9/2045%
17/2085%
13/2065%
15/2075%
14/2070%
12/2060%
17/2085%
15/2075% 70%
Pedi PIV Infiltrates NDNQI 0 0 0 0 0 0 0 0 0 0 0 0 5
NB Bilirubin Screening LF 90% 45/4894%
46/4896%
20/20100%
22/22100%
20/20100%
20/20100%
20/20100%
20/20100%
20/20100%
20/20100%
19/2095%
20/20100% 98%
NICU CLABSI NDNQI Q 0 0 0 0 0%
<37 wk adm temp on NICU adm PI 90% 18/1995%
10/1191%
16/1794%
10/1191%
11/11100%
10/1377%
9/1275%
13/13100%
13/13100%
11/11100%
20/2195%
10/10100% 93%
<1500 gm temp on NICU adm > 96F (36C) VON25% tile
2/2100%
Nocases
1/1100%
1/1100%
3/3100%
2/450%
1/1100%
3/3100%
2/2100%
4/4100%
8/8100%
1/1100% 93%
82 2016 Clinical Annual Report
Department of Pediatrics: Annual Report 2016
Departmental Research and Scholarly Activities
Abstracts and Papers
Jennifer Bragg, MD – Annemarie Stroustrup, MD, MPH, Jennifer
Bragg, MD, Syam Andra, PhD, Paul Curtin, PhD, and Chris
Gennings, PhD. NICU-Based Phthalate Exposure Impacts Early
Neurodevelopmental Performance.
Sara Shrager Lusman, MD – Sarah Lusman, Jillian Sullivan.
Nutrition and growth in cystic fibrosis. Cystic Fibrosis. Pediatric
Clinics of North America. Elsevier; August 2016.
Served as the site principal investigator for a project entitled:
Assessing the Association Between EPAs, Competencies and
Milestones in the Pediatric Subspecialties.
Hossein Sadeghi, MD – Abstract accepted at this year’s North
American CF conference titled: Patient perceptions on transition
and timing of transfer to adult care.
Community Outreach
The Department was represented at many events and health
fairs including:
• Health Wellness & Sports Expo at Chelsea Piers Connecticut
• Community Health Fairs
• Fairfield County Sports Commission
• March of Dimes March for Babies
• Early Childhood Fair School Readiness Council
• Fall Harvest at Fairgate Farms
• Stamford Children’s Health Collaborative
(formerly Stamford Obesity Task Force)
• Cystic Fibrosis Foundation’s Great Strides Walk
• Stamford Public School’s Teacher Orientation
• March National Nutrition Month, Stamford city-wide
initiative included 25 events
• Rye Country Day School 1st Annual Wellness Day
• Stamford STEMFEST at Mill River Park
• Yerwood Center Family Fun Fair
• HarborFest
Strategy/Future Direction
This coming year promises to be memorable with the opening of the
new Cohen Children’s Unit. Additionally, we will look to:
• Explore long-term strategic partnerships with prominent
academic medical centers.
• In collaboration with the Department of Emergency Medicine,
continue recruiting for our new Pediatric Emergency Department.
• Further recruit specialists for the Cohen Children’s
Specialty Center, particularly in Pediatric Surgery.
• Continue to work with independent physicians on
enhancing alignment strategies.
• Further develop of a simulation testing program for all
hospital-based physicians and nurses.
• Continue our collaboration with the Stamford Health
Department in the Connecticut Hospital Association’s
Statewide Asthma Initiative.
• Expand the NICU’s Infant Massage program.
• Continue efforts to recruit un- and under-insured children
and youth with special healthcare needs for the Medical
Home Initiative.
• Continue philanthropic activities related to Pediatrics
in the Healing Reimagined campaign.
• Explore research opportunities with the Vermont
Oxford Network.
• Together with Physician Relations continue visiting
area practices to apprise them of ongoing and planned
Departmental programs and initiatives.
83 2016 Clinical Annual ReportNursing Station in the Patient Tower
84 2016 Clinical Annual Report
PsychiatryWe continue to see large numbers of individuals from the community who present to the Hospital’s Emergency Department
in need of psychiatric and substance abuse services. There was a 7% increase in inpatient volume in the Psychiatry Unit
compared to the previous year and the average length of stay increased from 7.52 days in FY14 to 9.29 days in FY16, reflecting
the increased patient acuity and limited community residential resources for patients.
Teamwork. Facilitated.
85 2016 Clinical Annual Report
In the past year, the Department of Psychiatry has accomplished
a great deal in its role as the major provider of patient-centered
mental health assessment and treatment services for patients
with acute and serious psychiatric disorders in the greater
Stamford community. Specifically, we:
• Maintained a high-quality inpatient and consultation/liaison
service to meet the ever-increasing psychiatric care needs
of our patients
• Met all requirements to maintain substantial grant funding
through the Department of Mental Health & Addiction
Services in the amount of $289,000 per annum
• Continued to reduce Emergency Department gridlock and
improve clinical services through our emergency psychiatric
hold program, providing four psychiatric ED hold beds located
on the Inpatient Psychiatry Unit
• Modified the physical environment for psychiatric assessment
in the ED to accommodate increasing demand and improve
customer services and satisfaction; this was accomplished
with the opening of designated Behavioral Health space in
the new ED
• Maintained the program that began in July 2004 for provision
of evening and weekend psychiatric house physician services
in the ED to facilitate timely assessment of psychiatric patients
• Maintained a collaborative relationship with the Dorothy
Bennett Behavioral Health Center at Optimus Health Care
and Dubois Center in Stamford to provide continuity of
high-quality psychiatric care to patients
The Department’s clinical services remained quite busy with
significant activity. We continue to see large numbers of individuals
from the community who present to the Hospital’s Emergency
Department in need of psychiatric and substance abuse services.
There was a 7% increase in inpatient volume in the Psychiatry Unit
compared to the previous year and 21% increase over FY14 (5,796
days in FY16 compared to 5,416 in FY15 and 4,766 in FY14). The
average length of stay increased from 7.52 days in FY14 to 9.29
days in FY16, reflecting the increased patient acuity and limited
community residential resources for patients.
Department of Psychiatry: Annual Report 2016
Draupathi Nambudiri, MD, FAPAChair, Department of Psychiatry
A Message From The Chair The Year in Review
86 2016 Clinical Annual Report
Department of Psychiatry: Annual Report 2016
Figure 2: Consultation/Liaison Services Volume
Data on volume for the Inpatient Psychiatric Unit is presented
in Figure 1.
Compared to FY15, the Medical/Surgical and substance abuse
consultation volume remained stable in FY16. There were 2,705
consults in FY16 compared with 2,710 consults in FY15. It is
important to note that over the years the number of child and
adolescent psychiatry cases seen by the consultation service has
gone up from 109 cases in FY12 to 177 cases in FY16. Data for
psychiatric consultations is presented in Figure 2.
Scope of Clinical Services
Inpatient Services
The Inpatient Psychiatry Unit at Stamford Hospital is the major
provider of patient-centered mental health assessment and
treatment services for patients with acute and serious psychiatric
disorders in the greater Stamford community. The community
has come to trust and rely upon the high quality of acute
care with rapid assessment and stabilization delivered on the
inpatient service. As the only community hospital-based inpatient
psychiatric service between the New York/Connecticut border
and Norwalk, Connecticut, this service provides a vital link in the
mental healthcare of those who reside in lower Fairfield County.
We maintain a high caliber of service on this unit while exploring
how best to serve specialty populations in the area.
The Department’s approach to mental health is multidisciplinary,
and our care team is sensitive and compassionate to patients
and their families. In addition to psychiatrists, psychiatry nurse
practitioners and psychiatry physician assistants, nurses and
technicians, patients may also work with social workers, a
substance abuse counselor, a case manager, an activity therapist
and other support staff.
Treatment is highly individualized to the unique needs of each
patient. We offer dual-diagnosis behavioral health treatment
services, group and individual behavioral therapy, medical
psychiatry and psychopharmacological interventions. Pet therapy,
music therapy, spirituality and relaxation groups are also available.
Upon discharge, patients receive a carefully constructed discharge
plan and arrangements for aftercare. We invite involvement of a
patient’s family or significant other (with patient permission) during
this process.
ED Consults
Floor Consults
Substance Abuse
ConsultsTotal # of Consults
Change From Last
Year
FY12 1,486 1,188 93 2,767 +10%
FY13 1,541 1,984 126 3,651 +32%
FY14 1,501 1,533 22 3,056 -16%
FY15 1,554 1,156 — 2,710 -11%
FY16 1,776 939 — 2,705 0%
Figure 1: Psychiatric Inpatient Service (South-1) FY12-FY16
6000
5000
4000
3000
2000
1000
0FY12 FY13 FY14 FY15 FY16
Inpatient Volume
Child Adolescent Cases
250
200
150
100
50
0FY12 FY13 FY14 FY15 FY16
87 2016 Clinical Annual Report
Consultation Liaison/Medical, Surgical & Emergency Department Consultation Services
There is an ever-increasing demand for psychiatric evaluation services
in the Emergency Department. Disorders such as delirium, behavioral
difficulties associated with dementia, acute anxiety, panic, psychotic
disorders, depressive states and alcohol and substance use disorders
are but a few of the common difficulties which the Department
is called upon to address with the medical/surgical inpatient
population. The Psychiatry Consultation/Liaison service plays a vital
role in the care of these patients.
New Staff
• Robert Feeley, MD
• Taiye Ogundipe, MD
• Nicole Feagin, PA-C
Transitions
• Farid Force, MD left the medical staff in April 2016
• Linda Pettei, APRN left the ancillary staff in May 2016
• Rachit Patel, MD left the medical staff in June 2016
Hospital Committee Participation
Department members participate in various Hospital
committees, including:
• Department Executive Committee – Dr. Enenge
A’Bodjedi, Dr. F. Carl Mueller, Draupathi Nambudiri (Chair),
Dr. Jeffrey Koffler, Dr. Gopal Upadhya
• Outpatient Behavioral Health CQI Committee – Dr. Enenge
A’Bodjedi
Medical Staff
• Department Medical Peer Review Committee – Dr. Enenge
A’Bodjedi (Chair), Dr. Rachit Patel, Dr. Gopal Upadhya
• Medical Executive Committee – Dr. F. Carl Mueller,
Dr. Draupathi Nambudiri
• Graduate Medical Education Committee – Dr. Draupathi
Nambudiri
• Continuing Medical Education Committee – Dr. Draupathi
Nambudiri
• Inpatient Psychiatry CQI Committee – Dr. Draupathi Nambudiri,
Dr. Rachit Patel
• Patient Safety & Quality Committee – Dr. Draupathi Nambudiri
• Pharmacy & Therapeutic Committee – Dr. Rachit Patel,
Nicole Feagin, PA-C
• Hospital Nominating Committee – Dr. Jeffrey Koffler
• Department QIC Committee – Dr. Gopal Upadhya (Chair)
• Medial Staff Credentials Committee – Dr. Kenneth Graham
• Core Measures Work Group – Dr. Draupathi Nambudiri (member)
• Dementia Work Group – Dr. Draupathi Nambudiri
Departmental Safety and Quality
Psychiatry Core Measures, HBIPS
Psychiatry Core Measures target patient safety, quality of care
and timely transmission of clinical information to next level of
care. The Core Measures also include compliance with screening
all admissions to the Inpatient Psychiatry Unit for alcohol and
substance abuse using a special screening tool. HBIPS Appropriate
Care Measure Score for FY15 was 95% and for FY16 we achieved
a score of 96%, above the target of 95%. Since January 2015,
the Inpatient Psychiatry Unit has been participating in Tobacco
Screening (TOB) Core Measures. For FY15, we achieved 99%
compliance and in FY16 at 100% compliance in screening patients
for tobacco use. Although we were 98% compliant with ordering
nicotine replacement therapy, only about 80% of our patients
accepted the treatment. For Inpatient Psychiatry Alcohol Screening,
the compliance score was 100% in both FY15 and FY16.
HBIPS Immunization compliance score in FY16 was 99%, with the
target set at 98%.
F. Carl Mueller, MD, FAPA
Associate Chair
88 2016 Clinical Annual Report
Department of Psychiatry: Annual Report 2016
Patient Satisfaction
Patient satisfaction for the Inpatient Psychiatry Unit is tracked
by distributing a survey to all patients who are discharged from
the unit. The score range is from 1-5, with 1 being the lowest and
5 the highest. For FY16, the score was 4.44, which was higher
than prior years (4.36) as shown in Figure 3.
Thirty-Day Readmission Rate
Our 30-day readmission rates decreased from 14% in FY13 to 8% in
FY14. The rate for FY15 and FY16 remained at 10%.
Seven-Day Readmission Rate
Our seven-day readmission rate remained steady at 4% over the past
three years compared to a rate of 5% in FY13.
Figure 4: Average Length of Stay (ALOS)
Average Length of Stay (ALOS)
Our Inpatient Unit staff has worked hard to reduce the average
length of stay from 10.07 days in FY10 to eight days in FY14 as
shown in Figure 4. In FY15, the ALOS increased to nine days. In FY16,
the same trend continued with an ALOS of 9.29 days. This increase
in ALOS is due to increased patient acuity and limited community
residential resources for patients.
Awards and Accolades
• Justin Schechter, MD continued his appointment on the
Psychiatric Security Review Board (PSRB). This board monitors the
treatment, safety and security of those individuals found not guilty
by reason of insanity. This is Dr. Schechter’s third consecutive term
on the board. Appointment to this board was made by Governor
Malloy and the Connecticut State Legislature.
• Justin Schechter, MD serves as a Consultant for the Veterans
Administration Compensation and Pension Division.
Figure 3: Patient Satisfaction
4.45
4.4
4.35
4.3
4.25
FY15FY14 FY16
FY10
12
10
8
6
4
2
0
DAYS
FY11 FY12 FY13 FY14 FY15 FY16
Total DRGs Depressive Neuroses
Psychoses Alcohol/Drug Abuse/Dep.
89 2016 Clinical Annual Report
In addition:
• S.K. Vyas, PhD is continuing as Assistant Clinical Professor of
Psychiatry for the Icahn School of Medicine at Mount Sinai,
Mount Sinai St. Luke’s-Mount Sinai West Hospital Center.
• Gopal Upadhya, MD maintained a Clinical Adjunct Assistant
Professor position at Quinnipiac University for his active
participation in PA student education.
• Justin Schechter, MD was reappointed as Assistant Clinical
Professor of Psychiatry at Yale University School of Medicine.
• Draupathi Nambudiri, MD was reappointed as Assistant Clinical
Professor of Psychiatry at Weill Cornell Medical College
Departmental Research and Scholarly Activitities
Presentations
Clinical Lycanthropy Exacerbated by Cannabis Use Disorder: A Case
Report: Rachit Patel, MD, APA Annual Meeting May 2016, Poster
presentation.
Improved Treatment Acceptance and Adherence Following the
Diagnosis of Multiple Malformations of Cortical Development in a
Patient with Psychosis: Rachit Patel, MD, Kathleen Stuart, MSN, APRN,
Draupathi Nambudiri, MD, 1st Annual Research Day, May 2016.
Stamford Hospital, Stamford, CT, Poster session.
Clinical Lycanthropy Exacerbated by Comorbid Cannabis Use
Disorder: Rachit Patel, MD, 1st Annual Research Day, May 2016.
Stamford Hospital, Stamford, CT, Poster session.
S.K. Vyas, PhD. Grand Rounds held at the Stamford Hospital,
Department of Psychiatry: Sleep in Psychiatry: From a
Neuropsychological Perspective, November 12, 2015.
S.K. Vyas, PhD. An Update: Sleep in ADHD. Grand Rounds held at the
Stamford Hospital, Department of Pediatrics Stamford, CT. February
25, 2016.
S.K. Vyas, PhD. gave seminar to Psychiatry Residents at Mount Sinai
St. Luke’s- Mount Sinai West Hospital Center on “Psychological Testing
with a Focus on Neuropsychology.” April 26, 2016.
Departmental Educational and Teaching Activities
The Department’s academic activities continue to enhance the
quality of care rendered to patients, as well as the educational
experience provided to physician assistant students from Quinnipiac
College and nursing students from local universities. Academic
experiences with these students keep the Department vibrant and
provide the opportunity to teach and continue to learn.
Department members were involved in Grand Rounds
presentations at Stamford Hospital. This year’s Grand Rounds
presentations included:
TOPIC LECTURER
DSM-5 A Brief Overview for the Mental Health Professional
Gopal Upadhya, MDUnit Chief, Inpatient PsychiatryStamford Hospital
Emergent properties in Complex Systems such as Psychiatry and Health Care: Theoretical and Practical Concerns
JF. Carl Mueller, MDAssistant Clinical Professor, Yale School of MedicineAssociate Chair, Department of Psychiatry Stamford Hospital
Treating Patients in Crisis: Theory and Practice
Richard Gallagher, MDProfessor of Clinical Psychiatry and Behavioral Science, New York Medical College Faculty, Columbia Univ. Psychoanalytic Institute
Mood Disorders with mixed features in DSM-5: Diagnostic & Therapeutic Implications
Joseph Goldberg, MD Clinical Professor of Psychiatry Icahn School of Medicine at Mount Sinai, New York, NY
Sleep in Psychiatry; Neuropsychological Perspectives.
Sejal Vyas, PhDPediatric & Adult Neuropsychologist & Assistant Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai
Concussion Update: Evidence Based Approach to Concussion Management
Christina Kunec, PsyDNeuropsychologist Stamford Hospital
Insomnia, Tips and Tools on Assessing and Treating Patients with Insomnia
Christine Naungayan, MDCEO and Founder of Awakenings & Forensic Psychiatric Consultant
90 2016 Clinical Annual Report
Department of Psychiatry: Annual Report 2016
S.K. Vyas, PhD. gave seminar to Psychiatry Residents at Mount
Sinai St. Luke’s-Mount Sinai West Hospital Center on “What is
Neuropsychology.” May 3, 2016.
Christine Kunec, Psy.D gave Pediatric Grand Rounds on topic of
Concussion, at Stamford Hospital on March 2016.
Publication
Improved Treatment Acceptance and Adherence Following the
Diagnosis of Multiple Malformations of Cortical Development in a
Patient with Psychosis: Case Report, Rachit Patel, MD, Kathleen Stuart,
MSN, APRN, Draupathi Nambudiri, MD. Brain Disorders and Therapy,
Vol 4, issue 5.
Community Outreach
Christine Kunec, Psy.D, along with the Outpatient Rehab team, hosted
a workshop in March 2015 for athletic trainers in the area to learn the
vestibular ocular motor screen and how to incorporate it into their
concussion assessment protocol. A panel discussion also took place
during the workshop.
Strategy/Future Direction
The Department’s focus in the next year and beyond is in these areas:
Inpatient Services
• Geriatric Psychiatry — Expanding the geriatric psychiatry
services will become increasingly important with the aging of
“baby boomers.”
• Medical Psychiatry Service — Assessment and treatment of
co-morbid psychiatric/medical illnesses will have an increasingly
pivotal role, particularly as we are the only community providers
of these services in the area.
• With the opening of the new Hospital, there will be future
opportunity to create specialized treatment programs to meet
the needs of geriatric and medical psychiatric patients.
• Dual Diagnosis Treatment Services — As co-morbid psychiatric
substance abuse disorders continue to rise, the Unit will continue
to adopt evidence-based practices in order to provide high-quality
services for dually diagnosed patients.
• Behavioral Health Workgroup — Actively participate in the
Behavioral Health Work Group-led projects to raise awareness
and educate our communities about mental illness and impacts
of alcohol and substance abuse.
• Access to Care — Collaborate with community treatment providers
to improve access to care for mentally ill substance abuse patients.
• Community Care Coordination — Collaborate with Community
Case Managers to reduce preventable psychiatric readmissions
and improve psychiatric care for patients in the community.
• PA Student Training — With the opening of Sacred Heart
University PA School on-site, Department staff and the psychiatry
clinical services will play an important role in clinical training of
PA students from this program.
Consultation Liaison/Medical, Surgical and Emergency Department Consultation Services
• Continued strengthening of the psychiatric house physician
program to meet the growing demand for psychiatric evaluation
of patients presenting to the ED after hours and on weekends.
• Increased collaboration in the care of patients admitted to
general hospital floors with co-morbid alcohol and substance
abuse disorders.
• Close collaboration with geriatric medicine to implement the
dementia and delirium identification and management program
at the Hospital.
The Department of Psychiatry is committed to partnering with
colleagues in all departments and providing the finest psychiatric
and behavioral healthcare services available.
91 2016 Clinical Annual ReportWaiting Area
92 2016 Clinical Annual Report
RadiologyWe are the ones finding the breast and lung cancers early enough to be cured. We are the ones who will, through radiation
therapy, touch two of every three patients at some point in the cancer journey. We are the ones who can image the beating
heart with such speed and clarity that invasive catheterization for diagnosis has become obsolete. And we are the ones who
diagnose appendicitis before surgery, saving 80% of patients from a major operation they would have undergone just a few years
ago. There is no disease state, no organ system and no specialty that has not benefited profoundly from imaging technology.
Better yet, our solutions last year touched the lives of our patients in very consequential ways more than 216,000 times.
Treatment. Transformed.
93 2016 Clinical Annual Report
Department of Radiology: Annual Report 2016
Brian Stainken, MDChair and Medical Director, Department of Radiology
A Message From The Chair The Year in ReviewImagine… a giant copper coil cooled to negative 442 degrees
Fahrenheit. Through this super-cooled coil, electric current
pulses, without resistance, creating a magnet 20,000 times
greater than earth’s magnetic field. At a molecular level, this is
strong enough to cause every one of the seven billion, billion,
billion (7,000,000,000,000,000,000) protons in your body to shift
from random orbits and align with the magnetic field. From
there, we turn on a radio to FM frequency and listen. Why the radio
waves? Their wavelength makes your magnetized protons precess
or wiggle and emit sound that we can hear. Each proton’s signal
is influenced by its neighbors and, believe it or not, each is unique.
We take this signal, plot it by wavelength, amplitude and pitch,
and from there, with the help of a supercomputer, create images
of the human body. These images see in ways we humans cannot.
They see the body as a composition in temperature, motion, water
content, and of course pathology. When combined with some new
tracers, we can even see how you think.
Imagine MRI Imaging.
There are days when each of us in this exciting field has to step back,
and take in the view. In just over 100 years, we have gone from a
profession that translated shadows to the most pivotal of services
in healthcare. We are the ones finding the breast and lung cancers
early enough to be cured. We are the ones who will, through
radiation therapy, touch two of every three patients at some point
on their cancer journey. We are the ones who can image the beating
heart with such speed and clarity that invasive catheterization
for diagnosis has become obsolete. And we are the ones who
diagnose appendicitis before surgery, saving 80% of patients from
a major operation they would have undergone just a few years
ago. There is no disease state, no organ system and no specialty
that has not benefited profoundly from imaging technology. Better
yet, our solutions last year touched the lives of our patients in very
consequential ways more than 216,000 times. That’s more interaction
than there are people living in Stamford.
During the past year, we accelerated the process of reimagination
for the Stamford Health community. We opened the most advanced
CT imaging device in the region, giving us the ability to image most
parts of the body in 0.25 seconds. In trauma, there is good data to
show that survival is independently predicted by the distance from
the trauma bay to the CT scanner. So, we placed this robust tool
right next to the trauma bay where it will tell us what is broken and
will direct treatment in the moments when it matters most. This tool
will save lives. Imagine that.
In Interventional Radiology (IR), we witnessed a 20% growth in
2016 and that’s just the beginning. We performed the first seven
liver radio embolization procedures in southern Fairfield County
this year. This breakthrough technique allows us to deliver high
doses of radiation right into the tumor via the liver artery. We can
deliver these high doses while reducing risk to surrounding tissues,
thereby markedly reducing side effects. Radio embolization works
when chemotherapy fails and when surgery is not an option. It is
transforming the management of cancers involving the liver. It is one
of a group of new age image-guided IR solutions that are rapidly
rewriting the textbooks. And we are the only ones in the
area who do it. Imagine Interventional Oncology.
The following pages will tell you how we have worked to create,
communicate and deliver value. We will tell the story of how
we have strengthened our quality management systems and
expanded their scope to include everything from scheduling to IT
94 2016 Clinical Annual Report
Department of Radiology: Annual Report 2016
US: In our fleet, there are 14 dedicated Radiology US machines and
21 sonographers. In 2016, they performed 47,725 scans. Our staff
serves the Breast Imaging division, Interventional and the ED,
as well as our general diagnostic population. With the new
Hospital, we became the first Department in the region to offer
all inpatients the option of bedside US examinations.
VIR: This year was the beginning of what we expect to be a
strong growth trajectory for IR. In 2016, the program enjoyed
20% growth and that is only the start. We introduced new
procedures to Stamford like radio embolization of the liver and
cryoablation of the lung and kidney, and began to offer services
for peripheral arterial disease. Our new IR Clinic is open as is our
hospital-based consultation service. The staff in IR now consist
of eight dedicated IR nurses, two IR technologists and one PA.
In 2016, we began the planning process for a new IR suite to
be installed next summer.
General Diagnostics: This is where it all started and from a
volume perspective, remains the busiest area of the Department,
performing 73,798 examinations last year. In our fleet, we
maintain 13 dedicated digital radiography rooms and a dozen
portable devices, all digital. The staff of 23 serves the needs of
our busy ED, Hospital and outpatients at Tully, Darien, Chelsea
Piers Connecticut and the imaging facility at Long Ridge Road.
We began an educational program this year where once a month
the Radiologist reviews cases with the staff in this division.
Breast Imaging: Stamford Hospital was the one of the first
in the country to provide Digital Breast Tomosynthesis (3-D
Mammography) to all women because, compared with 2-D, the
newer technology offers superior breast cancer detection and
decreased rate of false positives. This reduces unnecessary return
visits for images and biopsies. Our cancer detection rate – an
important marker of accuracy – remains at the highest levels
nationally, and we are proud that the vast majority of cancers
we detect are at the smallest, most treatable stage.
Radiation Oncology: Twenty-one staff members, from radiation
oncologists to physicists, technologists and support staff, serve
our busy Radiation Therapy division. The division uses an
advanced Toshiba 64-slice large-bore CT for radiation therapy
simulation. For conventionally fractionated radiation therapy,
the Department has a Varian 21EX linear accelerator with
dual energy photon and multiple energy electron capabilities.
Our equipment allows for conformal 3-D treatments as well as
image-guided radiation therapy (IGRT) and intensity-modulated
radiation therapy (IMRT). Our Varian 600 C linear accelerator
to patient comfort. We will tell the big story, compiled from the stories
of each of the people we cared for every minute of every day last year.
As we move forward, we will continue to offer the most advanced
imaging solutions available, while never losing touch with the reason
we are all here. Having the chance to care for you and those who trust
their health to you is a privilege. Thanks.
Scope of Clinical Services
Imaging is the applied science of creating realistic representations
of the living human in ways that no anatomist could ever have
entertained. The Department performed over 200,000 studies this
past year, creating several million images. The interpretation of those
images will inform some of the most critical decisions we will ever
make. Beyond diagnosis, we use the same images to guide cutting-
edge image-guided treatment. In the world of imaging, our vision
uses x-rays, gamma rays, electrons, beta rays, ultrasound waves and
even FM radio waves. You see the finished products as 3-D Breast
Tomosynthesis, Bone Densitometry, Computerized Tomography,
General Radiography, Magnetic Resonance Imaging, Nuclear Medicine,
Positron Emission Tomography and Ultrasound.
MRI: Our team of 13 MRI technicians operate our three 1.5T MRI
scanners. In 2016, we completed 12,942 examinations. This year, our
focus was on developing new protocols and standardizing processes.
We reimagined how we image the small intestines with MRI using a
new and much more palatable contrast agent, and developed an early
radiologist review process for these studies.
CT: Six scanners and 16 highly trained, certified CT technologists
performed 32,487 examinations in 2016. We have scanners at Tully,
Darien and four at the Hospital where they run 24/7/365. Our newest
scanner is located in the new Hospital ED. This piece of equipment
is the most advanced in the county, able to scan an area of 8 cm. in
a quarter of a second. We also refined protocols especially in chest
and cardiac imaging. Below the diaphragm, to speed care in the ED
and improve imaging quality, we moved away from requiring that all
patients drink two pints of chalky dilute barium and wait two hours
before abdominal scans by replacing the barium with a cup of water,
and a 20-minute delay. Same results, faster turnaround and no chalky
aftertaste! CT staff is on-site 24/7/365.
95 2016 Clinical Annual Report
has been replaced by a new state-of-the-art Varian True Beam
linear accelerator. This unit will treat using 6 MV x-rays to all sites
and be operational by December 2016.
Clinical Focus/Signature Services
Cancer Care: Radiation Oncology represents a pillar of
Stamford Hospital’s comprehensive cancer program. Practicing
from the Bennett Cancer Center and CyberKnife® Center at
the Tully Health Center, our two Radiation Oncologists offer
state-of-the-art radiation therapy and stereotactic radiosurgery
to approximately 400 new patients every year, mostly on an
outpatient basis. This year, Stamford Hospital began offering
high-dose rate (HDR) remote implant therapy for use primarily
with gynecologic malignancies. This technology allows our
patients to access all aspects of gynecologic radiation therapy
at Stamford Hospital, thus eliminating the need for referrals
to other institutions.
Very proudly after an extensive review by the Dana-Farber/Brigham
and Women’s Cancer Center clinicians and staff, our outpatient
Bennett Cancer Center radiation oncology and medical oncology
services were selected to be a member of the Dana-Farber/Brigham
and Women’s Cancer Care Collaborative. This membership will
enhance our visibility and services and participation will provide
medical staff with increased educational opportunities and the
ability to consult with medical specialists at Dana-Farber/Brigham
and Women’s Cancer Center regarding complex cases. In addition,
our patients will have greater access to the latest cancer research
and clinical trials.
Vascular and Interventional Radiology (VIR) represents the other
therapeutic branch of Radiology. VIR is focused on delivering
solutions using imaging tools. In the oncology population, we
have developed solutions to treat tumors in the liver, lung, kidney
and pancreas in situ using cross-sectional imaging like CT and
MRI to guide specialized tools right to the tumor bed. From there
we are able to destroy the tumor where it lives using thermal
energy. These techniques open new possibilities for patients
who cannot tolerate conventional operations or in an increasing
number of cases, they offer an alternative. Similarly, for patients
on chemotherapy, we can often provide a break in treatment or
a solution when one area of disease fails to respond. This year, at
Stamford, we introduced these techniques to our community and
inaugurated a new one called radioembolization. This involves
treating liver tumors by delivering radiation through the tumor’s
feeding arteries. Radioembolization is more precise, with fewer
side effects than conventional alternatives. It offers our patients an
option not available at other hospitals in the region. In addition to
ablation and radioembolization, we serve the oncology community
at Stamford with general interventional services including biopsy,
chest port placement and palliative/pain management services.
In the Diagnostic division, Dr. Gregory Pearson joined our
Department this year after a 20-year career at Columbia
University/NewYork-Presbyterian Hospital. He is a nationally
known expert in imaging of the lungs and heart, and offers our
community a level of skill and experience unmatched in Fairfield
County. With our expert pulmonologists and Dr. Michael Ebright
anchoring Thoracic Surgery, Stamford Health offers bench depth
unmatched in the region for patients suffering from lung cancer
and other conditions affecting the lungs. As Radiology Director
of our Lung Cancer Screening program, Dr. Pearson has refined
our low-dose lung screening protocols and brought our collaborative
Lung Cancer Screening program, already the strongest in southern
Connecticut, to a new level of multidisciplinary excellence.
Stroke Neurosciences: Stamford’s team of four on-site and
nine off-site board-certified neuroradiologists interpret over
90% of our routine and emergency imaging involving the brain
and spine. This level of specialized care cannot be found in the
region outside of large university hospitals that depend largely
on trainees for front-line care.
Cardiac and Vascular Disease: Dr. Pearson’s extensive experience
in imaging of the heart and great vessels, is an asset to Dr. David Hsi
and members of the Cardiology division with whom we collaborate.
Dr. Pearson has helped refine our protocols for imaging of the
heart and imaging prior to transcatheter aortic valve replacement
(TAVR). As we evolve our MRI platforms, he will bring his experience
in cardiac imaging to Stamford, complementing the new adult
Structural Heart Program.
Orthopedics: Fellowship-trained at the Hospital for Special
Surgery, Dr. Elizabeth Gaary now reads the majority of our
advanced musculoskeletal imaging. She is supported by four
MSK-trained radiologists in the network.
Womens Health: The Breast Imaging division is a nationally
recognized leader in the delivery of comprehensive breast
diagnostic care. Four fellowship-trained mammography experts
provide comprehensive “one-stop” services. We remain the
only site in the region that provides results to all patients who
undergo breast imaging during regular business hours. Women
who choose to have their studies during the evening or over
96 2016 Clinical Annual Report
Department of Radiology: Annual Report 2016
Radiologists who provide services from remote locations. General
Diagnostics includes the subspecialty fields of Abdominal Imaging,
Chest Imaging, Musculoskeletal Imaging, Neuroimaging, Nuclear
Medicine and Interventional Radiology. We provide the full scope
of services 24/7 with 100% final reports in the major disciplines of
Radiology. Breast Imaging is served by a specialized group of four
mammographers who work in a center of excellence model with
our breast surgeons. Finally, our two Radiation Oncologist serve
as key members of Stamford Hospital’s Bennett Cancer Center
Chairman
Brian Stainken, MD (On-Site Hospital ext. 7881)
Specialty: Vascular and Interventional Radiology
Medical School: Georgetown University
Residency: Diagnostic Radiology, San Diego Naval Hospital
Fellowship: Vascular & Interventional Radiology, University of
California, Los Angeles
Board Certification: Diagnostic Radiology, CAQ Vascular and
Interventional Radiology
Thoracic Imaging
Gregory Pearson, MD (On-Site Hospital ext. 7789)
Director of Cardiothoracic Imaging
Specialty: Diagnostic Radiology, Cardiac and Thoracic Radiology
Medical School: Harvard Medical School
Residency: Diagnostic Radiology, Brigham & Women’s Hospital
Fellowship: Thoracic Imaging, Brigham & Women’s Hospital
Board Certification: Diagnostic Radiology
Body Imaging
Elizabeth Gaary, MD (On-Site Tully ext. 7799)
Director of Musculoskeletal Imaging
Specialty: Diagnostic Radiology, MSK/MRI Radiology
Medical School: Georgetown University
Residency: Diagnostic Radiology, Dartmouth-Hitchcock
Medical Center
Fellowship: MSK/MRI Radiology, Cornell University,
Hospital for Special Surgery
Board Certification: Diagnostic Radiology
the weekend receive results within one business day. With
Connecticut having the highest incidence of breast cancer in
the country, we are proud to provide this incredibly high level of
accuracy and timely service to the women in our community. We
are equally proud to have installed the latest generation of breast
MRI computer-aided detection software, which is used for all
breast MRI studies, as we strive to find the smallest tumors at the
earliest stage.
Pediatrics: Stamford Hospital has 14 board-certified Pediatric
Radiologists reading over 90% of the imaging for patients under the
age of 18. Commensurate with the growing portfolio of Pediatric
services in our system, we have worked to improve our services,
particularly in the areas of pediatric ultrasound and MRI imaging.
Our annual Radiology volume by location is shown in Figure 1.
Medical Staff
Stamford Hospital Radiology physicians complete five years of post-
doctoral training as well as one to two years of fellowship training
prior to obtaining subspecialty board certification in Body Imaging,
Breast Imaging, Pediatric Imaging, Musculoskeletal Imaging,
Neuroimaging, Nuclear Medicine, Vascular/Interventional Radiology
and Radiation Oncology.
The Department is organized into three divisions. The largest
is the General Diagnosis and Interventional Radiology group.
These services are currently anchored by a group of six on-site
specialized Radiologists as well as a network of 24 additional
Figure 1: Yearly Volume by Location
FY13
FY14
FY15
FY16
100,000
80,000
60,000
40,000
20,000
0Radiology ChelseaPiers
Radiology Darien
Radiology Long Ridge Road
Yearly Volume by Location
Radiology Stamford Hospital
Radiology Tully Health Center
97 2016 Clinical Annual Report
Mary L. Grebenc, MD (Off-Site 2747)
Office Location: San Diego, California
Specialty: Diagnostic Radiology, Body Imaging
Medical School: University of New Mexico School of Medicine
Residency: Diagnostic Radiology, Naval Medical Center
Fellowship: Body Imaging, National Naval Medical Center
Board Certification: Diagnostic Radiology
Jeffrey D. Kleinman, MD (Off-Site 2747)
Office Location: Solon, Ohio
Specialty: Diagnostic Radiology, Body Imaging
Medical School: Wright State University School of Medicine
Residency: Diagnostic Radiology, MetroHealth Medical
Center Case Western Reserve University
Fellowship: Body Imaging, MetroHealth Medical
Center Case Western Reserve University
Board Certification: Diagnostic Radiology
Anthony J. Minotti, MD (Off-Site 2747)
Office Location: Olmsted Township, Ohio
Specialty: Diagnostic Radiology, Body Imaging
Medical School: Wright State University School of Medicine
Residency: Diagnostic Radiology, MetroHealth Medical Center
Fellowship: Body Imaging, MetroHealth Medical CenterBoard
Certification: Diagnostic Radiology, CAQ Nuclear Radiology
Christopher Sidden, MD (Off-Site 2747)
Office Location: Greenville, South Carolina
Specialty: Diagnostic Radiology, Abdominal Imaging
Medical School: Eastern Virginia Medical School
Residency: Diagnostic Radiology, McGill University Health Centre
Fellowship: Abdominal Imaging, Brigham and Women’s
Hospital Board Certification: Diagnostic Radiology
Breast Imaging
David Gruen, MD (On-Site Tully ext. 4152)
Office Location: Stamford, Connecticut
Specialty: Breast Imaging
Medical School: Cornell University Medical College
Residency: New York Hospital Cornell, New York
Fellowship: Memorial Sloan Kettering
Board Certification: Diagnostic Radiology
William Caragol, MD (On-Site Tully ext. 7782)
Office Location: Stamford, Connecticut
Specialty: Breast Imaging
Medical School: New Jersey College of Medicine
Residency: New York Hospital, Cornell Medical Center
Board Certification: Diagnostic Radiology
Lily Kernagis, MD (On-Site Tully ext. 7710)
Office Location: Stamford, Connecticut
Specialty: Breast Imaging
Medical School: University of Pennsylvania School of Medicine
Residency: Hospital University of Pennsylvania, Radiology,
Presbyterian Medical Center,
Philadelphia Transitional Internship
Fellowship: University of Pennsylvania Women’s Imaging
Board Certification: Diagnostic Radiology
Valencia King, MD (On-Site Tully ext. 7710)
Office Location: Stamford, Connecticut
Specialty: Breast Imaging, Diagnostic Radiology
Medical School: Cornell University Medical College, New York
Residency: New York Presbyterian Hospital/Cornell Medical
Center, Diagnostic Radiology
Fellowship: Memorial Sloan Kettering Cancer Center,
Breast & Oncologic Imaging, New York
Board Certification: Diagnostic Radiology, General Certification
Musculoskeletal Imaging
Elizabeth Gaary, MD (On-Site Tully ext. 7799)
Director of Musculoskeletal Imaging
Specialty: MSK/MRI Radiology
Medical School: Georgetown University
Residency: Diagnostic Radiology, Dartmouth-Hitchcock
Medical Center
Fellowship: MSK/MRI Radiology, Cornell University,
Hospital for Special Surgery
Board Certification: Diagnostic Radiology
Chad Calendine, MD (Off-Site 2747)
Chief Medical Officer of ARIS
Office Location: Nashville, Tennessee
Specialty: Diagnostic Radiology, Musculoskeletal Radiology
Medical School: University of Tennessee
Residency: Diagnostic Radiology, Emory University Hospital
Fellowship: Musculoskeletal Radiology, Emory University Hospital
Board Certification: Diagnostic Radiology
98 2016 Clinical Annual Report
Department of Radiology: Annual Report 2016Department of Radiology: Annual Report 2016
Mark J. Halsted, MD (Off-Site 2747)
Office Location: Cincinnati, Ohio
Specialty: Neuroradiology
Medical School: Yale University School of Medicine
Residency: Diagnostic Radiology, University of California San Diego
School of Medicine
Fellowship: Magnetic Resonance Imaging, UCSD; Pediatric
Radiology, Cincinnati Children’s Hospital;
Pediatric Neuroradiology, Cincinnati Children’s Hospital
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology,
CAQ Neuroradiology
Tony Y. Maung, MD (Off-Site 2747)
Office Location: San Diego, California
Specialty: Neuroradiology
Medical School: New York Medical College
Residency: Diagnostic Radiology, Harbor UCLA Medical Center
Fellowship: Neuroradiology, Harbor UCLA Medical Center
Board Certification: Diagnostic Radiology
John R. Wohlwend, MD (Off-Site 2747)
Office Location: Henderson, Nevada
Specialty: Neuroradiology
Medical School: Ohio State University College of Medicine
Residency: Diagnostic Radiology, Henry Ford Hospital
Fellowship: Neuroradiology, Northwestern University Program/
McGaw Medical Center
Board Certification: Diagnostic Radiology
Nuclear Medicine/PET
Harvey Hecht, MD (On-Site Hospital ext. 7783)
Director of Nuclear Medicine and PET Imaging
Specialty: Diagnostic Radiology, Nuclear Imaging
Medical School: Albert Einstein College of Medicine
Residency: Diagnostic Radiology, Columbia Presbyterian Hospital,
NY; Montefiore Hospital, NY
Board Certification: Diagnostic Radiology, Nuclear Medicine
Josef Noga, MD (On-Site Hospital ext. 7787)
Director of Interventional Radiology
Specialty: Diagnostic Radiology, Nuclear Imaging
Medical School: Eastern Virginia Medical School
Residency: Diagnostic Radiology, Eastern Virginia Medical School
Fellowship: Vascular & Interventional Radiology, Columbia
University Medical Center
Board Certification: Diagnostic Radiology
Eric K. Lizerbram, MD (Off-Site 2747)
Office Location: Carlsbad, California
Specialty: Musculoskeletal Imaging
Medical School: USC Keck School of Medicine
Residency: Diagnostic Radiology, Cedars Sinai Medical
Center Program
Fellowship: MRI, University of California San Diego
Board Certification: Diagnostic Radiology
Michael A. Mahlon, DO (Off-Site 2747)
Office Location: Olympia, Washington
Specialty: Musculoskeletal Imaging
Medical School: Philadelphia College of Osteopathic Medicine
Residency: Diagnostic Radiology, Tripler Army Medical
Center Program
Fellowship: Musculoskeletal Radiology, Penn State
University/Milton S. Hershey Medical Center
Board Certification: Diagnostic Radiology
Neuro Imaging
Howard Liu, MD (On-Site Hospital ext. 7790)
Director of Neuroradiology
Specialty: Neuroradiology
Medical School: The Chicago Medical School
Residency: Diagnostic Radiology, Columbia University College of
Physicians & Surgeons, St Luke’s Roosevelt Hospital Center
Fellowship: Neuroradiology, Yale University School of Medicine
Board Certification: Diagnostic Radiology, CAQ Neuroradiology
Lorraine M. Ash, DO (Off-Site 2747)
Office Location: Bakersfield, California
Specialty: Neuroradiology
Medical School: Kirksville College of Osteopathic Medicine
Residency: Diagnostic Radiology, Cleveland Clinic Foundation
Fellowship: Neuroradiology, University of Michigan
Board Certification: Diagnostic Radiology, CAQ Neuroradiology
John D. Grimme, MD (Off-Site 2747)
Office Location: Eugene, Oregon
Specialty: Neuroradiology
Medical School: University of Cincinnati College of Medicine
Residency: Diagnostic Radiology, University of North Carolina
Fellowship: Neuroradiology, University of North Carolina
Board Certification: Diagnostic Radiology, CAQ Neuroradiology
99 2016 Clinical Annual Report
Anthony J. Minotti, MD (Off-Site 2747)
Office Location: Olmsted Township, Ohio
Specialty: Diagnostic Radiology, Nuclear Imaging
Medical School: Wright State University School of Medicine
Residency: Diagnostic Radiology, MetroHealth Medical Center
Fellowship: Body Imaging, MetroHealth Medical Center
Board Certification: Diagnostic Radiology, CAQ Nuclear Radiology
Pediatric
Terry L. Levin, MD (On-Site 2663)
Office Location: Mamaroneck, New York
Specialty: Pediatric Radiology
Medical School: Cornell University Medical College
Residency: Diagnostic Radiology, New York Presbyterian Hospital
Fellowship: Pediatric Radiology, Columbia Presbyterian Hospital
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology
Geoffrey A. Agrons, MD (Off-Site 2747)
Office Location: Kensington, California
Specialty: Pediatric Radiology
Medical School: University of Medicine and Dentistry of New Jersey
Residency: Diagnostic Radiology, University of Pennsylvania
Health System
Fellowship: Pediatric Radiology, Children’s Hospital of Philadelphia
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology
Katherine M. Gyves-Ray, MD (Off-Site 2747)
Office Location: Kansas City, Missouri
Specialty: Pediatric Radiology
Medical School: New York Medical College
Residency: Diagnostic Radiology, University of Michigan
Fellowship: Pediatric Radiology, University of Michigan Hospitals,
C.S. Mott Children’s Hospital
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology
Laura J. Hanahan, MD (Off-Site 2747)
Office Location: Columbia, Missouri
Specialty: Pediatric Radiology
Medical School: Leland Stamford Junior University
Residency: Pediatrics, University of New Mexico Program
Residency: Diagnostic Radiology, George Washington University
School of Medicine & Health Science
Fellowship: Pediatric Radiology, Children’s National Medical Center
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology
Michelle A. Hercher-Galvez, MD (Off-Site 2747)
Office Location: Portland, Oregon
Specialty: Pediatric Radiology
Medical School: Oregon Health Sciences University School
of Medicine
Residency: Diagnostic Radiology, University of New Mexico
Medical Center
Fellowship: Pediatric Radiology, Stanford University
Medical Center
Board Certification: Diagnostic Radiology
Michael E. Katz, MD (Off-Site 2747)
Pediatric Medical Director
Office Location: Boca Raton, Florida
Specialty: Pediatric Radiology
Medical School: Yale University School of Medicine
Residency: Diagnostic Radiology, Mallinckrodt
Institute of Radiology
Fellowship: Pediatric Radiology, Mallinckrodt Institute of Radiology
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology
Sandra G. Machado, MD (Off-Site 2747)
Office Location: Lincoln, Nebraska
Specialty: Pediatric Radiology
Medical School: River Plate Adventist University
Residency: Diagnostic Radiology, Loma Linda University
Fellowship: Pediatric Radiology, Loma Linda University
Board Certification: Diagnostic Radiology, CAQ Pediatric Radiology
Radiation Oncology
Frank A. Masino, MD (On-Site Hospital ext. 6230)
Office Location: Stamford, Connecticut
Specialty: Radiation Oncology
Medical School: Albert Einstein College of Medicine
Residency: Radiation Oncology, Yale New Haven Hospital
Board Certification: Radiation Oncology
Sean W. Dowling, MD (On-Site Hospital ext. 6630)
Office Location: Stamford, Connecticut
Specialty: Radiation Oncology
Medical School: Yale University School of Medicine
Residency: Radiation Oncology, Yale New Haven Hospital
Board Certification: Radiation Oncology
2016 Clinical Annual Report100
Department of Radiology: Annual Report 2016Department of Radiology: Annual Report 2016
Departmental Safety and Quality
The radiological specialties span almost every aspect of inpatient
and outpatient healthcare. We offer care to well over people every
year, and are involved in every organ system and disease state. We
serve your patients as well as your practices, and many of us also
maintain our own active clinical practices. The definition of quality
in each of these domains is different but unified by a common goal
of striving to deliver the best.
Radiation & Patient Safety
Radiology began in the 1930s in response to the growing
recognition that x-rays could cause harm. Our roots as a specialty
are invested in the protecting the patient. During training,
Radiologists and Radiation Oncologists, Radiation Physicists and
Technologists are all educated and certified in the physics of radiation
and the science of radiation safety. There is growing interest from
the public as well as regulators on the topic of radiation safety and
medical applications. This year we installed a radiation monitoring
and tracking software for quality and patient safety which allow us
to review all CTs performed at all locations, along with the ability to
review the amount of cumulative dose for every patient having a
CT within the organization. Statewide we continue being a part of
the Connecticut Hospital Association’s Radiation Dose Management
Collaborative committee. Sarah Bull, our Radiation Safety Officer, Dr.
David Gruen, Co-Director of the Women’s Breast Center, and Jory
Vidulich Savino, Quality Imaging Manager, are part of a subgroup
that has decided on what will be captured and sent to CHA for
state benchmarking. By April 2017 all participating hospitals will be
receiving benchmark reports on dose. This is a step closer to being
able to share cumulative dose statewide.
The Department also initiated the Radiology Continuous Quality
Improvement Committee (RCQIC) with three subcommittees.
Radiation Oncology was first and is going strong, while Radiology
and Women’s Imaging are in the beginning stages. These
subcommittees are modality specific and promote teamwork,
transparency and standardization system-wide. The purpose of the
RCQIC is to review protocols, policies and process improvement.
We continue to be committed to the two important radiation
safety initiatives, Image Gently (alliance for radiation safety in
pediatric imaging — “child-sized” radiation) and Image Wisely
Vascular Interventional
Bryan Lazzara, MD (On-Site Hospital ext. 7791)
Specialty: Vascular and Interventional Radiology
Medical School: New York Medical College
Residency: Diagnostic Radiology, Winthrop University Hospital
Fellowship: Neuroradiology, Northwestern University, Chicago;
Vascular & Interventional Radiology, Columbia University
Medical Center
Board Certification: Diagnostic Radiology
Josef Noga, MD (On-Site Hospital ext. 7787)
Director of Interventional Radiology
Specialty: Vascular and Interventional Radiology
Medical School: Eastern Virginia Medical School
Residency: Diagnostic Radiology, Eastern Virginia Medical School
Fellowship: Vascular & Interventional Radiology, Columbia
University Medical Center
Board Certification: Diagnostic Radiology
Brian Stainken, MD (On-Site Hospital ext. 7881)
Chairman, Department of Radiology
Specialty: Vascular and Interventional Radiology
Medical School: Georgetown University
Residency: Diagnostic Radiology, San Diego Naval Hospital
Fellowship: Vascular & Interventional Radiology, University of
California, Los Angeles
Board Certification: Diagnostic Radiology, CAQ Vascular and
Interventional Radiology
2016 Clinical Annual Report 101
(radiation safety in adult medical imaging) programs.
At Stamford Hospital, we are committed to:
• Communicating openly with parents about imaging
doses (“child-sized” imaging).
• Putting patients’ safety, health and welfare first by optimizing
imaging examinations to use only the radiation necessary to
produce diagnostic quality images.
• Conveying the principles of the Image Gently and Image
Wisely programs to the Imaging team to ensure that our facility
optimizes its use of radiation when imaging patients.
• Communicating optimal patient imaging strategies to referring
physicians and having Radiologists available for consultation.
• Routinely reviewing imaging protocols to ensure that the least
radiation exposure or dose necessary to acquire a diagnostic
quality image is used for each examination.
• Initiating a “time out” in all procedural areas.
• Providing on-site education for our staff. In 2016, we provided
CT/MR education along with MRI Safety & Musculoskeletal
MRI for staff growth.
Accuracy
Making all of the findings on an imaging study can be a daunting
task. What was one to four images per patient in the era of plain
film radiology is now easily 250–400 for a CT and up to 1,000
for many MRI examinations. We know that the average radiologist
misses between two and 20% of the findings on based on second
reviews. The more images, the more information, the higher
the chance something will be missed. Importantly, and perhaps
not as well understood, is that this error rate is roughly identical
for colonoscopy and missed major diagnoses at autopsy
(Ulster Med J. 2012 Jan; 81(1): 3 – 9. Discrepancy and Error in
Radiology: Concepts, Causes and Consequences Adrian Brady,
Risteárd Ó Laoide, Peter McCarthy, and Ronan McDermott).
We also know that we can impact our error rate through vigilance,
education and, perhaps most importantly, communication.
The fundamental importance of communicating up front about
presentation, examination and suspected diagnosis, and as
importantly, communicating when exam findings and clinical
metrics are discrepant, cannot be overstated.
In the Department, we track accuracy in a variety of ways. When
we hear about a possible error in a report or a problem with a
patient, we look at where we fell short and assess in the context of
the clinical significance of the event for the patient. This year we
created a technical variance program where challenges related
to image creation, everything from scheduling, to protocols, to
positioning, to our IT systems are tracked, reconciled and reviewed.
Trends are shown in Figure 2.
On the image interpretation side of the Department, we also
carefully review any time there is a question about a report,
generating about half the queries internally. Every time a question
is raised, it is independently evaluated, graded and, as necessary
the report is amended, process changed and feedback provided to
the person raising the query. Most of the time we accomplish this
within 24 hours of the query. In 2016, we reviewed and reconciled
127 variances, and this is less than half the number submitted for
review two years ago.
In addition to variances, we randomly select 3% of the studies
for peer review. These cases are submitted to a national registry
where normalized data is provided. Led by Howard Liu, MD, our
departmental Peer Review Committee reviews this data as well as
internal quality related reports to the administration quarterly. Once
a month, we also have an internal conference to review cases with
teaching value.
Radiology pathology correlation is a cornerstone for any imaging
quality system. The Breast Imaging division is constantly monitoring
their results and comparing them to national best practices.
As an example, in Breast Imaging, the sensitivity is well over 95%
every quarter and cancer detection rate remains at or above 5%.
Figure 2: Technical Variances Trending
History/Documentation Image Quality Protocol
Feb Mar Apr May Jun Jul Aug Sept
Technical Variances Trending
2016 Clinical Annual Report102
Department of Radiology: Annual Report 2016Department of Radiology: Annual Report 2016
outpatient diagnostic imaging sites. Darien led the way with over
27% of patients completing an evaluation. At all three sites for 2016,
the annualized patient reported satisfaction grade was over 95%.
Certification
There are multiple organizations involved in assessing quality
and program certification. The Stamford Radiology practices are
accredited by The Joint Commission and the imaging modalities of
CT, MRI and Ultrasound and Breast Imaging are also accredited by the
American College of Radiology (ACR). Nuclear Medicine is accredited
by IAC. We have been inspected by the Nuclear Regulatory
Commission (NRC), ACR, State of Connecticut and Mammography
Quality Standards Act (MQSA), all with excellent results.
In Breast Imaging, Stamford Hospital was one of the first in the nation
to become accredited by the National Accreditation Program for
Breast Centers and, more recently, was one of the first to receive
accreditation for the third consecutive time. The Breast Center
was cited on its most recent accreditation visit for numerous best
practices. In addition, it once again was designated as an American
College of Radiology Breast Imaging Center of Excellence.
Honors and Recognition
Awards: Breast Imaging
• Dr. David Gruen, Director of Women’s Imaging, became the
first diagnostic radiologist in the country to serve as an inspector
for the National Accreditation Program for Breast Centers.
• The Breast Imaging group is first in the world to be NAPBC
accredited with a third accreditation where we were cited for
five best practices.
• The Breast Center again received the Women’s Choice Award as
an America’s Best Breast Center.
• The Breast Center became a participant in the National Quality
Metrics Program for Breast Centers, one of only a few in the state.
• We also achieved ACR reaccreditation for MRI, CT, US
and Mammography.
This detection rate is well above the national average and achieved
without having patients return for additional views most of the
time. In Breast Imaging, the recall rate is consistently less than
5%, which is well below the national average. At Stamford, cases
presented to the breast tumor board as well as all organ biopsy
data are reviewed for concordance.
Timeliness
A report that is not available when decisions must be made has
no value. We are proud to note that our reporting turnaround
time is on average 20 minutes or less for a STAT request, less than
27 minutes for an urgent request and less than four hours for
routine requests as shown in Figure 3.
Patient Satisfaction
The Breast Imaging division enjoys high satisfaction rates every
month. This is driven by a nationally recognized best practice wherein
patients receive their breast imaging and results at the same visit.
In 2015, overall, our patients rated their satisfaction on a 100-point
scale between 90% and 97% (Press Ganey and customer feedback
survey results). Another way that Breast Imaging is reimagining
imaging is the team’s approach to patients needing breast
interventions such as a biopsy. Every patient who needs a biopsy
meets with our Breast Center navigator and is offered their biopsy
at the soonest convenience, often the same day.
In 2016, we made a decision to increase the utilization of point-of-
service evaluation tools at our Tully, Darien, and Chelsea Piers CT
Figure 3: Diagnostic Imaging Turn-Around-Time Complete to Final
120110100
908070605040302010
0
ED: 30 Mins.
Inpatient: 4 Hrs.
Outpatient: 24 Hrs.
Stroke CT head W/O: 20 Mins.
Oct
Nov
Dec
Jan
Feb
Mar Ap
r
May Jun Jul
Aug
Sep
TIM
E
2016 Clinical Annual Report 103
Departmental Education and Teaching Activities
• Harvey Hecht, MD, an Associate Clinical Professor in the
Department of Radiology at NewYork-Presbyterian Hospital
and a 46-year Stamford Hospital physician, continues to lecture
and teach medical students and Radiology residents at
monthly conferences.
• Dr. Gregory Pearson, our new Chief of Cardiac and Thoracic
Imaging, presented Stamford Hospital Medical
Grand Rounds on Management of Lung Nodules; lectured
on Emphesematous Endocarditis at the Society of Thoracic
Radiology Meeting; and spoke at the New York Roentgen
Ray Society on Transcatheter Aortic Valve Replacement.
• Dr. Brian Stainken spoke at the following meetings:
- Y-90 “The Complete Course” San Francisco, January
- Indian Society for Interventional Radiology,
Bangalore, February
- Society of Interventional Radiology, Vancouver, March
- Asia Pacific Society of Interventional Radiology,
Suzhou China, April
- Society of Radiologia Interventionista, Sao Paulo, Brazil, July
• A breast care symposium was organized by the nurses in the
Breast Imaging division, and featured Dr. David Gruen, Dr. Helen
Pass, director of breast surgery, Michele Speer, RN, breast center
nurse navigator, and Mary Navins, BSN, RN, OCN, who oversees
survivorship. More than 100 members of the medical community
participated in the four-hour, CME– and CEU-accredited program.
• Dr. David Gruen was the featured speaker at the annual New
England Radiation Division of the Department of Energy and the
Environment annual conference in Norwich, Conn. He presented
a lecture entitled, “Breast Health 2016: Prevention, Detection,
Treatment and Controversies.”
• Drs. Frank Masino and Sean Dowling organize and chair more
than 150 oncology-related conferences annually.
• Diagnostic Radiologists and Interventional Radiologists
participate and present imaging studies at the following weekly
multispecialty tumor boards: Breast, Gastrointestinal, Lung,
Neuro-Oncology, Gynecology, Hematology and Genito-Urinary.
• The Diagnostic Radiologists presented with Surgical house staff
at the weekly Trauma Conference.
Research and Scholarly Activity
• Gruen, DR. Benign Intra parenchymal Scarring in the DBT
Era (White Paper).
• Pass, A. Gruen, D. Breast Biopsy Can Be Avoided for Masses
without Suspicious Features in Women 25 and Younger.
Abstract presented NCBC, 2016.
• Pass, A. Bishop J., Gruen D. Benefits of a Personalized Breast Cancer
Risk Assessment in a Community Mammography Screening
Program. Abstract and Poster Presented, NCBC, 2016.
• Stainken, B. Trauma. Handbook of Interventional Radiology
Procedures. April 2016. Wolters Kluwer.
Community Outreach
Participated in the Paint the Town Pink Fashion Show; Stamford
Health, Health Sports and Wellness Expo at Chelsea Piers CT;
American Cancer Society Making Strides Cancer Walk; and The Susan
G. Komen Breast Cancer Walk.
The physicians and staff at the Bennett Cancer Center work
collaboratively with the City of Stamford Department of Health,
American Cancer Society and other physicians on the medical staff to
provide community outreach throughout the year.
Dr. David Gruen and Dr. Helen Pass wrote blogs for Stamford Health’s
social media program to promote breast health in the community.
Strategy/Future Direction
It has been a busy first year at Stamford. We have achieved many
of our initial goals and established a strong platform for the future.
We will continue to reimagine imaging, delivering the best in high
tech for the benefit of those practicing in the Stamford Health
system and, most importantly, those who benefit from our care.
104 2016 Clinical Annual Report
SurgeryWe now have the premier operating services in Fairfield and Westchester County. We have tripled the size of many of
our operating rooms and these include: the latest technology and integrated systems; state-of-the-art lighting; operating
tables that keep the patient warm; the most advanced systems for video and laparoscopic surgery; and the newest
version of the daVinci robot.
Expertise. Elevated.
2016 Clinical Annual Report 105
Department of Surgery: Annual Report 2016
Kevin M. Dwyer, MD, FACS, FACCInterim Chair, Department of Surgery
A Message From The Chair The Year in ReviewOn September 23, 2016, we moved all the surgical inpatients from
the “old” surgical floor to the “penthouse” 10th floor of the new
hospital. It was an exciting day for many; patients, transporters,
volunteers, housekeeping, maintenance, engineering, lab and
radiology technicians, physician assistants, resident and attending
physicians, and all the dedicated nurses and Hospital leadership.
This gorgeous state-of-the-art facility that we have seen rising like
a beacon for the past four years was now ready for our surgical
patients. The first reviews were that the patients loved their spacious
new rooms with the spectacular view of Long Island Sound or the
Connecticut countryside. But what they appreciated most was the
care and attention they received from all those mentioned who were
dedicated to moving the patients safely and joyfully. The move of the
surgical floor was completed without a problem due to the countless
dedicated hours of preparation by the Hospital staff, the Hospital
“family,” that is core of greatness for our Hospital, both old and now
new. The rest of the Hospital patients moved over the weekend and,
at 7:00 a.m. on September 26, the new Stamford Hospital opened
its Emergency Room and operating rooms for business.
In the new Stamford Hospital, we now have the premier operating
services in Fairfield and Westchester County. We have tripled the
size of many of our operating rooms and these include: the latest
technology and integrated systems; state-of-the-art lighting;
operating tables that keep the patient warm; the most advanced
systems for video and laparoscopic surgery; and the newest version
of the daVinci robot. We have specialized rooms for Cardiovascular
Surgery, Neurosurgery, Orthopedic Surgery and a hybrid room with
the latest technology for Vascular and Endovascular Surgery.
Despite the latest in technologic advances to meet the needs of our
surgical patients at Stamford Hospital, what makes us special is the
dedication of our Operating Services staff. Throughout the summer
they moved the equipment and materials to the new hospital.
They had countless education sessions to learn the new technology
and orient the surgeons and other staff to the new operating
rooms. The dedication of the operating room technicians, materials
management, and operating room nurses under the leadership
of Faith Dorio, Alyson Essenmacher and Sandy Swiatek, was truly
inspiring. Together with the effort of our Anesthesia colleagues,
under the leadership of Dr. Betty Ann Robustelli, we performed
our first surgical cases on September 26 in the same safe and caring
manner as always. By the next day, we were up to a full caseload
and the Operating Services team has been busy ever since.
Over the past the past several years, the Division of Orthopedic
Surgery has consistently worked toward enhanced quality care,
notably through achieving Joint Commission – Disease Specific
Certification for Hip Replacement, Knee Replacement and Spine
Fusion. This year, Stamford Hospital has entered into a collaborative
relationship with Hospital for Special Surgery (HSS) to further advance
our orthopedic services. It is expected that volume will increase,
resulting in the need for expansion of our operating room services
for orthopedic surgery at both the Tully Outpatient Surgery Center
in early calendar year 2017, and at the new Stamford Hospital in fall
2017. With this increase of our orthopedic service and volume, the
Hospital Board of Directors has determined that orthopedic surgery
will no longer be a division of the Department of Surgery, but will
become a separate Department of Orthopedic Surgery. We look
forward to the partnership we will have with the new department to
provide the latest in surgical care at Stamford Hospital.
This year we have added new surgeons to our team in General
Surgery, Surgical Oncology, Breast Surgery, Vascular Surgery,
2016 Clinical Annual Report106
Department of Surgery: Annual Report 2016
Scope of Clinical Services
Medical Staff
The following is an overview of the Department’s divisions and
active staff:
General Surgery
Division Leadership Active Staff:
• James Bonheur, MD
• Marissa De Freese, MD
• Kevin Dwyer, MD
• Csaba Gajdos, MD
• Kevin Miller, MD
• Harold Neyra, DO (No longer here as of October 31, 2016)
• Joey Papa, MD
• William Symons, MD
The Division of General Surgery continues to expand its expertise
in surgical care with emphasis on high-quality minimally invasive
surgery. We have excellent outcomes and high patient satisfaction.
Members of the Division are highly skilled in minimally invasive
approaches to hernia repair, endocrine surgery and bariatric
surgery. Our newest member is Dr. Will Symons who comes to
us from Washington University. Dr. Symons practices the full
gambit of general surgery, particularly laparoscopic surgery, and
has special interest in complex hernia repair. He is also fellowship
trained in trauma and surgical critical care. We welcome him to
our experienced and dedicated General Surgery medical staff.
Plastic Surgery, Hand Surgery, Colorectal Surgery, Orthopedics and
Neurosurgery. Our specialists come from the top programs of the
country and we have matched the best and most advanced hospital
in the state with the expertise of our gifted surgical specialists.
The leadership of the Department of Surgery is also in transition.
This annual report is my final report as the Interim Chair of Surgery.
It has been a very busy year and I am grateful to all the countless
professionals that have helped me and the Department through
this transition. I am particularly grateful for the support of
Dr. Michael Ebright, who stepped into an Associate Vice Chair
role and helped with his medical staff oversight to the Perioperative
Services, along with Executive Director Faith Dorio and Chair
of Anesthesia Dr. Betty Ann Robustelli. We have a great team.
We look forward to working with our new Chair, Dr. David Yuh,
the former Chief of Cardiothoracic Surgery at Yale, who started
here on November 1. We welcome him with great enthusiasm
and look to his leadership and fresh ideas to continue our
exponential growth as a top Department grounded in safety,
quality and expertise.
Figure 1. Department of Surgery - 2016 by the Numbers:
Divisions/Sections: 19
Staff (active, courtesy, honorary and provisional): 168
Surgical Residents: 17
Physician Assistants & Nurse Practitioners: 19
OR Procedures:
Total cases: 18,720 6.6% increase +5.2% vs. target
Tully: 6,109 6.1% increase +3.8% vs. target
Main OR: 5,488 9.4% increase +12.0% vs. target
Endoscopy: 7,123 4.9% increase +0.5% vs. target
Kevin M. Dwyer, MD, FACS, FACC
2016 Clinical Annual Report 107
Bariatric Surgery
Section Leadership
Active Staff:
• James Bonheur, MD
• Harold Neyra, DO (No longer here as of October 31, 2016)
The Stamford Health Center for Surgical Weight loss (CSWL) offers
a comprehensive program to meet the surgical, medical and
emotional needs of patients regarding weight loss. Our surgeons
have extensive training in minimally invasive/laparoscopic bariatric
surgery and offer the most advance surgical procedures available.
Procedures include the gastric bypass, sleeve gastrectomy, lap
band, gastric balloon and revisional weight loss surgery as well as
endoscopic (incisionless) surgery. Using endoscopic techniques,
we are able to treat individuals who are regaining weight despite
previous weight loss surgery without undergoing an extensive
abdominal procedure. The endoscopic procedures are painless
and recovery is almost immediate.
I am proud to announce that the CSWL has been designated a
Fully Accredited Metabolic and Bariatric Surgery Accredited Quality
Improvement Program (MBSAQIP) by the American Society for
Metabolic and Bariatric Surgery (ASMBS) and the American College
of Surgeons (ACS). The MBSAQIP Accreditation recognizes surgical
programs with a demonstrated track record of favorable outcomes
and low complication rates.
MBSAQIP works to advance safe, high-quality care for bariatric
surgical patients through the accreditation of bariatric surgical
centers. A bariatric surgical center achieves accreditation
following a rigorous review process during which it proves that
it can maintain certain physical resources, human resources, and
standards of practice. All accredited centers report their outcomes
to the MBSAQIP database.
As the Division continues to grow we continued to identify and
recruit surgeons with expertise in minimally invasive/laparoscopic
bariatric surgery. In November, Dr. Neyra relocated to Orlando to
be closer to family. With this in mind, we are currently interviewing
qualified surgeons interested in joining our team
Bariatric Surgery
Division Leadership
Active Staff:
• Valerie Brutus, MD
• Mandy Greenburg, MD
• Helen Pass, MD
The Section of Breast Surgery saw significant change in personnel.
Dr. Valerie Brutus was recruited to replace Dr. Zandra Cheng, and
recruitment is ongoing to find a replacement for Dr. Jennifer
Bishop. Both surgeons left Stamford Hospital to relocate closer
to their families.
During her time at Stamford, Dr. Jennifer Bishop was appointed
Program Chair of the Connecticut Chapter of the American College
of Surgeons, while continuing to serve on the Education
Committee of the American Society of Breast Surgeons and the
Product Committee of Stamford Hospital.
James Bonheur, MD Medical Director
Helen A. Pass, MD Director of Breast Surgery
Co-Director, Stamford Health Breast Center
2016 Clinical Annual Report108
Intramural Invited Presentations:
1. “Best Breast Papers of the Past Decade” General Surgery Grand
Rounds, Stamford Hospital, Stamford, CT, October 29, 2015.
2. “What’s in Your Genes?” Rockrimmon Country Club, Stamford, CT,
May 12, 2016.
3. “Breast Care: Current and Future Directions” Annual Nursing
Symposium, Stamford, CT, September 9, 2016.
Posters
1. “Benefits of a Personalized Breast Cancer Risk Assessment
in a Community Mammography Screening Program.” Pass AR,
Hammarquist S, Gruen D. Poster Presentation 26th Annual Meeting
of the National Consortium of Breast Centers. Las Vegas, NV.
April 9-13, 2016.
2. “Breast Biopsy Can Be Avoided for Masses Without Suspicious
Features in Women 25 and Younger.” Pass AR, Bishop J, Volpicelli E,
Gruen D. Poster Presentation 26th Annual Meeting of the National
Consortium of Breast Centers. Las Vegas, NV. April 9-13, 2016.
3. “Dr. Mary Walker, Changing the Face of Surgery.” Pass AR, Bishop J.
Poster Presentation The Annual Meeting of the American College
of Surgeons. Washington, DC. October 16-20, 2016.
4. “The History of Clinical Trials.” Pass AR, Bishop J. Poster Presentation
The Annual Meeting of the American College of Surgeons.
Washington, DC. October 16-20, 2016.
Papers
1. Chafe S, Moughan J, McCormick B, Wong J, Pass HA,
Rabinovitch R, Arthur DW, Petersen I, White J, Vicini FA. Long-term
Update of NRG Oncology/RTOG 0319: A Phase I/II Trial to Evaluate
Three-Dimensional Conformal Radiation Therapy (3D-CRT)
Confined to the Region of the Lumpectomy Cavity for
Stage I and II Breast Carcinoma. Submitted Int J Radiat Oncol.
2. Pass AR, Bishop J. Dr. Mary Walker: Trailblazing Feminist,
Surgeon, and War Veteran. Submitted Surgical History Journal.
Dr. Pass continues to serve as:
Extramural Activities:• Governor of the American College of Surgeons (ACS)
• Member of the Committee on Applicants of the Connecticut Chapter of the ACS
• Member of the Executive Committee of the Commission on Cancer
• Chairman of the Bylaws Committee of The American Society of Breast Surgeons
• Member of the American College of Surgeons Committee on Surgical Volunteerism and Humanitarian Awards
• Member of the International Committee of the National Accreditation Program for Breast Centers (NAPBC)
Intramural Activities:
• Co-Chair: Breast Steering Committee, Stamford Hospital
• Co-Chair: Breast Operations Committee, Stamford Hospital
• Co-Chair: Breast Program Leadership Committee, Stamford Hospital
• Member and Physician Representative: STAR (Survivorship, Training and Rehabilitation) Committee, Stamford Hospital
• Member: Cancer Coordinating Committee, Stamford Hospital
• Member: Chairman of Surgery Search Committee
Presentations Members of the Section presented at numerous national, regional, and community lectures on breast health and care over the course of the year.
Extramural Invited Presentations:
1. “What You Need to Know about Breast Health” Invited Lunch and Learn First County Bank, Stamford, CT, October 23, 2015.
2. “Neoadjuvant Treatment of HER-2 Positive Breast Cancer” invited lecture Society of Surgical Oncology Conference, Boston, MA, March 3, 2016.
3. “What’s in Your Genes? How Family History Affects Your Risk of Breast Cancer” invited lecture JCC, Stamford, CT, March 28, 2016.
4. “The ‘Best” Breast Papers of 2015” invited lecture for the American Society of Breast Surgeons 17th Annual Conference, Dallas, TX, April 15, 2016.
5. “The Best Papers, Benign and Malignant of 2015” invited lecture Winthrop’s 1st Annual Breast Health Symposium, Mineola, NY,
September 30, 2016.
Department of Surgery: Annual Report 2016
2016 Clinical Annual Report 109
Blog Posts
The Section also increased its social media presence with blog posts
throughout the year.
1. “Don’t Survive….Thrive”
https://stamfordhospital.org/Blogs/DontSurviveThrive.aspx
October 2015
2. “Addressing the Confusion about Mammograms”
https://stamfordhospital.org/Blogs/Addressing-Confusion-
about-Mammograms.aspx
October 2015
3. “Thanksgiving Day is National Family History Day”
https://www.stamfordhospital.org/Blogs/Thanksgiving-Day-is-
National-Family-History-Day.aspx
November 2015
4. “Top 5 Tips for a Healthier New Year”
https://stamfordhospital.org/Blogs/Dr-Katie’s-Top-5-Tips-for-
a-Healthier-New-Year.aspx
December 2015
5. “Heart Health Affects Breast Cancer Risk”
https://stamfordhospital.org/Blogs/Heart-Health-Affects-Breast-
Cancer-Risk.aspx
February 2016
6. “Detection is Protection: Mammograms Save Lives”
https://stamfordhospital.org/Blogs/Detection-is-Protection.aspx
March 2016
7. “Sleep and Breast Cancer: What’s the Link?”
https://www.stamfordhealth.org/healthflash-blog/cancer/sleep-
and-breast-cancer/
April 2016
8. “Breast Cancer in Men: Risk Factors and More”
https://www.stamfordhealth.org/healthflash-blog/
cancer/mens-breast/
June 2016
9. “In Breast Cancer Care, as In All Things, Choose Wisely”
https://www.stamfordhealth.org/healthflash-blog/cancer/
choose-wisely/
July 2016
10. “New Guidelines for Patients with DCIS”
https://www.stamfordhealth.org/healthflash-blog/cancer/
margin-guidelines/
August 2016
Honors and Awards
Dr. Pass was named to:
Top Doctors: New York Metro Area: 2015 and 2016
Top Doctor of Fairfield County: 2015 and 2016
America’s Top Surgeons: 2016
Best Doctors in America: 2015 and 2016
Cardiovascular Surgery
Division Leadership
Active Staff:
• Michael A. Coady, MD, MPH, MBA
• William C. Feng, MD, ScD
• David D. Yuh, MD
Stamford Hospital offers patients the full spectrum of surgical
procedures within the field of Cardiac Surgery, ranging from elective
through immediate and life-saving. Clinical growth within the
Division of Cardiac Surgery rose by 37% for FY16, with 117 open
heart surgeries, and 20 TAVR procedures. This clinical growth
spanned all procedures within Cardiac Surgery, including CABG,
aortic and mitral valves, and thoracic aortic aneurysms. The surgical
team has continued to achieve outstanding clinical outcomes,
with a zero percent 30-day mortality rate for FY16.
In addition to conventional Cardiac Surgical procedures, the Division
also provides the Convergent Ablation Procedure for patients with
long-standing atrial fibrillation, and actively participates with the
Division of Cardiology to support our growing TAVR program for
patients with severe aortic stenosis at high or intermediate risk.
Unlike other institutions offering similar programs, the Stamford
Hospital surgical team is very focused on making each individual
patient experience extraordinary. We have a full-time, dedicated
Michael A. Coady, MD, MPH, MBA Chief of Cardiac Surgery
Co-Director, Stamford Health Heart & Vascular Institute
2016 Clinical Annual Report110
anal manometry program to provide better care for patients
with pelvic floor problems. A member of the Hospital’s Robotic
Committee, Dr. Shahzad Zafar’s has advanced the use of the
robot for colonic surgery at Stamford Hospital.
The Division implemented the use of one of the first 3-D
laparoscopes in the state to enhance visualization in patients
having minimally invasive colon and rectal surgery.
Presentations:
Littlejohn, Charles. Presidential Address at the American Society
of Colon and Rectal Surgeons, May 2, 2016; Los Angeles, CA.
Bakes D, Calhoun J, Novack M, Frenk V, Littlejohn C. Effectiveness
of Adding Transverse Abdominus Plane (TAP) Catheters to Patient-
Controlled Analgesia (PCA) in Laparoscopic Colon Resections: a
retrospective chart review. Poster presentation. American Society
of Colon and Rectal Surgeons, May 1, 2016, Los Angeles. CA.
Hand Surgery
Section Leadership
Active Staff:
• Jeffrey Brooks, MD • Haik Kavookjian, MD
• John D. Dowdle, MD • Richard Magill, MD
• Harold Gewirtz, MD • Emily Slate, MD
The Hand Surgery section has grown with the addition of Dr. Richard
Magill and Dr. Emily Slate. All hand abnormalities as well as hand and
wrist injuries are managed at Stamford Hospital.
patient navigator who coordinates care and guides patients
through the process from pre-surgery through surgery and
beyond. This Planetree approach to patient-centered care makes
Stamford Hospital a very special place to practice medicine.
Dr. Coady is a reviewer for the Annals of Thoracic Surgery, Journal
of Thoracic and Cardiovascular Surgery, Circulation and Aorta.
Dr. Feng published a new manuscript in the Annals of Thoracic
Surgery. Feng W, Coady M. “Epicardial Tachosil patch repair
of ventricular rupture in a 90-year-old following mitral valve
replacement.” Ann Thoracic Surg 2016;101:2361-3.
Dr. Yuh joined Stamford Hospital on November 1 as the new
Chief of Surgery, and an active cardiac surgeon who specializes
in minimally invasive cardiac surgery, particularly with respect to
mitral valve disease and hybrid procedures for atrial fibrillation.
As a nationally respected leader in cardiac surgery, Dr. Yuh serves
as a frequent reviewer for the Annals of Thoracic Surgery, Journal
of Thoracic and Cardiovascular Surgery and Circulation.
Colon and Rectal Surgery
Section Leadership
Active Staff:
• Ryan Bendl, DO • James McClane, MD
• Marilee Freitas, MD • Shahzad Zafar, MD
• Charles E. Littlejohn, MD
Dr. Charles Littlejohn is immediate Past President of the American
Society of Colorectal Surgeons (ASCRS). This is the highest and
most prestigious position in the world’s premier society of
surgeons dedicated to the practice of colorectal surgery.
Only the top colorectal surgeons in the country can achieve this.
Dr. Marilee Freitas has led the Division’s efforts in starting up an
Department of Surgery: Annual Report 2016
Charles E. Littlejohn, MD Director of Colon and Rectal Surgery
John D. Dowdle, MD Director of Hand Surgery
2016 Clinical Annual Report 111
Neurosurgery
Section Leadership
Active Staff:
• Paul Apostolides, MD • Avinash Mohan, MD
• Mark Camel, MD • Marc Otten, MD
• Alain De Lotbiniere, MD • C. Cory Rosenstein, MD
• Andrea Douglas, MD • Scott Simon, MD
• Amory Fiore, MD
The Division of Neurosurgery continues to grow the depth and
breadth of neurosurgical services offered to our community.
With the adoption of new intraoperative stereotactic guidance
technologies, spinal neurosurgery remains the greater volume
of neurosurgical cases performed in the Division. Continued
collaboration with our Oncology and Endocrine colleagues
will provide sustained focus on strategies aimed at increasing
the volume of cranial neurosurgical cases that can remain in
the community for comprehensive care at our new hospital.
Two new neurosurgeons, Dr. Alain De Lotbiniere and
Dr. Avinash Mohan, joined the Neurosurgical staff a year ago.
Dr. De Lotbiniere has been practicing in Fairfield and Westchester
counties for the last 10 years, after spending 17 years specializing
in Functional and Stereotactic Neurosurgery at Yale University.
His practice focuses on stereotactic radiosurgery of cranial and
spinal pathologies, pituitary surgery and functional treatment
of facial pain and other chronic pain syndromes. Dr. Mohan is
a Pediatric Neurosurgeon who has been practicing in Fairfield
and Westchester counties for the last seven years. He treats both
children and adults with neurosurgical abnormalities.
Opthamology
Division Leadership
Active Staff:
• Robert J. Fucigna, MD • Lauren Schneider, MD
• Gregory Gallousis, MD • Elizabeth Siderides, MD
• Joan Gewirtz, MD • Esteban C. Vietorisz, MD
• Peter Libre, MD • Eric L. Wasserman, MD
• Jacqueline J. Littzi, MD • Richard B. Weber, MD
• Glenn E. Ostriker, MD • Andrew B. Wolf, MD
• Philip A. Piro, MD • James Wong, MD
The Division of Ophthalmology is one of the largest subspecialty
divisions in the Department of Surgery at Stamford Hospital.
While the majority of procedures are performed at the Wilton
Surgery Center, which is affiliated with Stamford Hospital, we
continue to provide laser and other surgical procedures at the Tully
Health Center and retinal surgery procedures at Stamford Hospital.
Our deep and very well-trained Division includes subspecialists
in the fields of cornea, glaucoma, pediatric ophthalmology and
retina. Members of our staff have been recognized many times on
Best Doctors lists and include medical school faculty members at
Columbia, Mount Sinai and New York University Medical Center.
Drs. Robert Fucigna, Gregory Gallousis, Peter Libre, Jacqueline
Littzi, Glenn Ostriker, Lauren Schneider, Esteban Vietorisz and
Andrew Wolf provide emergency services for Stamford Hospital’s
Emergency Room and inpatients, along with the Immediate Care
Center at Tully.
Andrea Douglas, MDChief of Neurosurgery
Glenn E. Ostriker, MDDirector of Ophthalmology
2016 Clinical Annual Report112
• Benjamin D. Roye, MD • Corinne VanBeek, MD • William T. Schmidt, MD • Avi Weiner, MD • Krishn M. Sharma, MD • Daniel Zelazny, MD • Marc D. Silver, MD
• Craig D. Tifford, MD
• Allen I. Troy, MD
In 2016, the Division of Orthopedic Surgery continued to hold
steady in terms of medical staff. Overall orthopedic surgery volume
declined 11% from the prior year. Inpatient surgical volume held
steady with the decline being seen in outpatient sports medicine
surgeries. This is attributable to the outmigration of orthopedic
surgery volume to one of several new area ambulatory surgery
centers that have opened this year in Stamford. Figure 2 shows the
total volume of orthopedic surgery patients by patient type.
The Orthopedic & Spine Institute (OSI) at the Chelsea Piers CT (CPCT)
campus has enjoyed continued growth in the number of physicians
seeing patients at that location. As a result, imaging at that location
has also increased. The space is home to Orthopedic Surgery,
Neurosurgery, Integrative Care, Pain Management, Podiatry and the
Concussion Center.
The Rehabilitation Department is an important ancillary service for
orthopedics and the new Sports Rehab location at CPCT opened
in January. The program has been successful in exceeding budget
within the first few months of operation. The services offered at this
location are targeted to musculoskeletal patients.
The Orthopedic Service line continues to function with an
infrastructure that includes three subcommittees that are essential to
monitoring performance of programs from an operational, financial
and clinical standpoint. The subcommittees include Joint and Spine,
Hip Fracture and Sports Medicine. Each committee works in a
collaborative and interdisciplinary fashion to advance that program.
The Hip and Knee Replacement Programs achieved initial
certification from The Joint Commission in 2009 and was recertified
in 2015. The Spine Fusion Program achieved initial Certification
Oral and Maxillofacial Surgery
Division Leadership
Active Staff:
• Donald Case, DMD
• Christine Hamilton-Hall, MD, DMD
• Robert M. Yudell, MD
Orthopedic Surgery
Division Leadership
Active Staff:
• David Asprinio, MD • Alex Gitelman, MD
• Theodore A. Blaine, MD • Andrew Grose, MD
• Adam R. Brodsky, MD • Andrew L. Haas, MD
• Jeffrey J. Brooks, MD • Margaret Harvey, DO
• Russell J. Cavallo, MD • Peter W. Hughes, MD
• Robert Cristofaro, MD • Richard Magill, MD
• Joseph M. D’Amico, MD • John Nelson, MD
• Frank A. DiFazio, MD • Adam Lazzarini, MD
• John D. Dowdle, MD • Haik G. Kavookjian, MD
• Edward Feliciano, MD • Kevin D. Plancher, MD
• Filip Findling, MD • Charles Popkin, MD
Department of Surgery: Annual Report 2016
Robert M. Yudell, DDS, MD Director of Oral and Maxillofacial Surgery
Rudolph F. Taddonio, MDDirector of Orthopedic Surgery
Figure 2: Yearly Volume by Location
Total Volume by Patient Type
Inpatient or Outpatient FY2016 FY2015 FY2014
I 823 827 758
O 1,845 2,143 2,025
Grand Total 2,668 2,970 2,783
2016 Clinical Annual Report 113
in 2010 and was also recertified in 2015. Performance measures
are monitored and discussed monthly at the Joint and Spine
Subcommittee meetings. The data is reported to The Joint
Commission monthly, with periodic updates given to the surgeons
at Division meetings. The measures currently monitored for the
programs are as follows:
Hip and Knee Replacement:
DVT Assessment Neurovascular Check
Care Partner Discharge to Home
Spine Fusion:
Care Partner Incentive Spirometer
Early Mobilization Pain Control
Members of the Division continue to bring advanced technologies
to the organization and the community including advanced 3-D
navigation technology continues to be utilized in spinal surgery,
especially in complex scoliosis and spinal deformity correction.
The spine surgeons in the Orthopedic and Neurosurgery specialties
continue to work collaboratively through combined spine peer
review as well as partnering at times in the OR.
Orthopedic residents from Westchester Medical Center-New
York Medical College continue to rotate through the orthopedic
program at Stamford Hospital. The rotation consists of four
residents (PGY 2, 3 and 4) rotating on a four-month block.
This includes an academic schedule for education through case
reviews, peer review presentations as well as Journal Club.
The surgeons in the Division participated in various activities on
the educational calendar this year including general community
talks as well as CME lunch-and-learns provided to primary care
physicians.
Looking ahead to 2017, growth is anticipated in various programs.
We expect to add physicians to the CPCT Orthopedic & Spine
Institute offices. The Concussion Center recruited an additional
neuropsychologist to increase its capacity to see patients.
Also in partnership with the Outpatient Rehab department,
specialty rehabilitation will be opening at the OSI offices to
support Concussion Center patients with vestibular, ocular
and physical therapy.
The most widely anticipated opportunity to grow orthopedics
is expected to come by way of a new collaborative agreement
developed with Hospital for Special Surgery. This management
services agreement will strengthen the existing program and
grow surgical volume for the organization. The Division of
Orthopedic Surgery will be re-established as the Department
of Orthopedic Surgery.
Otolaryngology and Head and Neck Surgery
Division Leadership
Active Staff:
• Steven A. Bramwit, MD • Jason R. Klenoff, MD
• Jacquelyn M. Brewer, MD • Biana G. Lanson, MD
• Bruce H. Klenoff, MD
The Division of Otolaryngology and Head and Neck Surgery has
continued to increase the number of minimally invasive approaches
to surgery and now have 99% or our surgeries as outpatient surgery.
Overall case volume has increased by 5% this year. The Division’s
volume at Tully has increased by 1.5% while Hospital volumes have
increased by over 24%. We have continued to grow our balloon
sinuplasty program and most of our sinus surgery is now done
with image guidance for increased safety. We collaborate with
our Neurosurgery and our Thoracic Surgery colleagues for complex
oncologic procedures including minimally invasive skull base surgery.
We have optimized our sinus surgery anesthesia protocols and
have worked with the Pediatric team to improve the pediatric
perioperative experience. Members of the Division have also been
actively involved in the treatment of balance, hearing, taste and
smell disorders, and have been an integral part of the new Stamford
Hospital Balance Center.
Members of the Division teach residents and medical students,
provide lectures at the Hospital and to community groups, and are
on the faculty of both Columbia and Yale medical schools.
Bruce H. Klenoff, MDDirector of Otolaryngology
2016 Clinical Annual Report114
Podiatry
Division Leadership
Active Staff:
• Jeremy A. Bier, DPM • Mary Reilly, DPM
• Rui De Melo, DPM • David Rosenzweig, DPM
• Marissa Girolamo, DPM • Steven Shindler, DPM
• Ellen Golden, DPM • Peter Siroka, DPM
• Matthew Juriga, DPM • Josephine Velasquez, DPM
• Chris Kassaris, DPM • Robert Weiss, DPM
• Francisco Lago, DPM • Scott Weiss, DPM
• Kelly Powers, DPM, MS
Dr. Kelly Powers joined Associated Podiatrists in Fairfield and
Greenwich. She was a resident in Podiatry at Boston University and
completed a fellowship in Plastic Reconstruction at Georgetown
University Medical Center.
Drs. Robert and Scott Weiss have added a third associate, Dr. Matthew
Juriga. Dr. Juriga was trained at the Beth Israel Deaconess Medical
Center where the Podiatry Department works closely with vascular
and medical physicians from the Joslin Diabetes Center to produce
some of the highest rates of limb salvage in the country.
Drs. Bier, Weiss and Juriga provide Podiatric Surgery Emergency
Department call services at Stamford Hospital to ensure high-quality
care to our patients with podiatric emergencies.
Members have also enjoyed extensive recognition as outstanding
practitioners in many distinguished lists such as Castle Connolly’s
Top Doctors, New York Magazine, Connecticut magazine,
Westchester WAG and other regional publications.
Plastic and Reconstructive Surgery
Division Leadership
Active Staff:
• Harold S. Gewirtz, MD • David Passaretti, MD
• Chang Soo Kim, MD • Arthur R. Rosenstock, MD
• Gregory Latrenta, MD • Alfred Sofer, MD
• Rafael Magana, MD • Mrudangi Thakur, MD
• Sandra L. Margoles, MD • Julie V. Vasile, MD
• Leif O. Nordberg, MD
The Division of Plastic Surgery continues to provide excellent
and current plastic surgical expertise to the Hospital. Members
provide a variety of reconstructive procedures including tissue
flaps and closure of complex wounds, as well as an array of
cosmetic procedures. The Division is dedicated to complete
coverage of the Emergency Department and other urgent consults
at all times.
Department of Surgery: Annual Report 2016
Harold S. Gewirtz, MDDirector of Plastic andReconstructive Surgery
Jeremy A. Bier, DPMDirector of Podiatry
2016 Clinical Annual Report 115
Surgical Oncology
Section Leadership
Dr. Gajdos has just joined the medical staff at Stamford Hospital
after enjoying an extensive and successful practice in surgical
oncology at the University of Colorado in Denver. Dr. Gajdos
specializes particularly in hepato-biliary and gastrointestinal cancers
as well as cancer of the esophagus. He also has vast experience
with melanoma and soft tissue sarcomas. We welcome Dr. Gajdos
to Stamford Hospital, and look forward to his leadership in
re-establishing a first-rate surgical oncology program.
Thoracic Surgery
Division Leadership
Active Staff:
• Michael Ebright, MD • Mark E. Ginsburg, MD
• William C. Feng, MD • Joshua R. Sonett, MD
The Thoracic Surgery Division continues to grow in volume and
breadth. It is truly a multidisciplinary enterprise, intersecting with
colleagues from Pulmonology, Gastroenterology, Radiology, Medical
Oncology, Radiation Oncology and Pathology. Although the majority
of our cases are oncologic in nature, a growing number deals with
benign disease as well.
Over the past year, two of Dr. Michael Ebright’s partners from
the Columbia group have been added to the active medical
staff — Dr. Joshua Sonett and Dr. Mark Ginsburg. The program
is augmented by our dedicated nurse practitioner, Lauren
Drysdale, and thoracic nurse navigator, Melissa Ronk.
The Lung Cancer Screening Program continues to progress
and is one of the largest and most successful in the area.
It has been designated as a Center of Excellence by both the
American College of Radiology and the Lung Cancer Alliance.
This is a truly evidence-based program which has been studied
as a model for other regional programs to emulate. Highlights
include standardized reporting, a HIPAA-compliant computerized
database and the ability to provide real-time results to patients
and their physicians. It is coupled with our one-to-one smoking
cessation program, Commit to Quit. This year we have recruited
a dedicated chest radiologist with a special interest in lung
screening and cardiac imaging, bolstering several Hospital
programs. Since 2014, we have detected 14 patients with lung
cancer, all treated with curative intent (Stage IA-IIIB).
The heart of our program is the multidisciplinary thoracic tumor
board conference, which is consistently well attended. Our
thoracic nurse navigator ensures efficient evaluation of every
patient with seamless care. Evidence-based protocols are
followed and available clinical trials are reviewed. We utilize
surgical and endoscopic diagnostic and staging techniques
such as navigational bronchoscopy, endobronchial ultrasound
(EBUS), esophageal ultrasound (EUS) and mediastinoscopy.
Stamford Hospital is on the forefront of minimally-invasive
pulmonary surgery, using all available techniques including
video-assisted resection (VATS), robotic surgery and traditional
open surgery to perform lobectomy, segmentectomy and
non-anatomic resections. Roughly 90% of our operations are
performed in a minimally-invasive format. All outcomes are
entered into the Society of Thoracic Surgeons (STS) General
Thoracic Surgery Database, a voluntary prospective databank
utilized mainly by academic medical centers, allowing us to
measure our surgical results against national standards. We
are currently below STS average for length of stay, major
complications and mortality rates for pulmonary lobectomy.
Case volume has quadrupled over the past four years.
Our center recently began to accrue patients to a landmark
national randomized controlled trial comparing lobar and
sublobar resection for early stage lung cancer.
Csaba GajdosSection Chief, Surgical Oncology
Michael Ebright, MDSection Chief, Thoracic Surgery
2016 Clinical Annual Report116
Muñoz-Largacha JA, Ebright MI, Litle VR, Fernando HC.
Electromagnetic navigational bronchoscopy with dye marking for
identification of small peripheral lung nodules during minimally invasive
surgical resection. Submitted.
Narsule CK, Nair D, Gupta A, Oommen RG, Ebright MI, Litle VR,
Fernando HC. Percutaneous thermal ablation for Stage IA non-small cell
lung cancer: long-term follow-up. Submitted.
Hewes PD, Jachey KJ, Zhang X, Tripodis Y, Rosenkranz P, Ebright MI,
McAneny D, Fernando HC, Litle VR. Evaluation of the Caprini model for
venothromboembolism in esophagectomy patients. Annals of Thoracic
Surgery. 2015; 100(6): 2072-8.
Trauma Surgery and Critical Care
Division Leadership
Active Staff:
• Marissa De Freese, MD • Joey Papa, MD
• Kevin M. Dwyer, MD • William Symons, MD
• Kevin Miller, MD
Stamford Hospital is a Level II Trauma Center designated by the
Office of Emergency Medicine of the State of Connecticut and
verified by the American College of Surgeons (ACS) to care for
acutely injured trauma patients. The Trauma Center has three
fellowship-trained Trauma and Critical Care surgeons and is the
regional leader for outreach, injury prevention, education and
research. The American College of Surgeons visited in November
2015 and re-verified the Hospital for three additional years.
In FY16, Stamford Hospital’s Emergency Department saw 917
trauma activations and an additional 222 patients who required
admission for isolated fractures and hip fractures for a total of
1,139 patients seen and treated in the Emergency Department for
moderate to severe traumatic injuries. Of these patients, 760 were
admitted to the Hospital.
New initiatives include increasing awareness of surgical options
for the treatment of gastroesophageal reflux disease including
laparoscopic fundoplication and the novel LINX procedure.
Stamford Hospital became the first center in Connecticut to treat
an esophageal cancer patient with photodynamic therapy, an
endoscopic treatment using a photosensitizing agent to fulgurate
malignant tissue.
Dr. Ebright is an ad hoc reviewer for the Journal of Thoracic and
Cardiovascular Surgery, Annals of Thoracic Surgery, Annals of Surgical
Oncology, Journal of Surgical Oncology, Journal of Thoracic Oncology and Diseases of the Esophagus. He is editor of the International
Thymic Malignancy Interest Group Newsletter.
Several local seminars to primary care physicians and specialists
were delivered over the course of the year on a variety of topics.
Dr. Ebright gave following lectures and presentations:
Muñoz-Largacha JA, Ebright MI, Litle VR, Fernando HC.
Electromagnetic navigational bronchoscopy with dye marking
for identification of small peripheral lung nodules during minimally
invasive surgical resection. Presented by Dr. Ebright at the
International Society for Minimally Invasive Cardiothoracic
Surgery 2016 Annual Meeting, Montreal, Canada, June 2016.
Ebright MI. Moderator, Live Thoracic Surgery Session, Poster
Presentation, and Video Session, International Society for Minimally
Invasive Cardiothoracic Surgery 2016 Annual Meeting, Montreal,
Canada, June 2016.
Addagatla K, Ebright MI. Solitary fibrous tumor masquerading as
pulmonary sequestration. Presented at the Connecticut Chapter
of the American College of Surgeons, Farmington, Connecticut,
November 2015.
Ebright MI. Keynote, Shine a Light on Lung Cancer, Lung Cancer
Alliance, Stamford, Connecticut, November 2015.
The following manuscripts were published or in process:
Ebright MI, Sridhar P, Litle VR, Narsule CK, Daly BDT, Fernando HC.
Endoscopic fundoplication: effectiveness for controlling symptoms of
gastroesophageal reflux disease. Submitted.
Addagatla K, Mamtani R, Babkowski R, Ebright MI. Solitary Fibrous
Tumor of the Pleura with Abdominal Aortic Blood Supply. Annals of
Thoracic Surgery. In press.
Department of Surgery: Annual Report 2016
Kevin M. Dwyer, MDDirector of Trauma and Critical Care
2016 Clinical Annual Report 117
The Division hosted the Southwestern Connecticut Trauma
Symposium for trauma professional staff in November 2016. The
symposium included presentations on recognizing signs of child
abuse, pulmonary arterial hypertension, treatment of traumatic brain
injuries for EMS providers, an epidemiological review of non-fatal
firearm injuries and updates on pediatric trauma surgery.
The Trauma Center is engaged in public and professional education,
and offers a dedicated referral and access line to Trauma Center
resources. Prevention activities center on priorities based on local
injury data. For example, injury prevention activities include an
Annual Trauma Fair that focuses on falls in the elderly. The Trauma
Center collaborates with national, regional and state programs,
including the Trauma Quality Improvement Program (TQIP). TPM
participates in senior and family health fairs where information
is provided on falls, helmet use, concussion and trauma safety in
general, as well as the Hospital’s ongoing Fall Prevention Program.
The Hospital’s outreach programs include teaching pedestrian
and bike safety at the elementary school level, the Annual Trauma
Symposium, roundtable sessions provided for pre-hospital providers,
an annual injury prevention fair, programs for local high school
students interested in healthcare careers, participation in a large
annual mock trauma disaster drill and presentations on injury
prevention throughout the spectrum of pediatrics for the local
school system’s health and physical education educators.
Dr. Dwyer is a member of the Eastern Association of Trauma (EAST)
and the American Association of Trauma (AAST). Additionally, he is a
member of the military liaison committee of the AAST.
Dr. De Freese was inducted into the American College of Surgeons
(ACS) this past October. She is a member of EAST and on the Program
Committee for the annual CT Trauma Conference presented by the
CT Committee on Trauma of the ACS.
Dr. De Freese is also a reviewer for the World Journal of Surgery.
Presentations:
Kramer, Kristina; Krinsley, James; Dwyer, Kevin: Time in Target Blood
Glucose Range is Associated with Survival in Trauma ICU Patients.
Region 1 Trauma paper competition, Boston, MA; November, 2015.
De Freese, Marissa. Ultrasound: The Wave of the Future. CT Trauma ’16
18th Annual Conference. Ledyard, CT; April, 2016.
Urology
Division Leadership
Active Staff:
• Jonathan Bernie, MD • Eric J. Moskowitz, MD
• Lori Dyer, MD • Michael J. Nurzia, MD
• Ronnie Fine, MD • Richard P. Santarosa, MD
• Michael E. Karellas, MD • Vincent J. Tumminello, MD
• Robert H. Lovegrove, MD • Paul Zelkovic, MD
2016 was an exciting year for the Division of Urology. Coverage
for all aspects of urgent urology issues remained strong under
the leadership of Dr. Richard Santarosa. In April, we welcomed the
addition of Dr. Michael Karellas to our medical staff. Dr. Karellas has
quickly made an impact on the Division and has enhanced coverage
of the Urology service with his general practice and his particular
interest and expertise in urologic oncology. He has also been well-
received by the Operating Room staff and enjoys educating the staff
as well as the surgical residents. In August 2016, Dr. Eric Moskowitz
joined the Division after completing his fellowship in robotic and
minimally invasive urology at the Icahn School of Medicine at Mount
Sinai. For 2017, we expect to grow our center as a premier provider
for surgical and non-surgical treatment of prostate cancer.
Richard P. Santarosa, MD Director of Urology
2016 Clinical Annual Report118
demanding well-educated clientele of lower Fairfield County and
will continue to strive to maintain the high standard of care for the
treatment of vascular disease at Stamford Hospital.
Department of Surgery
New Staff in 2016
Surgeons:
Joseph Ajdinovich, MD – Orthopedic Surgery
Ryan Bendl, DO – Colon and Rectal Surgery
Jonathan Bernie, MD – Urologic Surgery
Valerie Brutus, MD – Breast Surgery
Filip Findling, MD – Orthopedic Surgery
Ronnie Fine, MD – Pediatric Urology
Mark Ginsburg, MD – Cardiothoracic Surgery
Shareef Jandali, MD – Plastic and Reconstructive Surgery
Michael Karellas, MD – Urologic Surgery
Peter Libre, MD – Ophthalmology
Eric Moskowitz, MD – Urologic Surgery
William Symons, MD – General Surgery, Trauma & Critical Care
Mrudangi Thakur, MD – Plastic and Reconstructive Surgery
Physician Assistants:
Genie Ball, PA-C – Cardiac Surgery
Elizabeth Bubbico, PA-C – Surgery Subspecialties
Dean Rivers, PA-C – Cardiac Surgery
Janine Tedesco, PA-C – Vascular Surgery
Bridget Ward, PA-C – Surgery Subspecialties
The following staff members have departed from Stamford Hospital:
Jennifer Bishop, MD – Breast Surgery
Zandra Cheng, MD – Breast Surgery
Diane Goodwin, PA-C – Surgery Subspecialties
Peter Liebert, MD – Pediatric Surgery
Jennifer McDermott, PA-C – Surgery Subspecialties
David McKee, MD – Otolaryngology
Henry Rubinstein, MD – Orthopedic Surgery
Sarah Russel, DPM – Podiatry
Michael Stone, MD – Surgical Oncology
Paul Travlos, PA-C – Cardiac Surgery
Vascular Surgery
Division Leadership
Active Staff:
• Stephen M. Bauer, MD • Taras V. Kucher, MD
• Jonathan N. Bowman, MD • Timothy Manoni, MD
• Paul J. Gagne, MD • Ben U. Marsan, MD
• Lee Goldstein, MD • Bart Muhs, MD PhD
In welcoming Dr. Bart Muhs in 2015, the Vascular Surgery Division
developed an Aortic Center of Excellence and 2016 saw a growth
in the number of complex aortic aneurysm treated at Stamford
Hospital. In 2017, the Division plans to build on this trend with the
opening of our beautiful state-of-the-art new hospital.
In 2016, the Division continued to serve as a vital member of the
Heart & Vascular Institute. The vascular surgeons continue to be assist
the TAVR team with peripheral artery support for these sometimes-
challenging cases. In addition, Division members in collaboration
with the HVI and Columbia Presbyterian Hospital, have participated
in the education of visiting physicians from China.
We also remain a vital member in the surgical residency program.
This year Dr. Stephen Bauer initiated an endovascular training
lab. Here the residents get hands-on endovascular experience on
a “real-life” computer simulator in the treatment of aortic disease.
We also continued to support the residency Journal club and
Lecture Series conferences.
In research activity, surgical resident Kostantino Poulikidis worked
with Dr. Paul Gagne on two clinical trials. One on the treatment of
lower extremity venous hypertension and another on the patency
of drug eluting stents for peripheral artery disease. The trials plan to
finish in 2017 with results published soon after.
Overall, we are quite pleased with the state of our Division in this
competitive healthcare market. We are prepared with our current
resources and expertise to meet the challenges posed to us by this
Department of Surgery: Annual Report 2016
Timothy Manoni, MDDirector of Vascular Surgery
2016 Clinical Annual Report 119
Stamford Hospital surgeons were listed among the Castle Connolly’s, Connecticut magazine and New York Magazine’s Top Doctors in 2016. They are:
• Paul Apostolides • Michael Nurzia
• Stephen Bauer • Glenn Ostriker
• Jeremy Bier • Helen Pass
• Mark Camel • David Passaretti
• Russell Cavallo • Philip Piro
• Michael Coady • Kevin Plancher
• Joseph D’Amico • Cory Rosenstein
• John Dowdle • Arthur Rosenstock
• Kevin Dwyer • Stephen Salzer
• Michael Ebright • Richard Santarosa
• William Feng • William Schmidt
• Jay Fleischman • Elizabeth Siderides
• Joan Gewirtz • Marc Silver
• Harold Gewirtz • Peter Siroka
• Andrew Haas • Scott Simon
• Peter Hughes • Craig Tifford
• Haik Kavookjian • Allen Troy
• Bruce Klenoff • Esteban Vietorisz
• Jason Klenoff • Eric Wasserman
• Charles Littlejohn • Richard Weber
• James McClane • Andrew Wolf
• Kevin Miller • David Zelazny
Departmental Safety and Quality
The American College of Surgeons National Surgical Quality
Improvement Program (ACS NSQIP®) is the first nationally validated,
risk-adjusted, outcomes-based program to measure and improve the
quality of surgical care. The Department of Surgery has participated
since 2012 and participates in the Connecticut Surgical Quality
Collaborative, a NSQIP subgroup. Entering data to compare our
performance to others, and the opportunity to learn from our
colleagues across the state and country are key components
of the program.
Our first outcomes report showed that our mortality rate, adjusted
for the severity of illness of our patients, put us in the top 10%
nationally. Importantly, the report identified areas for improvement:
reducing surgical site infections, especially in colorectal surgery, and
pulmonary complications across all subspecialties.
Our efforts to develop a culture of safety are bearing fruit as
evidenced by the reduction in our surgical site infections overall,
and in colorectal surgery patients specifically as shown in Figure
3. We continue to review our outcomes through reports from the
Infection Prevention and Control team and the National Healthcare
Safety Network (NHSN, a subsection of the CDC) and through NSQIP.
In 2016, we continued with our efforts of decreasing surgical site
infections with our overall rate of infection dropping form 0.65% in
2015 to 0.61%. In the beginning of the fiscal year we saw a rise in
colon soft tissue infection and so we established our Skin and Soft
Tissue Infection (SSI) multidisciplinary committee. We refocused our
efforts on our colon surgery protocol and we have not had a single
colon SSI in the past six months. Also in 2016, we have decreased our
post-surgical pulmonary complications as monitored by NSQIP.
Through our SSI committee and the leadership of Perioperative
Services, our goal is to establish the principles of the Enhanced
Recovery after Surgery for all our abdominal surgery to improve our
outcomes in all aspects as recorded by NSQIP. This is in keeping with
the goals of the Connecticut Surgical Quality Collaborative, of which
Stamford Hospital is a member.
We are enhancing our methods of data collection, review and
assessment to better understand the costs of surgical care to improve
our financial performance while maintaining quality and safety.
Figure 3: Colorectal Surgery Standardized Infection Ratio
Stamford Hospital Colorectal SurgeryStandardized Infection Ratio
2.42
4.77
2.87
1.31 1.16
0.55
1.130.92
5.00
4.00
3.00
2.00
1.00
0.00Q3Q42012
Q1Q22012
Q3Q42013
Q3Q42014
Q1Q22013
Q1Q22014
CTState 2013
USA2013
2016 Clinical Annual Report120
Current Residents
PGY 2:
• James Clarke, MD, Georgetown University School of Medicine
• Diane Durgan, MD, St. George’s University
• Kristin McCoy, MD, American University of the Caribbean School of Medicine
PGY 3:
• John Calhoun, MD, University of Central Florida College of Medicine
• Elise McKenna, MD, New York Medical College
• Hebroon Obaid, MD, St. George’s University
PGY 4:
• Kamal Addagatla, MD, State University of New York, Buffalo, School of Medicine and Biomedical Sciences
• Basil Nwaoz, MD, Tufts University School of Medicine
• Kostantinos Poulikidis, MD, New York Medical College
PGY 5:
• Christian Cain, MD, University of Illinois College of Medicine
• Mohamad Zanbrakji, MD, Ross University School of Medicine
• Kristina Kramer, MD, University of Connecticut School of Medicine
2016 Graduates and Positions Taken
• Debbie Bakes, MD, Colorectal – Fellowship at Jackson Memorial Hospital/ University of Miami
• Elijah Min, MD – Fellowship at Transplant, NYU Medical Center
• Heather Player, MD – Fellowship at Surgical Oncology, City of Hope
Congratulations to our Chief Residents who have already been
accepted to fellowships in Trauma, Acute Care and Critical Care
Surgery. Dr. Christian Cain will be attending Maryland Shock Trauma
in Baltimore; Dr. Kristina Kramer will be attending Cook County
Medical Center in Chicago; and Dr. Mohamad Zanbrakji will be
attending Yale Medical Center in New Haven.
Departmental Education and Teaching Activities
Student Education
Dr. Marissa De Freese has been the surgical site clerkship
director for the past year. Her duties include providing
orientation (which includes expectations, responsibilities, key
paperwork for submission, and technical skills); coordinating
daily student activities (including bedside rounds, didactic
teaching sessions with attending faculty and residents, and other
similarly related educational activities); developing and revising
curriculum; providing ongoing formative feedback to students;
objectively assessing core competencies; reviewing summative
evaluation for mid-clerkship feedback; and conducting exit
interviews. In addition, Dr. De Freese provides weekly lectures
for the medical students while on rotation.
Surgical Residency Program
Program Director
Kevin Dwyer, MD, FACS
The Surgical Residency Program continues to attract bright students
from much of the East Coast with over 700 applicants this past year.
Our graduates leave with a deep and broad comprehension of
surgical care and technique. Almost all go on to highly competitive
fellowships in subspecialties. This year, our graduates went on to
fellowships in colorectal surgery at the University of Miami, transplant
surgery at New York University and surgical oncology at City of Hope.
Our goal is to develop excellent clinical surgeons with a broad range
of knowledge, with focus on areas such as quality, safety and team
approaches to healthcare delivery. If our chief residents did not want
to go onto a fellowship, we have given them a good basis to join a
general surgery practice after graduation.
New Interns (PGY-1)
• Rami Al-Aref, MD, Wayne State University School of Medicine
• Borna Dabiri, MD, University of California, Irvine, School of Medicine (Prelim)
• Ryan Duggan, MD, University of Connecticut School of Medicine (Prelim)
• Marissa Novack, MD, Ross University School of Medicine
• John Tedesco, MD, St. George’s University School of Medicine, Grenada
Department of Surgery: Annual Report 2016
2016 Clinical Annual Report 121
In November 2015, Dr. Kramer represented Stamford Hospital with
her winning presentation on “Time in Target Blood Glucose Range
is Associated with Survival in Trauma ICU Patients” in Boston at
the Region I, New England trauma paper competition and placed
second.
Dr. Debbie Bakes presented Effectiveness of Adding Transverse
Abdominus Plan (TAP) Catheters to Patient-Controlled Analgesia
(PCA) in Laparoscopic Colon Resections: A Retrospective Chart
Review” as a poster on May 1, 2016 in Los Angeles at the American
Society of Colon and Rectal Surgeons. This was also presented as an
oral presentation at the 1st Annual Research Day at Stamford Hospital
on May 19, 2016.
Residency Program: Scholarly Activity
An absolute requirement of a complete education is the
development of critical thinking skills through the intellectual
stimulation of research, which is highly encouraged in
the Department.
Residents were highly visible as presenters at state and national
conferences over the past year, including nine presentations at the
2016 Connecticut Annual and Scientific Meeting (CT-ACS).
Resident Abstract
The Stamford Hospital resident team, Drs. Kristina Kramer, John
Calhoun, and Marissa Novack, won second place in the 8th Annual
Surgical Skills Competition at the Connecticut CT-ACS meeting.
RESIDENT ABSTRACT
Hebroon Obaid, MD Endoscopic Revision of Lap Sleeve Gastrectomy: A Novel Approach
Borna E. Dabiri, MDMultiple Xanthogranulomas in the Setting of a Retropectoral Silicone Breast Implant. Faculty Mentors: Zandra H. Cheng, MD, Leif O. Nordberg MD, Elgida R. Volpicelli, MD, FCAP
Elise McKenna, MD A Contemporary Review of Firearm Fatalities in Connecticut
Marissa Novack, MDDiagnosing Muir-Torre Syndrome in a Patient with Non-Hodgkin’s Lymphoma and Sebaceous Carcinoma
John Tedesco, MD Phaeohyphomycosis Presenting as a Right Index Finger Mass in a Renal Transplant Patient
Basil Nwaoz, MD A Novel Technique for Spinal Wound closure
Kristin McCoy, MD*Differing methods of peritoneal flap closure in Laparoscopic trans-abdominal preperitoneal hernia repair affects post- operative pain and narcotic usage
John Calhoun, MDIntrathoracic Malignant Peripheral Nerve Sheath Tumor Compressing the Trachea in an 18-Year-Old Male with a History of Neuroblastoma Status Post Resection, Bone Marrow Transplant and Chemotherapy
Rami Al-Aref, MD Basal Cell Carcinoma: A case report on a unique presentation
*Kristin McCoy, MD – 2nd Place
2016 Clinical Annual Report122
Resident Awards 2015-2016
• Research Award: Debbie Bakes, MD
• Patient Care Award: Kristina Kramer, MD
• Teaching Award: Mohamad Zanbrakji, MD
Departmental Lectures/Visiting Professors
• “Is Halsted’s Model Still Relevant? Surgical Training Then and
Now,” David Daiho Yuh, MD, FACS, FACC, Surgical Director,
Heart and Vascular Center, Thoracic Surgery Residency Program
Director, Yale-New Haven Hospital, New Haven, CT.
• “Surgical Rescue: The Fifth Pillar of Acute Care Surgery,” Andrew B.
Peitzman, MD, Vice President for Trauma and Surgical Services,
the Mark M. Ravitch Professor of Surgery and Vice Chairman,
University of Pittsburgh Medical Center and Chief, Division of
General Surgery - Stewart King Lecture.
• “An Introduction to Skilled Nursing Facilities and Palliative
Care,” Christianne Bishop, Clinical Faculty, Geriatric Medicine.
• “Melanoma: A Case-Based Review and Update,” Laura
Sowerby, MD, Dermatologist, Harvard University Fellowship
in Mohs Surgery.
Other Educational and Scholarly Activities
The Division of Trauma Surgery and Critical Care hosted the
5th Annual Community Safety & Injury Prevention Fair in
October 2016.
The Division of Trauma Surgery and Critical Care hosted the
11th Annual Southwest Connecticut Trauma Symposium in
November 2016.
Strategy and Future Direction
Technology, healthcare delivery and financing are changing
rapidly. We heed the rejoinder from Satchel Paige: “Don’t look back.
Something might be gaining on you.” We will continue to bring that
newest and most advanced care to the people of Fairfield County,
but we will also remember to bring the most personal care. We are
looking ahead, toward, and with a plan to be, the future of surgical
healthcare in Fairfield County.
Department of Surgery: Annual Report 2016
2016 Clinical Annual Report 123 Surgery Family Lounge
Photograph: © Anton Grassl/Esto
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