Healing. Reimagined. - Stamford Health · Reimagined. changing the way patients think about their health. The Chairs begin with a year in review, which provides a sense of the scope

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


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.


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



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


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



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


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.


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.


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



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.


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


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%


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.


Suzy Shukovsky, MDAssistant Medical Director

Alexandr Rafailov, MD

Chair, ED Quality Review Committee

Douglas Gallo, MD EMS Medical Director


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


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


17 2016 Clinical Annual ReportPediatric Emergency Department


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.


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




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


• 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


• Dr. Joseph Connelly had a faculty appointment


• 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


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



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.



Patient Room


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.


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




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.


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


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



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


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


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.


Ellen S. Naidorf, MD

Director of Dermatology

33 2016 Clinical Annual ReportPatient Room


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


Noel I. Robin, MD

Director of Endocrinology


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


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.


Allison B. Ostroff, MDDirector of Geriatric Medicine

37 2016 Clinical Annual ReportMain Lobby


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


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


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



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


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


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


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


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


Michael Parry, MDThomas Jay Bradsell Chair of Infectious Diseases, Stamford Hospital

Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons


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


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.


Louise D. Resor, MDDirector of Neurology


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


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,


Anne Brewer, MD, MPH, FAAFPMedical Director of Palliative Care


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


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



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.


• 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



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


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.


Tomas Vietorisz, MD

Director of Rheumatology


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.


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.


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)


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.


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


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.


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.



• 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.


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.


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.


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


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


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


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


New Staff:

• Barry Whitt, MD Reproductive Endocrinology

Transitions:

The following Department members resigned in 2016:

• Mariel Focseneanu, MD

• Emre Seli, MD


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


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


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.


• 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.


• Spontaneous Orgasm with Movement after TOT Placement:

A Case Report, Sarah Elliott, MD; Brian Hines MD. State of

Connecticut Resident Research Day, Hartford Hospital.


• 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.


• 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.


• Intrahepatic Cholestasis of Pregnancy in Stamford, Ana Pantel,

MD. ACOG District 1 Annual Meeting. Toronto Canada.

August 2016. Poster Presentation.


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.


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%)


65 2016 Clinical Annual ReportMain Concourse


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.


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




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.


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.



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


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.



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


Medical Staff Hospital Committee Participation



• 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


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.


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.


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




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


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



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%


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)


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


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.


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.


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


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%



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


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


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.


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




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.


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


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




• 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


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




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.


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



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.


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


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.


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



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.


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.


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



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)

[email protected]

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


Residency: Diagnostic Radiology, Dartmouth-Hitchcock

Medical Center

Fellowship: MSK/MRI Radiology, Cornell University,

Hospital for Special Surgery


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


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


Jeffrey D. Kleinman, MD (Off-Site 2747)

Office Location: Solon, Ohio


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


Anthony J. Minotti, MD (Off-Site 2747)

Office Location: Olmsted Township, Ohio



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


William Caragol, MD (On-Site Tully ext. 7782)



Medical School: New Jersey College of Medicine

Residency: New York Hospital, Cornell Medical Center


Lily Kernagis, MD (On-Site Tully ext. 7710)



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


Valencia King, MD (On-Site Tully ext. 7710)


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


Residency: Diagnostic Radiology, Dartmouth-Hitchcock

Medical Center

Fellowship: MSK/MRI Radiology, Cornell University,

Hospital for Special Surgery


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



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


Medical School: New York Medical College

Residency: Diagnostic Radiology, Harbor UCLA Medical Center

Fellowship: Neuroradiology, Harbor UCLA Medical Center


John R. Wohlwend, MD (Off-Site 2747)

Office Location: Henderson, Nevada


Medical School: Ohio State University College of Medicine

Residency: Diagnostic Radiology, Henry Ford Hospital

Fellowship: Neuroradiology, Northwestern University Program/

McGaw Medical Center


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



Residency: Diagnostic Radiology, Eastern Virginia Medical School

Fellowship: Vascular & Interventional Radiology, Columbia

University Medical Center


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


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


Neuro Imaging

Howard Liu, MD (On-Site Hospital ext. 7790)

Director of 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


Medical School: Kirksville College of Osteopathic Medicine

Residency: Diagnostic Radiology, Cleveland Clinic Foundation

Fellowship: Neuroradiology, University of Michigan


John D. Grimme, MD (Off-Site 2747)

Office Location: Eugene, Oregon


Medical School: University of Cincinnati College of Medicine

Residency: Diagnostic Radiology, University of North Carolina

Fellowship: Neuroradiology, University of North Carolina



Anthony J. Minotti, MD (Off-Site 2747)

Office Location: Olmsted Township, Ohio



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


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


Katherine M. Gyves-Ray, MD (Off-Site 2747)

Office Location: Kansas City, Missouri



Residency: Diagnostic Radiology, University of Michigan

Fellowship: Pediatric Radiology, University of Michigan Hospitals,

C.S. Mott Children’s Hospital


Laura J. Hanahan, MD (Off-Site 2747)

Office Location: Columbia, Missouri


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


Michelle A. Hercher-Galvez, MD (Off-Site 2747)

Office Location: Portland, Oregon


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


Michael E. Katz, MD (Off-Site 2747)

Pediatric Medical Director

Office Location: Boca Raton, Florida



Residency: Diagnostic Radiology, Mallinckrodt

Institute of Radiology

Fellowship: Pediatric Radiology, Mallinckrodt Institute of Radiology


Sandra G. Machado, MD (Off-Site 2747)

Office Location: Lincoln, Nebraska


Medical School: River Plate Adventist University

Residency: Diagnostic Radiology, Loma Linda University

Fellowship: Pediatric Radiology, Loma Linda University


Radiation Oncology

Frank A. Masino, MD (On-Site Hospital ext. 6230)


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)


Specialty: Radiation Oncology


Residency: Radiation Oncology, Yale New Haven Hospital

Board Certification: Radiation Oncology

2016 Clinical Annual Report100



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)



Residency: Diagnostic Radiology, Winthrop University Hospital

Fellowship: Neuroradiology, Northwestern University, Chicago;

Vascular & Interventional Radiology, Columbia University

Medical Center


Josef Noga, MD (On-Site Hospital ext. 7787)

Director of Interventional Radiology



Residency: Diagnostic Radiology, Eastern Virginia Medical School

Fellowship: Vascular & Interventional Radiology, Columbia

University Medical Center


Brian Stainken, MD (On-Site Hospital ext. 7881)

Chairman, Department of Radiology



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


(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



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.


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.


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



• 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.


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.


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.


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,




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


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


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.



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


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


Charles E. Littlejohn, MD Director of Colon and Rectal Surgery

John D. Dowdle, MD Director of Hand Surgery


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


• 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


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


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


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.


Harold S. Gewirtz, MDDirector of Plastic andReconstructive Surgery

Jeremy A. Bier, DPMDirector of Podiatry


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


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.


Kevin M. Dwyer, MDDirector of Trauma and Critical Care


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


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


Timothy Manoni, MDDirector of Vascular Surgery


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


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


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.


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



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


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.


2016 Clinical Annual Report 123 Surgery Family Lounge


StamfordHealth.org

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