MIT Reports to the President 1994-95

Medical Department

This has been an eventful year. The almost two year effort to develop a strategic plan for the Department was realized and a robust document has been produced and distributed. The plan includes immediate operational efforts to reduce costs. Strategic efforts to position the Department for the future have been developed to proceed incrementally, realizing the restlessness of the external environment with mergers and deals, and the financial problems faced by MIT.

The Strategic Plan completion dovetails nicely with the commencement of work by a blue ribbon panel to evaluate medical benefits and provision of those benefits internally by the Department. The task of the Panel will be helped by the data gathered for the Strategic Plan and by a consultant working with the Panel.

Major changes have occurred in leadership areas essential to the vitality of the Department. Executive Director Linda Rounds migrated to the Washington, D.C. area. The appointment of Ms. Annette Jacobs followed a national search and the very active participation of a highly representative committee that included individuals from central MIT administration, nonmedical and medical members of the Department. Arriving here after a decade of service as Executive Director in the Department of Medicine at Boston University Medical School, Ms. Jacobs made her entry on Halloween Day and her efforts on multiple fronts have been a treat for the Department and for MIT.

Dr. Michael Kane, Associate Medical Director for a decade, made a decision to return to full time practice in the autumn of 1994. He continues to serve the Department in many areas, centering around patient care, but including contributions to many of the important committees of the Department. Fortunately, his outstanding clinical, teaching and administrative abilities remain at MIT to serve patients, colleagues and the Institute. Finally, Dr. J. Christian Kryder, stepped down as Assistant Medical Director for Planning in July 1994 after the strategic planning process was completed. He has continued to serve the Department and his patients, but will be leaving us to assume a major administrative-managerial role with a national health group.

I have been very fortunate to be able to recruit from the Departmental ranks Dr. William Kettyle, who serves as Associate Medical Director, with responsibilities that embrace many of the roles previously assigned to Dr. Kane and Dr. Kryder. He joins me and Ms. Jacobs in a new leadership team working closely in a six member operations group, as well as with Vice President for Administration, James J. Culliton. We are organized and energized to move forward with operational and strategic changes to better serve MIT and its students, staff and faculty.


Dental Service: Cynthia Stevens, D.D.S., Chief

During this year a business plan emphasizing the needs, strengths and weaknesses of the Dental Service was developed. The aim is to bring the Service to a point where queues are reduced and patients can be evaluated and cared for as rapidly as is conveniently possible. The hope is that with some expansion in providers and reevaluation of fees and with the consideration of an incentive model for providers, we can reach the goal of becoming a revenue neutral Service.

Medical Service: William A. Ruth, M.D., Chief

A number of changes have occurred in staffing, including those related to Dr. Michael Kane, Dr. J. Christian Kryder and Dr. William Kettyle, as noted in the Introduction. Internists continue to meet monthly for a business meeting focusing on issues such as patient confidentiality, teaching, preventive practices and a variety of testing measures that can be routinized in the best interest of patient care. The Off Hours Clinic area under the direction of Dr. Leigh Firn has seen improvement in the flow through of patients, especially on weekends, through the development of an appointment system. In addition internists are meeting in primary care rounds and nurse practitioners and physician assistants have joined in these conferences which we plan to expand to meet weekly in the near future. Improvements in information systems have included the addition of voice mail for all internists as well as the addition of computers to each of the provider offices. This has enabled such basic inquiries as scheduling of providers, scheduling of patients, renewing of pharmacy prescriptions, inquiries regarding laboratory tests and internal communication through the use of E-mail. There was broad participation by primary care providers in the advanced cardiac life support course that was given recently.

Off Hours Service: Leigh M. Firn, M.D., Coordinator

Emergency and urgent care are provided on a 24 hour basis by the After Hours Service which is staffed by a roster of Department internists and nurse practitioners and by part time internists and pediatricians from leading hospitals in the Boston area. Over the past year weekend volume has increased significantly, sometimes resulting in long patient waits. By instituting a same day appointment system for the peak weekend hours, this has smoothed the patient load and allowed us to maintain a high standard of quality care, while not inconveniencing patients. The change has been universally welcomed by patients. We continue to conduct focused quality assurance reviews of common medical problems seen on the Service, update our equipment and medications and reeducate our staff in emergency procedures including advanced cardiac life support.

Inpatient Medical Service: Elaine L. Shiang, M.D., Chief

For the period ending June 1, 1995, the Unit had a total of 577 admissions with an average length of stay of 3.7 days which is down from 5.5 days in the previous year. With the resignation of Head Nurse Theresa Connolly, Ms. Marie Avelino was appointed Head Nurse and has immediately established a leadership role in the Unit. There were 152 Clinical Research Center (CRC) admissions this past year. These included patients being studied for amino acid metabolism, neurologic disease and sleep metabolism. Minor changes and renovations are under way to provide the CRC with more efficient use of laboratory space in the Inpatient Unit. The Utilization Committee completed a year long survey of student admissions indicating that over 85 percent of those students hospitalized needed intravenous therapy, antibiotics or other measures that required a hospital setting. Discussions are under way regarding the optimal use of the Unit for Medicare patients. Therapeutic phlebotomies have been added to the list of procedures that are now performed in the Inpatient Unit which continues to serve broad segments of the MIT community in a unique and exemplary fashion.

Obstetrics and Gynecology Service: Lori A. Wroble, M.D., Chief

The year commenced with the retirement of Dr. Charles Eades after 29 years at MIT, but even with the loss of his clinical hours, the Service had one of its busiest years with 8,820 visits, 207 deliveries, 68 surgeries including 44 major surgeries. In addition to the retirement of Dr. Eades, Dr. York left to assume a full time position at the Massachusetts General Hospital and has been replaced by Dr. James Marquardt as a full time member of the staff. We have assessed ways in which procedures can be brought in-house and the purchase of two items of equipment have made this possible, a fetal monitor for performance of non-stress test service was acquired and patients now can be conveniently tested at MIT rather than having to make the journey to Brigham and Women's Hospital. All new nursing assistants have been trained in monitoring and to date 159 tests have been performed that have saved us a total of almost $40,000 for this year. We recently also acquired Leetz equipment for the performance of cervical Cone biopsies, procedures that likewise were performed at Brigham and Women's Hospital. Ms. Karen Halvorson, RNC, has continued to coordinate the Infertility Consult Committee which assessed 35 new couples referred for initial infertility evaluation. All members of the staff participated in the IAP lecture series given in January and these offerings were received enthusiastically. Dr. Liau and Dr. Wroble have been asked to supervise residents in the clinic at Brigham and Women's Hospital. Additionally, members of the Service have been advising premed students at MIT and teaching first year students in the HST program during their rotations in the Medical Department. This has been a very active year and we look forward to implementing a variety of other in-house services that will provide value for our patients while reducing costs to the Department.

Pediatric Service: Mark A. Goldstein, M.D., Chief

During the year we were able to improve patient flow through improvements in triage, coordination and processing of patient needs. The Service area was renovated allowing the waiting area to become more patient friendly with office space more efficiently and conveniently set and wall space better able to be utilized for patient activities as well as to make it possible to interact with the Pharmacy without flooding the Pharmacy area with young children and their parents.

Psychiatric Service: Peter Reich, M.D., Chief

Total numbers of patients and individual visits remained at peak levels and inpatient days and outside hospitals decreased somewhat as partial hospitalization days increased, reflecting a trend toward greater utilization of less secure, less costly, facilities in the care of psychiatric patients. At the same time utilization of the MIT Inpatient Unit fell significantly. Trainees from the Longwood Psychiatric Residency Program at Harvard Medical School served the Department well and were likewise able to receive a great deal of on site training. Community services provided by Psychiatry are in great demand. Of special note are the Wives Group for spouses of international students, the ongoing liaison program with the counseling and housing deans, consultation to the Committee on Academic Performance, and consultation to the Institute administration. Together with Social Work Service, Health Education and primary care medicine, members of the Psychiatry Service are planning a community initiative to address the problem of binge drinking by MIT undergraduates.

Social Work Service: Ronald C. Fleming, LICSW, Chief

The missions of the Social Work Service are to assist the Medical Department in responding to health care needs of those who work, study and do research at MIT as well as to contribute to the development and maintenance of an environment facilitating such activities. We play an important part in assisting the community in adjusting to local pressures that are generated by financial retrenchment, position attrition, re-engineering, regional and national pressures, all of which have had an effect in altering the infrastructure of mental health and health care services.

Clinical activities included a request from 170 persons (up 18%), including 352 (up 23%) new requests for assistance during this fiscal year. The Social Work Service continues to provide on site direct clinical services at the Lincoln Laboratory. Through the use of groups the Social Work Service could flexibly respond to community needs. The many groups that have commented upon in previous years continue. Many others are time limited. One new group was added in response to community interest. In addition, the Service operates a clearing house for self help organizations most of which meet within the Medical Department building. Community social work is another vital part of our activities and active contributions are made to the environment of all MIT constituencies. Minority student concerns, elder care issues, Women's Advisory Group interactions, Human Service Network group, assistance for the Equal Opportunity Officer are all continuing activities that relate to community social work. The Institute Personal Assistance Program celebrated its sixteenth year and provided on site assistance to the entire community. This year the impact of MIT's commitment to reengineering created special demands for these services. Nowhere was this plainer than in response to the employees at the Office of Laboratory Supply where considerable time was spent with senior managers, line supervisors and employees as MIT implemented decisions which affected the role of the laboratory and the loss of jobs. Within the Medical Department the Social Work Service contributes to numerous activities both in a consulting way for ambulatory patients as well as the Inpatient Unit, meeting with nurses as well as seeing patients.

Surgical Service: Stephen J. Healey, M.D., Chief

With reduction of staffing to two members there has been significant increase in their individual activities in clinic as well as the day surgery here at MIT and in the operating room at Mount Auburn Hospital..

Nursing Service: Janet V. Beyer, RNC, Chief

The activities of the Nursing Service revolve around the ambulatory service in which nurse practitioners and physician assistants work side by side with members of internal medicine, the specialty clinics, After Hours Service, and the clinical research activities of the CRC. The Inpatient Unit had a change in Head Nurse leadership and has continued to be a busy resource serving the entire student and staff MIT community. In addition, the Nursing Service extends to Lincoln Laboratory where we have a physician/nurse covering on a daily basis and where a variety of educational programs have been initiated. Three other areas are important to note for contributions of the Nursing Service. Community service has included a variety of orientation and screening activities, work with MedLinks as an outreach to students, vaccination activities including influenza, hepatitis B, educational activities in the IAP period in January 1995 and with the MedLinks Spring Fling. Continuing education has included an annual education day that was held at Wellesley College. CPR recertification totaled 40 participants that included three members of the Nursing Service. Finally, Infection Control has been a vital area for contributions of the Nursing Service through coordinator, Dolores Vidal. She has been the principle associate to Dr. David Diamond in the Infection Control Committee and has coordinated a variety of orientation programs, vaccine programs and communicable disease reporting and follow up.


MIT Reports to the President 1994-95