MIT
Reports to the President 1994-95
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.
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.
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.
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.
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.
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.
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.
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.
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.
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..
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.
OTHER DEPARTMENT ACTIVITIES
MIT
Reports to the President 1994-95