2003 Annual Report

RANKED

AMONG

THE BEST

Y ale-New Haven has been included on U.S. News & World Report’sannual “America’s Best Hospitals” issue for the past 11 years for

several of its specialties. In 2003, Yale-New Haven Hospital wasranked among the best in the country in 12 of the 17 medical spe-cialties evaluated. YNHH’s 2003 annual report examines those 12specialties, which include:

1

Of those, Yale-New Haven’s geriatrics and psychiatry departments are ranked among the nation’stop 10, and the digestive disorders, gynecology, respiratory disorders and urology departments areranked among the top 25. Yale-New Haven Hospital, named in 12 specialties, placed second amongall New England hospitals, ranking behind Massachusetts General Hospital, which was named in 14specialties. Clearly those are not the only areas in which Yale-New Haven excels. In fact, nearlyevery department listed in U.S. News and World Report this year credited collaboration with otherdisciplines as crucial to its success.

RANKED AMONG THE BEST

CANCER

DIGESTIVE DISORDERS

EAR, NOSE & THROAT

GERIATRICS

GYNECOLOGY

HORMONAL DISORDERS

KIDNEY DISEASE

ORTHOPEDICS

PEDIATRICS

PSYCHIATRY

RESPIRATORY DISORDERS

UROLOGY

To be named among thebest hospitals in the U.S. recognizesthe commitment and skills that our physicians,employees and volunteers bring to our patients everyday.We are proud to be recognized for our accomplishments, andare grateful for the progress we have been able to make for our patients.”

Joseph A. Zaccagnino, President and CEO

“

We are pleased to have Yale-New Haven Hospitalso well represented in the U.S. News & World Reportlisting. While it is not a scientific study or a true indicator of quality of care, still it does reflect national recognition of the expertisethis institution provides and the reputation of our medical staff and our services.”

“

Peter N. Herbert, M.D., Chief of Staff

The best way to be a cutting edge cancercenter is to learn the languagecancer cells speak and outsmart them.”

“

“

Ranked Among the Best

The trickis to get thepatient’s own immunesystem to attack the cancer.”

Richard L. Edelson,M.D., director, YaleCancer Center

(clockwise from top): Danielle Jef frey, R.N.; photopheresis patient Joseph Lawrence; bone marrow transplant patient Bob White with Dr. Richard Edelson

32

}CANCER

T he Yale Cancer Center (YCC)

is part of a select network of

comprehensive cancer centers

around the country — and the

only one in southern New

England — as designated by the

National Cancer Institute (NCI).

Bringing together the resources of

Yale-New Haven Hospital and

the Yale University School of

Medicine, its mission encompass-

es patient care, research, cancer

prevention and

control, communi-

ty outreach and

education. The

three organizations

recently teamed up

to open the new

Yale-New Haven

Breast Center.“Being a NCI-

designated cancer cen-

ter gives us the oppor-

tunity to access the latest novel

therapies along with an outstand-

ing team of experts spanning the

spectrum of important cancer dis-

ciplines,” said Dr. Edelson. The

cancer center brings together

expertise in oncology surgery,

pediatric surgery, radiation thera-

py, medical oncology, gynecology

oncology, hematology and many

other specialties, as well as a

newly expanded Yale-New Haven

Breast Center.Dr. Edelson believes that the

immune system holds the key to

the treatment of several cancers.

“The trick is to get the patient’s

own immune system to attack the

cancer cells,” he said. The process

is called transimmunization and

Dr. Edelson has been on the

ground floor of this field, called

cancer immunology,

for most of his

career. “I believe

we are at a water-

shed moment in

the care of can-

cer.”“Patients are

cared for by pri-

mary nurses, most

of whom have

over eight years’

experience in oncology nursing

and who hold special certification

for chemotherapy administra-

tion,” said Catherine Sumpio,

R.N., patient service manager.

“The treatment center provides

state of the art cancer therapy

and highly supportive care, which

helps maximize patient function-

ing and prevents hospitalization.”

“

“

Our greatest strength is keeping our long tradition ofdoing basic research that advances ourunderstanding of how the digestive system works.”

Ranked Among the Best

Michael H. Nathanson, M.D., Ph.D.,chief of digestive disorders

This non-invasivemethod obviates the needfor surgery, which these sorts ofcommon conditions always used to require.”

4 5

(p. 4): Colonoscopy patient Frank Tramontano (p. 5, clockwise from top): Dr. Morris Traube; Frank Tramontano; W. Keith Marquant and Linda Kinney, R.N.

DIGESTIVE DISORDERS

}W e have world experts in an unusu-

ally broad range of areas,” said Dr.Nathanson. Among them are special-ists in bile formation in the liver,bleeding and liverdisease, hepatitisC, pancreatitis,motility disordersand disorders of theesophagus, colon dis-eases and inheriteddiseases of the liver.

“Although our cli-nicians practice thefull gamut of treatingdigestive diseases, weare fortunate to havewell-recognized expert-ise in many special clinical areas of digestivediseases,” said CynthiaDabbraccio, R.N., patient service man-ager. “We have been fortunate, too, inhaving a very collegial, team approachbetween nursing and medical leader-ship in the GI Procedure Center,a major site of activity for digestivediseases at Yale-New Haven Hospital.”

Revolutionary to gastroenterologyhas been the development of the fiberoptic endoscope. “The endoscope is a

powerful tool that allows doctorsto visualize what’s going on insidethe patient and do things like

remove polyps and cauter-ize bleeding ulcers,” saidDr. Nathanson. “This non-invasive method obviatesthe need for surgery, whichthese sorts of common con-ditions always used torequire.”

A distinctive feature ofthe section of digestive dis-orders at Yale-New Havenis its teaching program,which over the past 50years has produced a largenumber of chiefs of gas-

troenterology and hepatology, chairsof medicine and deans of medicalschools around the country. The sec-tion of digestive diseases has long beenand continues to be at the forefrontnationwide in research, clinical careand training.

“

Ranked Among the Best

The future ofotolaryngology looks bright withsurgeons and nursing staff collaboratingto produce the best patient outcomes available.”

“Peter Longley, R.N.,patient service manager

6 7

}

“The advanceswe have been able to makeare not so much reflected in cure ratesbut in terms of improving patient comfort and lifestyle.”}Clarence T. Sasaki, M.D.,

chief of otolaryngology

patients who undergo surgery and recov-er reasonably well so they can continueto speak and swallow.”

The section’s highly collaborativeapproach to care includes otolaryngolo-gy, medical oncology, plastic surgery,neurosurgery, dermatology, radiationtherapy, head and neck radiology, oralsurgery and surgical pathology.

Otolaryngology has a particularlybusy pediatric practice with patientswho are treated for a broad range of

problems such as congenital abnormali-ties, hearing and chronic nasal problems,cochlear implantation, recurring drooling,obstructed sleep apnea, airway problemsand oral rehabilitation.

A communication disorders center(CDC) diagnoses and treats both chil-dren and adults with hearing, speech orbalance disorders. The CDC offers reha-bilitation services for people recoveringfrom a stroke or following a laryngectomy,voice or swallowing disorders, and vertigo.

EAR, NOSE & THROAT(below): Dr. Sasaki and Shelley Jolie, R.N.

(above): Dr. Clarence Sasaki and Anne McHugh

T he section of otolaryngology, underthe direction of Clarence T. Sasaki,

M.D., the Charles W. Ohse Professor ofSurgery at the Yale School of Medicine,offers a broad range of services for dis-eases affecting the ear, sinuses, larynxand pharynx.

The section is probably best knownfor its head and neck cancer servicewhich consists of a team of dedicatedphysicians and surgeons joined by skilledrehabilitation specialists in speech, swal-

lowing and hearing restoration. As partof the Yale Cancer Center, the teamoffers expert care for tumors of the skullbase and other malignancies of the headand neck.

“The advances we have been able tomake are not so much reflected in curerates but in terms of improving patientcomfort and lifestyle,” said Dr. Sasaki.“Innovative procedures introduced ordeveloped here have made a differencein the lives of head and neck cancer

Are the problems associated with old ageinevitable or are many ofthem predictable and preventable?

Ranked Among the Best

What makesthe geriatrics section astrong team is their commitmentto holistic care of our older patients.”

“

8 9

In both areas, a diverse team ofprofessionals — which can includegeriatric physicians, nurses, socialworkers, patient care associates, phar-macists, physical and occupationaltherapists, dieticians and a clinicalpsychologist — is dedicated to pre-serving the independence of older per-sons.

“What makes the geriatric sectiona strong team is their commitment toholistic care of our older patients,”said Catherine Bursey, R.N., patient

service manager. “They embrace a mul-tidisciplinary team approach, valuingevery team member’s contribution inassisting these patients back to theiroptimal level of functioning.”

“Training general physicians in thespecial problems of the frail elderly isalso a high priority for us," said LeoCooney, M.D., who leads the section.“The medical center offers wonderfulopportunities for training and its lead-ership is committed to this effort.”

Catherine Bursey, R.N.,patient service manager}

GERIATRICS(left to right): Elsie Spivey and Linda Voisine; Dr. Leo Cooney and Joseph Defrancesco

(left): Linda Voisine, phlebotomist, and Joseph Defrancesco

I t is a question that has been asked,and answered, at Yale-New Haven

Hospital, well known throughout thecountry for its expertise ingeriatric services.

Over the past decade,geriatric researchers at Yale-New Haven were among thefirst to study the causes and prevention of commonhealth problems among theelderly, such as falls, injuries,delirium, functional declineand driving difficulties.While the prevailing opinionis that these are inevitableproblems of growing older,investigators now believe that suchconditions, while common and associ-ated with morbidity, are also pre-dictable and preventable.

“As people grow older theybecome increasingly diverse,” saidMary E. Tinetti, M.D., director of

Yale’s program on aging andthe Claude D. Pepper OlderAmericans IndependenceCenter. “While manyremain generally healthyand active, others developa variety of impairmentsand diseases that putthem at risk.”

The Dorothy AdlerGeriatric AssessmentCenter, the section’soutpatient consultative

service, provides compre-hensive evaluation of older people.

When hospitalization is needed,the continuing care unit is the geriatric inpatient rehabilitation unit.

“

Ranked Among the Best

Specially trainednurses, dedicated to the care of women, work closely withthe medical team to provide collaborative care.10 11

}Charles J. Lockwood, M.D.,chief of obstetrics, gynecologyand reproductive services

Not only does ourteam have the knowledgeand ability to thoroughly interpret,understand and implement the best andmost appropriate treatments for women,but in fact we often discover them.”

GYNECOLOGY

(clockwise from top): Dorothy Lawrence with Sybil Kehaya, R.N.; Marilou Erickson with Kate Osmanski, R.N.; Dr. Charles Lockwood with staf f

D octors at Yale-New Haven inventedfetal monitoring, the first screening

test for premature delivery and manyfetal diagnostic and treatment tech-niques. They helped pioneer obstetri-cal ultrasound, in vitro fertilization,minimally invasive gynecological sur-gery, contraceptives and new treat-ments for ovarian cancer.

Patient care, medical education and scientificresearch form a strong foun-dation, and a talented staffof both university- and com-munity-based obstetriciansand gynecologists provide acontinuum of care towomen in their pre-repro-ductive, childbearing andmenopausal years.

With close to 5,000 babies borneach year at the Yale-New HavenChildren’s Hospital, the mainstay ofcare is obstetrics. The hospital is inter-nationally known for its high-risk mater-nity care, and the division of reproduc-tive endocrinology and infertility pro-vides a full line of services for womenfrom menstruation through menopause.

The division of gynecologic oncol-ogy has become a center of care forwomen diagnosed with gynecologiccancer or pre-cancerous conditions.“What brings us national attention isbeing a leader in research related togynecologic cancer,” said Peter E.

Schwartz, M.D. Recently,the division has developeda potent new, non-toxictreatment for advancedovarian cancer.

Rounding out thedepartment is a divisionof urogynecology andreconstructive pelvic sur-

gery that offers evaluationand treatment of urinaryand fecal incontinence, uri-

nary tract disorders, uterovaginal pro-lapse and vulvar pain syndrome.

“We have a 36-bed dedicated unitfor patients with gynecologic cancer,high-risk pregnancies and infertility,”said Tracy Carafeno, R.N., patient serv-ice manager. Specially trained nurses,dedicated to the care of women, workvery closely with the medical team toprovide collaborative care.

“

Ranked Among the Best

Endocrinology atat Yale-New HavenHospital and Yale University isnationally recognized for their long- standing contributions to outstandingclinical care and ground-breaking researchinto the causes, diagnosis and treatment of avariety of endocrine conditions.”

1 2 13

Arthur Broadus, M.D.,chief of endocrinology}

(p. 12): Dr. Sillvio Inzucchi and Irene Hill; (p. 13, clockwise from top): a busy endocrinology clinic; Dr. Inzucchi with Rober t Altshuler

“H istorically, our major research inter-est has been in the areas of dia-

betes, insulin resistance, calciummetabolism and osteoporosis,” saidSylvio Inzucchi, M.D., clinical directorof endocrinology, whichincludes the Yale DiabetesCenter (YDC), theMultidisciplinary Thy-roidClinic and the Yale BoneCenter.

He added, “Our clinicalexpertise also encompassesrenal stone disease, adrenaland pituitary conditions, andrare hormonal syndromes.What makes us unique is ourstrong links to other top specialists,including cardiologists, endocrine sur-geons, vascular surgeons, neurosur-geons and researchers throughout themedical center.”

The Yale Diabetes Center serves asa regional resource for diabetes care

and education. The YDC cares formore than 1,500 patients with type 1and type 2 diabetes, with a strongemphasis on strict glucose control andaggressive management of cardiovas-

cular risk factors to pre-vent or forestall the long-term complications ofdiabetes. The new book-let, YDC Diabetes Factsand Guidelines, has anational circulation ofmore than 100,000. Inaddition, the section ofendocrinology is wellknown for the evalua-

tion and management ofpatients with pituitary disease, withspecific expertise in treating a varietyof neuroendocrine diseases, includinghypopituitarism, pituitary tumors,Cushing’s disease, acromegaly, prola-cinomas and adult growth hormonedeficiency syndrome.

HORMONAL DISORDERS

Lillian Falko, R.N., M.S.N.,clinical nurse specialist}I believe

we have the bestgroup of professionals working to make life easier forpeople with endocrine problems.”

“

“I believe we have the best groupof people working to make life easierfor patients with endocrine problems,”said Lillian Falko, R.N., M.S.N., clini-cal nurse specialist. “We work togetheras a team, always putting the patientand family first, and we work extreme-ly well together because ‘teamwork’ isour motto. It is a high standard that weall strive for together.”

One of the manycritical strengths ofnephrology at Yale-New HavenHospital is our contributions to theunderstanding of hypertensive diseases relatedto genetic disorders.”

“

Ranked Among the Best

Stefan Somlo, M.D.,chief of nephrology

14 15

This section isexceptionally strong inthe interplay between understanding blood pressure from research to bedside.”

“

}

}Mark Perazella, M.D.,director of dialysis services

B lood pressure control is the begin-ning and end of kidney disease ther-

apy. Understanding the pathogenesisof blood pressure is very important toadvancing the field,” said Dr. Somlo.

“This section is exceptionallystrong in the interplay between under-standing blood pressure from researchto bedside,” agreed MarkPerazella, M.D., director ofacute dialysis services. “Wehave led the way in studyingfamilies with inherited formsof high or low blood pres-sure to identify genes thatunderlie blood pressure con-trol. From this work, an oldidea has been reborn — sodi-um handling by the kidney isessential for blood pressurecontrol. That understandinghas entered into our dailythinking on how we treat patientswith hypertension.”

The section of nephrology at Yale-New Haven is home to many outstand-ing clinician-teachers who are recipi-ents of major research awards and whohave prominence in their respectivefields. With funding from National

Institutes of Health, the PolycysticKidney Disease (PKD) Center atYNHH has earned national impor-tance in its research and treatment ofPKD — one of the most commonhereditary diseases affecting all racesand both genders equally.

A large kidney failure programprovides primary care toover 250 patients with end-stage renal disease (ESRD)who are treated with eitherhemodialysis or peritonealdialysis. Chronic kidneydisease is a growing healthcare problem that requirescoordinated subspecialtycare by nephrologists.

“We provide cuttingedge treatment to patientswith this complex diseasestate,” said Dr. Somlo. “We

see the range from rare diseases andcomplicated anomalies to the morecommon forms of kidney diseaseresulting from hypertension or dia-betes. Our partnership with interven-tional radiology, vascular surgery andtransplant surgery allows us to provideurgent care to all of these patients.”

KIDNEY DISEASE

“

(clockwise from top): Dr. Mark Perazella and Angela Aconfora; Cynthia Thorne, R.N.

Orthopedics atYale-New Havenhas a spectacular team,but if you put exceptionalpeople in the middle of the desert,you don’t get the same results.”

“

Ranked Among the Best

Gary E. Friedlaender, M.D.,chief of orthopedics

Those are theingredients of world class care.No mystery…but lots of magic.”

16 17

“

}(p. 16): Jason Graham and Mohammad Abedin, physical therapist; (p. 17, clockwise from top): Maria Maiaroto, R.N., and Charles Benton;

Dr. Gar y Friedlaender per forming knee surger y; Mohammad Abedin

ORTHOPEDICS

W e are not working in an isolatedenvironment; rather we benefit

from a well-run academic medical cen-ter where we use our many resourcesto the patient’s best advantage,” saidDr. Friedlaender, who believes itrequires expert teamwork to haveone’s clinical services rec-ognized at a national level.“It’s a combination of envi-ronment and people — wehave the ability to attractand retain outstanding clini-cians and let them use thisnurturing environment toreach their full potential.”

The wide range of servic-es within Yale-New Haven’sorthopedics program con-tributes to its success. Itincludes expertise in: musculoskeletaloncology; total joint replacement;hand and upper extremity disorders;sports medicine; trauma; pediatricorthopedics; spine; foot and ankle;podiatry; as well as physical medicineand rehabilitation.

“You can’t accomplish world classcare in orthopedics in isolation,”explained Dr. Friedlaender, who saidthe department works very closely

with several services, such as diagnos-tic imaging, pathology, medicine, theYale Cancer Center, surgery, neuro-surgery and pediatrics. “The additionalfact that YNHH reflects a partnershipbetween full-time university faculty

and community-based physi-cians makes the program even

stronger.”He cites the energy and

devotion of the inpatient,outpatient and operatingroom nurses. “It’s a wonderfulgroup, and when you get allthe great instruments tunedtogether, you create anorchestra capable of produc-ing a creative, compelling

and accomplished symphony.It begins with answering the

phone, includes the staff’s welcomingattitude, the facility’s ability to pro-vide the advanced technological serv-ices that patients expect and deserve,and having care-givers who have notonly expertise, but an ability to applytheir skills in a timely, compassionateand sensitive manner.”

“Those are the ingredients ofworld class care. No mystery … butlots of magic.”

“

The Yale-New HavenChildren’s Hospital opened just 10 years ago, and already itsaccomplishments have been impressive.”

“

Ranked Among the Best

“

We truly believe that family-centered careand a partnership between the health careteam and the child’s parents creates the best outcomes. ”18

“

Margaret Hostetter, M.D.,chief of pediatrics}

Cathy Stevens, R.N.,patient service manager }

I n addition to ranking nationally inour pediatric services, I think our

biggest contribution is how well wetranslate research findings to improve-ments in clinical care for children, andthose are very real benefits felt bychildren at home and in the communi-ty,” said Dr. Hostetter.

“So much of the department’sstrength relates to the marriagebetween research and clini-cal care,” said MichaelApkon, M.D., the medicaldirector of the pediatricintensive care unit. “As oneof the largest recipients ofNational Institutes of Healthfunding, we are able to bringnew understanding of dis-ease to the patient’s bed-side,” he explained.

Advances in diabetescare, interventional cardiolo-gy, infectious diseases and cysticfibrosis care have kept the Yale-New Haven Children’s Hospital(YNHCH) at the cutting edge ofpediatric services. Collaborationbetween the hospital’s highly-traineddoctors and nurses is advancing science to help infants and children.

“Our ability to collaborate with abroad range of pediatric specialistsallows us to provide the rightresources and care,” said CathyStevens, R.N., patient service manager.“We truly believe that family-centeredcare and a partnership between thehealth care team and the child’s par-ents creates the best outcomes,” addedStevens. Other strong services at the

Children’s Hospital includethe treatment of asthma,cancer, cardiac problemsand endocrine disorders.

According to Dr.Hostetter, the newbornspecial care unit, pedi-atric emergency room,pediatric critical careunit and children’s sur-gery services are“superb.” She added,“We are the only level1 trauma center forchildren in the stateof Connecticut, andone of but a few

children’s hospitals in thecountry that provide anesthesiologiststo respond to children’s pain 24 hoursa day.”

(p. 18): Eight-year-old Paige Raf fer ty and her mom; (p. 19, clockwise from top): Third-year medical student Anil Vedula and pediatric patient Davin Fischer; Haley Mossa with her parents; Sarah Gusatella and her daughter Amber

PEDIATRICS

19

What makesour psychiatry servicespecial is the combinationof research and teaching.”

“

“

Ranked Among the Best

“

Benjamin S. Bunney, M.D.,chief of psychiatry

Leslie O’Connor, A.P.R.N.,

clinical director, Yale-New

Haven Psychiatric Hospital

Another big strengthis our ability to create a therapeutic environment, in which

everyone works together to make this

a safe place for patients to get well.”

W e teach what is discovered throughresearch to residents who then go

out and practice with that newknowledge, which in turn bene-fits patients,” said Dr. Bunney.

Yale-New Haven Hospital, aleading center for comprehen-sive psychiatric care, has beenconsistently ranked among thenation’s top 10 hospitals forpsychiatric services in U.S.News and World Report. Thepsychiatric services include the70-bed inpatient services of theYale-New Haven PsychiatricHospital and extensive partialhospitalization and intensiveoutpatient programs for adoles-cents and adults.

A crisis intervention unitwithin the hospital’s emergencydepartment provides assess-ment, treatment and referral foradults who are experiencingsevere psychiatric symptoms or arein immediate danger. There is alsoan active consultation liaison serviceto help manage psychiatric problemsof patients in the hospital’s medical orsurgical units.

Yale-New Haven’s psychiatry serv-ice is now a combination of the former

Yale Psychiatric Institute (YPI) andthe former psychiatric services of

Yale-New Haven Hospital.According to William Sledge,M.D., medical director of theYale-New Haven PsychiatricHospital, “When Yale-NewHaven took over the manage-ment of the former YalePsychiatric Institute threeyears ago, it blended the besttraditions of both institu-tions. YNHH was orientedtoward a biological anddescriptive approach withsymptom management. YPIwas developmentally orient-ed, focusing on characterissues and life tasks. Theycombined to form a highlyeffective, very humaneapproach.”

The clinical director ofYale-New Haven PsychiatricHospital, Leslie O’Connor,A.P.R.N., calls the “true

interdisciplinary patient care” atremendous asset. “Another bigstrength is our ability to create a ther-apeutic environment, in which every-one works together to make this a safeplace for patients to get well,” she said.

2 0

(p. 20): Leslie O’Connor and her clinical team (p. 21, left to right, foreground): Doctors William Sledge and Benjamin S. Bunney

PSYCHIATRY

}

}

2 2 2 3

Ranked Among the Best

We have becomea place of international renownfor people to get diagnosed and receivestate-of-the-art treatments.”

“

We believeYale-New Haven Hospital shouldbe a one-stop shopping location for people with pulmonary diseases and disorders.”

W e believe we have the bestresources to handle everything

from garden-variety pulmonary issuesthrough complex medical problems,”said Dr. Elias.

Joyce D’Amato, R.N., patient serv-ice manager, has worked in theWinchester Chest Clinic for 32 of her34 years at YNHH, overseeing day-to-day management of theclinic. “We care for a broadrange of pulmonary condi-tions, including tuberculo-sis,” said D’Amato. “TheWinchester Fund helps sub-sidize tuberculosis treat-ment for patients, withadditional outreach assis-tance from area healthdepartments and publichealth nursing.”

The section’s asthma clinic, one ofthe largest in New England, is desig-nated by the National Institutes ofHealth as a specialized center for asth-ma research. As a result, patients ben-efit from physician input, daily physi-ologic evaluations, nursing outreachand education and the latest in newtherapies. There is also an internation-ally known interstitial lung disease

(ILD) program which offers patientsthe latest in diagnostic and therapeu-tic options, particularly those withidiopathic pulmonary fibrosis.

The center for sleep medicinefocuses on the entire range of primarysleep problems and related conditions.The interdisciplinary team works

closely with physicians inotolaryngology, neurology,cardiology, psychology, den-tistry and bariatric surgery.

On the inpatient side is amedical intensive care unit,a step-down unit and a res-piratory care unit, whichserve as regional referralcenters. These units treatpatients with life-threaten-ing illness of all sorts,

including acute and chronicrespiratory failure, acute lung injury,sepsis, septic shock and cardiogenicshock. They also care for patients with renal, liver or cardiac failure,some of whom are awaiting or havehad transplants.

“We have become a place of inter-national renown for people to getdiagnosed and receive state-of-the-arttreatments,” said Dr. Elias.

“

“

(p. 22): Dr. Mark Siegel and JoAnn Friedlander; (p. 23, clockwise from top): Josephine Barnes with Carrie Winslow R.N.; Dr. Michael Nead and Carl Sheeley; Dr. Siegel and JoAnn Friedlander

RESPIRATORY DISORDERS

Jack A. Elias, M.D.,chief of pulmonary and critical care services}

2 52 4

Ranked Among the Best

We provide state-of -the-art urologiccare at one of the country’spremier academic institutions.”

“(p. 24): Dr. Rober t Weiss; (p. 25, clockwise from top): 10-year-old Darby Dyar and Dr. Weiss;

Sabrina Barjon and Claire Puklin, R.N.; Dr. Harris Foster and Dr. Weiss

UROLOGY

Robert M. Weiss, M.D.,chief of urology

Each care-giver isdedicated to providing the highestlevel of medical and surgical care.”

“

“E ach care-giver is dedicated to pro-viding the highest level of medical

and surgical care,” said Dr. Weiss.Major areas of strength include

urologic oncology; minimally invasiveurology, including laparoscopic andendourologic surgery; renal lithotrip-sy; reconstructive surgery; neuro urol-ogy; female urology and incontinence;and pediatric urology, as wellas male sexual dysfunctionand infertility.

Pediatric urology special-ists care for children withurologic diseases such ascongenital anomalies includ-ing hypospadias, undescend-ed testes, urinary tractobstruction and bladderexstrophy, and have expert-ise in the management ofurologic neoplasms includ-ing Wilms’ tumor, sarcomas of the urinary tract, and testis cancers.

Laparoscopic techniques are usedfor the management of intra-abdomi-nal undescended testes and for themanagement of a number of renalabnormalities requiring kidneyremoval. Expertise is available for themanagement of neurogenic bladdersassociated with spina bifida.

The urology incontinence programprovides care for voiding dysfunction,incontinence, female urologic prob-lems and urinary tract difficultiesrelated to neurologic diseases.Treatment options include pharma-cotherapy, behavioral modificationand surgery.

Urologic oncology encompassesthe diagnosis and treatmentof malignancies of the blad-der, prostate, testes, kidneyand penis. For men orwomen with bladder can-cer, the section offersintestinal neo-bladders topreserve more normalvoiding, as well as expert-ise in a variety of conti-nent urinary diversiontechniques. A nerve-spar-ing radical prostatectomy

is commonly utilized for localizedprostate cancer, as is an alternativetreatment with radioactive seedimplantation. Many kidney tumors areremoved using laparoscopic tech-niques. Lymph node dissections for themanagement of testicular cancer areperformed with nerve-sparing to pre-serve ejaculation or for the removal oftumor following chemotherapy.

}

YEAR-END MESSAGE

Patient Care

YNHH treated more patients in 2003than any previous year in the hospital’shistory. A major focus throughout theyear was ensuring the highest levels ofpatient safety and clinical quality. YNHHparticipated in a national voluntary ini-tiative to collect and report hospitalquality performance information forthree medical conditions: acute myocar-dial infarction, heart failure and pneu-monia. In addition, 27 patient safety-related projects were implemented,including hand hygiene; medication safe-ty; antibiotics to prevent post-operativeinfections; and mandated surgical mark-ing and verification to double-checkpatient identification. YNHH receivedthe prestigious John D. Thompson Awardfrom the Connecticut HospitalAssociation for successful efforts inreducing bloodstream infections in thesurgical intensive care unit.

There were several important mile-stones during the year. YNHH achievedaccreditation with full standards compliance from the Joint Commissionon Accreditation of HealthcareOrganizations (JCAHO). JCAHOawarded YNHH an overall evaluationscore of 94, and a perfect 100 in behav-ioral health. Yale-New Haven was againnamed one of America’s best hospitalsfor the 12th consecutive year by U.S.News & World Report in its annual survey

issue. The hospital was named among thebest in 12 of 17 medical specialties, rank-ing second in New England afterMassachusetts General Hospital in thetotal number of specialties recognized.

The hospital continued to invest inclinical advancements and improvedpatient care programs throughout theyear. The New Clinical ProgramDevelopment Fund (NCPDF) supportedenhancements in cardiac transplantationand the Yale-New Haven Breast Center.The Yale-New Haven Heart Centerbecame the first in Connecticut toimplant newly approved drug-elutingstents for the treatment of coronaryartery disease; and the first center in theeastern United States to implant theJarvik 2000 artificial heart for the treat-ment of the failing heart in patientsawaiting cardiac transplantation.

The year also saw improvements inbed management, which resulted infewer operating room delays and cancel-lations; shorter waits for patients in theemergency department (ED); andincreased patient satisfaction scores inadult and pediatric inpatient services,outpatient clinics and most notably, thepediatric emergency department.

Yale-New Haven Children’s Hospital(YNHCH) celebrated its 10th anniver-sary and continued to lead the state inpediatric care — caring for nearly 25percent of Connecticut’s hospitalizedchildren.

(left to right, standing:) Marna P. Borgstrom, Executive Vice President and

COO, Joseph A. Zaccagnino, President and CEO. (seated:) Marvin K.

Lender, Chairman of the Board of Trustees, and Peter N. Herbert, M.D.,

Chief of Staff

2 6

2 7

The health careenvironment remained

tumultuous during 2003,

as hospitals dealt with higher costs,

decreasing reimbursement, increasing demand for

services and more and more uninsured and underinsured patients.

Y ale-New Haven Hospital (YNHH) weathered the storm better than many hospi-tals, in large part because it remained focused on its mission and managed

proactively. For Yale-New Haven, 2003 was a good year, characterized by enhancedpatient care services, important clinical program advancements and improvementsin quality, safety and patient satisfaction.

2003 Performance

2003 was very positive for Yale-NewHaven Hospital in terms of the numberof patients cared for, financial perform-ance and day-to-day operation.Inpatient volume reached the highestlevel in the hospital’s history, with over45,000 discharges, almost 4 percentabove last year. Outpatient visits andtrips to the emergency department alsoincreased. Yale-New Haven’s reputa-tion, its strong clinical leadership andprogram investments, as well as increas-ing use by an aging population, con-tributed to the record number ofpatients seen this year. YNHH accom-modated this demand within existingresources by enhancing and improvingclinical and operating processes, manag-ing expenses and reducing the overalllength of stay. The strong volume bol-stered patient revenue, and althoughexpenses were also up, the hospital wasable to re-invest substantial resourcesback into patient care and medical tech-nology.

A broad range of recruitment andretention initiatives helped maintain anexcellent work environment at YNHH.In 2003, the hospital hired 368 nurses,and reduced its overall vacancy ratefrom 7.2 percent to below 5 percent. Asystem-wide employee opinion surveywas held this year to monitor employ-ees’ views and concerns, and actionplans helped guide positive changes.The Performance Incentive Programagain recognized employees’ contribu-tions to achieving hospital goals with aspecial payout last December (for FiscalYear 2002 performance) of 1.3 percentof employees’ annual pay, or nearly $2.5million.

The three-year, $51.5-million SouthPavilion renovation was completed at

the end of September and came in $1million under budget. In May, ground-breaking for the new Yale-New HavenShoreline Medical Center (YNHSMC)was held in Guilford. The Center isscheduled to open in the summer of2004.

This positive performance wasaccomplished despite an ongoing, cor-porate campaign by the ServiceEmployees International Union (SEIU),District 1199. The union attempted todamage the reputation of the hospitaland pressure its leadership to forego theprotections from coercion its employeeshave under the National LaborRelations Board (NLRB) process. Thiscampaign to pressure the hospital toagree to recognize union representationof its employees without a NLRB-supervised secret election ballot hasapparently been undertaken because theunion has been unsuccessful in attract-ing significant employee interest usingtraditional means.

The union’s corporate campaignstrategy, based on organizing the com-pany and not its employees, is beingused against hospitals in Illinois,California and other states. The strategyidentifies a major policy issue, withwhich all Americans can relate, and thenfocuses that issue on the institution it istrying to organize, presenting one sideof local human interest stories to maskthe complexity of the issues. At YNHH,the union has identified billing, collec-tions and free care issues, using theConnecticut Center for a NewEconomy, a union-financed organizationto research and advance the grass rootscampaign. Nonetheless, demand for ourpatient care services and our medicaland allied health training programs con-tinues to increase and employee supportof the hospital remains strong.

Support from the Health System

YNHH continued to benefit extensive-ly from its relationship with Yale NewHaven Health System. YNHHS sup-ported key YNHH initiatives and con-tinued to out-perform many local andnational organizations despite a turbu-lent health care market. In 2003,YNHHS was again the state’s marketleader, caring for more than 18 percentof Connecticut’s inpatients.

This year, YNHHS announced anew system-wide performance manage-ment initiative to train managers, clini-cal leaders and staff in performanceimprovement techniques; and a system-wide college recruiting program, with agoal of hiring 160 new graduates forclinical and technical positions. In addi-tion, teams from the three YNHHS hos-pitals measured and improved commonindicators of safe care, reaching bestpractice performance in several areas.

YNHHS continued its revenueenhancement work and oversaw a suc-cessful supply management initiative,which assisted the New Haven,Bridgeport and Greenwich delivery net-works in enhancing revenues and man-aging corporate expenses. As part of aYale New Haven Health System initia-tive, the hospital reviewed and updatedits billing and collection practices toensure they were consistently managedand consistent with industry standards.

Community Service

As one of the area’s largest employers,Yale-New Haven is committed to thehealth of the entire community. In addi-tion to providing free, uncompensatedand under-compensated care, YNHHworks with other community organiza-

tions, public agencies and communityleaders to improve the quality of life inNew Haven. In 2003, YNHH providedan estimated $59.5 million for the careof the poor and the uninsured; $30.5million for free and charity care and $29million to offset insufficient Medicaidand uncompensated care payments

Through YNHH’s leadership of theGreater New Haven Partnership for aHealthy Community, the hospital’scommunity health program enjoyed keysuccesses in its community-wide asthmainitiative; the Wellness InformationNetwork/Community Access Program, acity-wide effort to link uninsuredpatients who frequent emergencydepartments with primary careproviders; the YNHH dental program;100% access/0% disparities program tofacilitate access to health care for theuninsured; and maternal child healthprogram.

Over the past year, YNHH reachedan estimated 3,000 students, grades K-12, with programs and services relatedto health promotion and education,career exploration and volunteer serviceopportunities. YNHH continued tooperate eight school-based health cen-ters that served 3,482 students withmore than 10,000 visits during the pastacademic year. The hospital regularlymakes financial and in-kind donationsto area non-profits, and this year, YNHHemployees donated over $193,000 tothe United Way campaign. In addition,YNHH accepted the sponsorship rolefor the United Way’s Day of Caring andJoseph Zaccagnino served as itsspokesperson. YNHH employees con-tributed more than 14,000 school sup-plies to benefit two local schools; andover 800 employees — 13% of the staff— volunteered for a variety of Day ofCaring projects.

2 8 2 9

3 0

Leadership

The hospital’s Board ofTrustees, clinical leader-ship and senior manage-ment team were keycontributors to the suc-cess of the past year. InOctober, Marvin K. Lenderwas re-elected as chairman of the Boardof Trustees, and in February, Kevin F.Walsh joined the board.

The past year saw a number ofchanges in clinical leadership. DennisD. Spencer, M.D., chief of neuro-surgery, was named acting dean of theYale School of Medicine. Joseph M.Piepmeier, M.D., was named interimchief of neurosurgery. Richard L.Edelson, M.D., chief of dermatology,was appointed director of the YaleCancer Center; David L. Coleman,M.D., was named interim chief of inter-

nal medicine; andJames A. Brink, M.D.,was named interimchief of diagnosticimaging.

Conclusion

YNHH’s strong performance during the past year reflects its unwaveringdedication to its missions of patientcare, teaching, clinical research andcommunity service. The year’s successwas made possible by the continuedsupport of its Board of Trustees, and the dedication, commitment and quali-ty of its physicians, management team,employees and supporters. These fac-tors ensure that Yale-New HavenHospital will continue to be among the premier health care centers in the nation.

BOARD OF TRUSTEES

COMPARATIVE STATISTICS

Comparative Statistics

(in thousands) Year Ended September 30

2003 2002

AssetsCurrent Assets

Cash $ 20,971 $ 14,765Marketable Securities 147,753 114,091Accounts Receivable (Net) 84,592 92,068All Other Current Assets 24,574 23,141

Total Current Assets 277,890 244,065

Assets Limited As to UseFunds Reserved for Plant

Improvements and Expansion,Clinical Programs and Other 147,566 134,767

Beneficial Interest in Perpetual Trusts 11,487 10,752Escrow Funds for Long Term Debt 557 668

Total 159,610 146,187

Long Term Investments 114,904 105,195All Other Assets 33,055 22,567Property, Plant and Equipment (Net) 240,495 229,523Construction in Progress 8,621 19,611

Total Assets $ 834,575 $ 767,148

Liabilities and Net AssetsCurrent Liabilities

Accounts Payable 42,981 33,872Accrued Expenses 64,388 64,014Other Liabilities 4,916 8,469Current Portion of Long Term Debt 1,100 3,995

Total Current Liabilities 113,385 110,350

Long-Term Debt, Less Current Portion 111,645 124,830Accrued Post Retirement Benefits

other than Pensions 29,954 28,644Other Long Term Liabilities 97,631 66,443

Total Liabilities 352,615 330,267

Net AssetsUnrestricted 358,322 326,879Temporarily Restricted 96,819 83,918Permanently Restricted 26,819 26,084

Total Net Assets 481,960 436,881

Total Liabilities and Fund Balance $ 834,575 $ 767,148

BALANCE SHEET

Bishop Theodore L. Brooks

Marna P. BorgstromExecutive Vice President & COO

Marvin K. LenderChair

Michael H. Flynn

Kevin F. WalshJonathan BushAssistant Secretary

Robert L. Culver

Richard L. Edelson, M.D.

Joseph R. Crespo Vice Chair and Treasurer

Betty Ruth Hollander

Richard C. Levin

Linda Koch Lorimer

Bernard A. Pellegrino, Sr.

Marion Russell

Peter N. Herbert, M.D.Chief of Staff

Robert A. Haversat Secretary

John L. Lahey

Julia M. McNamaraVice Chair

Walter H. Monteith, Jr.

Peyton R. Patterson Nathaniel D. Woodson

Henry K. Yaggi, III

Elsa L. Stone, M.D.

Patricia B. Sweet

James A. Thomas

Richard G. BellVice Chair

Board of Trustees ( As of September 30, 2003 )

Joseph A. ZaccagninoPresident and CEO

David A. Kessler, M.D.

3 2 3 3

Comparative StatisticsComparative Statistics

3 4 3 5

(in thousands) Year Ended September 30

2003 2002

Operating Revenue

Net Patient Service Revenue $ 646,414 $ 577,371Other Revenue 17,788 14,171

Total Operating Revenue 664,202 591,542

Operating ExpensesSalaries and Benefits 352,114 327,853Supplies and Other Expenses 264,623 241,832Depreciation and Amortization 32,416 28,940Insurance 27,309 10,984Bad Debts 2,749 3,070Interest 7,060 7,496

Total Operating Expenses 686,271 620,175Recovery of Expenses from

Grants and Other Institutions (47,904) (46,347)

Total 638,367 573,828

Operating Gain Available for Debt and Capital Needs 25,835 17,714

Clinical Development Fund (5,750) (5,750)Scheduled Debt Repayment (1,100) (3,995)

Balance for Equipment Replacement and

New Technology $ 18,985 $ 7,969

STATEMENT OF OPERATIONS

Year Ended September 30

2003 2002

Cardiology ProceduresPTCA 1,819 1,708Diagnostic Catheterization 3,297 3,277Electrophysiology Studies 2,173 2,005AICD (Defibrillator) 328 294Pacemakers 645 635

Diagnostic ImagingCT Scan 51,816 48,544MRI 13,828 13,844Nuclear Medicine 17,157 18,524Ultrasound 52,625 51,034X-ray 167,543 164,592

Laboratory ProceduresBlood Bank 242,055 235,494Clinical Chemistry 2,982,313 2,823,216Clinical Virology 80,399 80,352Hematology 594,351 550,903Immunology/Prenatal Testing 104,315 98,491Microbiology 198,530 201,847Pheresis Transfusion Center 7,760 7,492

Radiation Therapy Treatments 23,427 18,089Rehabilitation Services Treatments 46,781 47,805Respiratory Care Ventilator Hours 426,217 411,732Surgery

Inpatient Cases 11,896 11,512Outpatient Cases 11,714 11,282

SELECTED DIAGNOSTIC AND THERAPEUTIC SERVICES

UNCOMPENSATED & UNDERCOMPENSATED CARE COSTS(in thousands) Year Ended September 30

2003 2002

Free Care Allowance $ 8,733 $ 3,611Charity Care Allowance 21,723 24,356Subtotal 30,456 27,967Medicaid Underpayments (net) 28,900 23,400

Total Uncompensated andUndercompensated Care $ 59,356 $51,367

PHILANTHROPIC AND OTHER SUPPORT(in thousands)

Year Ended September 30

2003 2002 Charitable Contributions

Medical Equipment Fund $ 515 $ 322Fund for Care of the Indigent 477 483Other Gifts5,028 6,221

Subtotal 6,020 7,026Income and Appreciation on Invested Funds 5,845 24,667Total Philanthropic andOther Support $ 11,865 $ 31,693

GENERAL INFORMATION SUMMARYYear Ended September 30

2003 2002

Number of Patients Discharged 45,349 43,516Patient Days of Care Provided 241,142 236,162Average Length of Stay 5.32 5.43Average Daily Patient Census 661 647Volunteer Hours Donated 85,060 88,070

INPATIENT DISCHARGES

Year Ended September 30

2003 2002

AdultsMedical 26,949 25,958

Surgical 8,329 8,217

Total Adults 35,278 34,175

Total Pediatrics 5,162 4,583

Total Newborn 4,909 4,758

Total Inpatient 45,349 43,516

OUTPATIENT CLINIC VISITS

Year Ended September 30

2003 2002

Primary Care Center 43,198 42,044

Women’s Center 60,551 59,038

Medicine 91,421 84,221

Ophthalmology 21,717 22,257

Surgery 23,136 23,211

Pediatrics 30,895 30,467

Dermatology 15,169 16,484

Otolaryngology 10,504 10,891

Orthopedic 20,426 20,301

Dental 5,436 5,932

Urology 7,544 7,491

School Based Clinics 7,805 9,068

Total Outpatient

Clinic Visits 337,802 331,405

Emergency Services 91,881 91,259

Occupational Health 17,667 17,626

Total Outpatient

Visits 447,350 440,290

Yale-New Haven Hospital’s 2003 Annual Reportis published by the Office of Marketing and CommunicationsTelephone: 203-688-2488Fax: 203-688-2491www.ynhh.org

Senior Vice President,Public Affairs:Vincent P. Petrini

Administrative Director,Marketing and Communications:William R. Gombeski, Jr.

Editor: Katherine Krauss

Writers: Katie Fischer, Katherine Krauss

Creative Direction and Design: Sopkin Design/Guilford, CT

Major Photography: Siegfried Halus;page 26: Frank Poole; Board & staff photos, page 20:Robert Lisak

Printing: Harty Press

Published in the spring of 2004Copyright 2004, Yale-New HavenHospital. All rights reserved. Nopart of this publication may bereproduced or transmitted by anymeans or in any form without permission from YNHH.

YNHH is an EEO/AAP employer.

If you received a duplicate copy of the annual report, please passit along to a friend and send thelabel you would like deleted to:

Yale-New Haven HospitalMarketing and Communications20 York StreetNew Haven CT 06510-3202

Mark L. AndersenSenior Vice President Technology and CIO

Marna P. BorgstromExecutive Vice President and

Chief Operating Officer

T. Brian CondonSenior Vice President

Clinical Administration

Edward J. DowlingSenior Vice President

Human Resources

Alvin JohnsonVice President

Employee Relations

Thomas LearyVice President

Physician Network Development

Norman G. RothSenior Vice President

Administration

Joseph A. ZaccagninoPresident and

Chief Executive Officer

Peter N. Herbert, M.D.Chief of Staff and

Senior Vice President, Medical Affairs

Vincent P. PetriniSenior Vice President

Public Affairs

James M. StatenSenior Vice President Finance and CFO

Robert SerowVice President Development

Sue Fitzsimons, R.N., Ph.D.Senior Vice President

Patient Services

Senior Management

3 6

Thank you to those who supported Yale-New Haven Hospital in 2003.Please join us in solidifying our place among America’s best hospitals and ensuring your

loved ones experience the peace of mind Yale-New Haven brings to our community.If you would like to make a donation to Yale-New Haven Hospital, please use the

enclosed donation card or contact:

Yale-New Haven Hospital Office of DevelopmentP.O. Box 1849

New Haven, CT 06508-1849

A hospital does not becomeone of the best in the nation without a strong philanthropic commitment that mirrors our devotion to patient care and advances in treatment.

AMONG THE BEST