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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d2029e61cc63be3fb1d3969311cf1150.pdf?Expires=1712793600&Signature=NaDUvw9Htw-TDp5T1-GjUf1k12tutmQ38twQg7owg2lkSrXxQdn0vX-lbcRiJ5Nry5gNeklgxRfYli5ZDaRTg7vfJRohSBqfFkkU8oAitr-Y8q-NXguPYKn8Lo5FKFbDeMn7OtC%7EpQfOBuCTvZhZcTSPReTf7wqeGnSACp8wAtd2rmbsFiwC3uu6oOEvIZsEZuHxEK57xVJGIQ6T-9IE2ggxr0oDm9OI2hmQeKQuyaZCKuz2b%7ECWr9704swFMtT8W7goMPgJZK1qjqpedGk6vo1Yz93KCIkLd1SmfFYhRTehz3DtARpLY1zguuojRMICPwqR6p5Vq0OCzjtLL0qs6A__&Key-Pair-Id=K6UGZS9ZTDSZM
1191e6e85ca53d399588dca53aeb32f6
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Text
The perceived value of just-in-time in-situ simulation training as a preparedness measure
for the perioperative care of COVID-19 patients
Jeffrey R. Keane, R.N.,1 Liana Zucco M.B.B.S.,2 Michael J. Chen B.S.,2 Nadav Levy, M.D.,2 Allison Hyatt, M.D.,2 Richard Pollard, M.D.,2 John D. Mitchell, M.D.,2 Satya Krishna Ramachandran, M.D.2
1. Unit Based Educator, Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Introduction
•
•
•
Training of redesigned perioperative workflows was urgently required due to COVID-19 pandemic.
Just-in-time (JIT) training is known to promote confidence in specific tasks.
COVID-19 Training was set up and delivered via JIT, in-situ simulation, team training.
Results
•
Up to 12 sims run per day over 3 weeks, through March-April 2020.
•
Trained 428 BILH perioperative staff members, across multiple sites.
•
Survey responses (n=110) revealed the following regarding all 4 simulation stations:
Methods: Implementation of Training
•
•
•
•
JIT in-situ simulation stations focused on minimizing viral exposure & transmission risk [Fig. 1].
Core group of faculty trained to run simulations in vacant OR’s.
Single page checklists created as cognitive aids.
Training delivered throughout Beth Israel Lahey Health Network (BILH) across disciplines.
(anesthesia, surgery, nursing, technicians) [Fig. 2].
Daily feedback & debriefing from faculty allowed for iterative changes to SOP’s & sims.
•
•
•
•
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Methods: Assessment of Training
•
Post simulation training surveys (Likert scale and free text) administered via email & QR code to assess
knowledge & comfort of COVID protocols, pre vs. post-simulation, and belief of impact on practice.
March-August 2020: reviewed anonymized HCW infection rates amongst perioperative staff and
compliance with COVID-19 protocols for COVID cases in the OR.
•
A
Knowledge of and comfort in adopting new workflows increased post-sim
(all p-values < 0.001; all means increased by ≥ 1.2 points on a 5-point Likert scale).
> 90% of respondents agreed or strongly agreed that this training would impact their future practice.
Free text responses appreciated timeliness of training, hands-on nature and inter-professional collaboration.
Constructive feedback through facilitated iterative changes to training and organizational SOP's.
95% compliance with COVID precautions in perioperative setting (121 of 127 cases through March – August 2020).
Network’s perioperative HCW test positive rate was < 1% (March – August 2020).
B
62% 65%60%64%
31%
25%
0% 0% 0% 0%
Strongly
Disagree
0% 1% 0% 0%
Disagree
35% 33%
7% 9% 6% 4%
Neutral
Agree
Strongly Agree
Belief that the simulation will create an impact on their clinical practice
Sim A - Pre-op Huddle (n=90)
Sim C - ICU Transfer (n=104)
C
D
Figure 1: JIT in-situ simulation training stations.
A: Pre-op huddle & OR set up for COVID-19 case.
B: Donning & doffing PPE.
C: Transfer of a COVID-19 patient from the ICU to the OR.
D: Airway management with enhanced infection control measures.
Figure 2: Schematic representation of the simulation
implementation team and framework. The core development
team (blue) trained the faculty trainers (grey)—who in turn
trained the rest of our network’s inter-professional perioperative
staff (green). Daily feedback was obtained from participants and
faculty trainers following each simulation, and regular updates
on changes to materials or SOPs were communicated through
faculty trainers or directly to staff members.
All of our up-to-date
COVID-19 perioperative
resources are available
online by scanning QR code:
(Includes resources on OB / GI / IR and more)
”Simulations provided an
opportunity to hear about the most
up-to-date protocol/policy changes,
and also about complaints."
Figure 3: Survey
results for perceived
impact of JIT
simulation training
on clinical practice.
Results expressed as
percentage of
responses for each
simulation drill.
X-axis represents a
5-point Likert scale.
Sim B - Don & Doff PPE (n=103)
Sim D - Airway Management (n=83)
"It really helps the nursing staff in
preparing to care for these patients
and increases communication
between the disciplines."
"Simulation got you thinking about
the issues in dealing with a COVID19 patient, and helped you learn
from others' trial and errors."
Discussion:
•
In context of COVID-19 and personal risk to HCW’s, we speculate “hunger for information” and
•
increased anxiety about a lack of knowledge on viral exposure risk & transmission served as drivers for
change.
This method of training facilitated “error proofing” of our newly designed workflow;
on-site observations, daily feedback and survey responses from participants triggered iterative
changes
to help refine our COVID-19 perioperative workflow.
Conclusions:
•
JIT in-situ simulation training is not only an effective education method in preparing our perioperative
HCW’s for COVID, but also an effective way to implement updates to perioperative workflows. Training
was highly regarded by participants, we observed high precaution compliance, and low test-positive
rate.
QR Code to
view online
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jeffrey R. Keane (<a href="mailto:jkeane1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jkeane1@bidmc.harvard.edu</a>)
Project Team
Jeffrey R. Keane
Liana Zucco
Michael J. Chen
Nadav Levy
Alison Hyatt
Richard Pollard
John D. Mitchell
Satya Krishna Ramachandran
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Anesthesia, Critical Care and Pain Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Perceived Value of Just-In-Time In-Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b4021f2b223c5abadd774ed9b8f1d4b7.pdf?Expires=1712793600&Signature=FYASO4RkMm0xnp5GLu-i4Fhb7wwHSRz%7EbKO2yNmT83SqI98ulBRpJIDTN7oeaUGgzCQqswqr6nm0IyQHRBAd%7Ezv9DaSOkwjoupnLorIKk5ty9vaVM15lwZcxR5eVxb8-dzgnLmoxH3TwdOT-tUHjtKseUKCtIdTCt3JpyBqOlWMZ3sss8fbDRJMWZluX6cxpx3qAc07Nb9at1yVY2LJp1o-0Z8MJ38q%7EKxN9Lx2JgJFygJpZH8OS7dzCkwyeQkpOc-Q-habs12R94ZRj44yHszpAPdwvbOIDzdsZXjbGbVgFZyHrtB1w7l4Xwmu4ChhUapKIRx1lzIouOVFusBgelw__&Key-Pair-Id=K6UGZS9ZTDSZM
b82a5f46d6b6bd429361c72940ef9715
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Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
Remdesivir was an early front runner for therapeutic agents of interest given activity against other
coronaviruses, some experience with Ebola and a relatively clean adverse event profile.
Notably the agent was used in the first published experience of a patient in Washington state who received the
drug as part of his hospitalization for CoVID-19
Gilead and the NIH had designed early trials to examine its usefulness in hospitalized patients in a placebo
controlled fashion but also in trials to examine the duration of therapy (5 vs. 10 days) in patients with varying
degrees of illness
Prior to initiation of these trials, the only access to the agent was through compassionate use via the FDA and
Gilead.
Once BIDMC was selected as a trial site for two trials, a process of rapid evaluation and enrollment was
necessary before patients received unapproved therapies, notably hydroxychloroquine which would become
exclusionary.
Remdesivir was then approved for Emergency Use Authorization just four months into the pandemic requiring
a level of regulatory compliance not seen at BIDMC.
Four months after EUA approval, the drug was FDA approved in full with limited restrictions to use lending to
the need for a stewardship process to ensure safe, equitable and responsible prescribing.
Aim/Goal
To enable access to remdesivir through its life cycle from compassionate use to emergency use to FDA
approval while meeting regulatory requirements and conscious stewardship.
The Team
Jamie Levash, MSW
Project Manager
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Disease
Julius Yang, MD
Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
Healthcare Quality
Infectious Diseases
Pharmacy
Health Care Quality
Health Care Quality, Infectious Dis
Pharmacy
Initiated compassionate use access to remdesivir through an FDA-Gilead-BIDMC pathway for patients with limited treatment
options
Incorporated remdesivir into treatment guidelines for review for research enrollment
Reviewed CoVID 19 admissions for hydroxychloroquine initiation requests through stewardship and directed primary teams
to the remdesivir local study team
Developed the Emergency Use Pathways for important inclusions and exclusion details and daily treatment tracking with
Health Care Quality
Once study results were published, provided education and review for the treatment collaborative
Tracked adverse events of concern from the Emergency Use experience
Worked with Health Care Quality to devise an allocation scheme when early release of product did not meet demand
With EUA transition to FDA approval, worked collaboratively to develop a treatment guideline and stewardship review
Continually reviewed study data publication, local results, national guidance and provided BILH network guidance for best
practice
Results
Early review of
access limited to
a restrictive
compassionate
use process with
limitations to
degree of illness
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
K Stephenson/BIDMC
selected as site for two
trials
US Clinical trial
development and linkage
Work with trial team and
Research Pharm given rapid
enrollment
Initiated compassionate use
prior to study launch
38 yo M transferred from BI-Milton
for ICU admission
Patient excluded from two trials due to
need for ventilation enrolled in
compassionate use protocol
58 yo M, high risk w/ obesity,
hypertension had to be rapidly
intubated.
Created a reference document,
snippet below for compassionate
use consideration to ensure
accepted and not study eligible
24 yo F pregnant excluded from trials
enrolled in compassionate use acces
Developed an early review
by Stewardship team for
potential enrollment in
remdesivir trials
Developed a primer for
primary teams to enable
study drug release given
high volume
Response to primary team demand
May 2020 Emergency Use
Authorization granted but
allocation process in
question
1 Completed 5 days hydroxychloroquine
2 Completed 5 days hydroxychloroquine
3 None
4 Hydroxychloroquine
5 None
6 Hydroxychloroquine
7 HCQ 3/17-18, stopped
8 Lopinavir/ritonavir
9 Hydroxychloroquine
10 Hydroxychloroquine
11 Hydroxychloroquine
12 Hydroxychloroquine
13 Hydroxychloroquine
14 Remdesivir compassionate use
15 Completed 5 days hydroxychloroquine
16 Completed 5 days hydroxychloroquine
17 None
18 Hydroxychloroquine
19 None
20 Hydroxychloroquine
22 Lopinavir/ritonavir
23 Hydroxychloroquine
24 Hydroxychloroquine
25 Hydroxychloroquine
26 Hydroxychloroquine
27 Hydroxychloroquine
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Remdesivir EUA guideline
developed locally
Algorithm for trial versus EUA
Includes an algorithm to allow for
continued enrollment in the clinical trials
to avoid dipping into the EUA limited
supply
Stewardship team daily tracking
and dose release approval to
avoid waste
Development of unique guidance for
an Emergency Use Authorization to
meet regulatory compliance and
receive further allocation
Built cPOE screens to encourage
laboratory screening before
entry as well as special
considerations for other study
meds
Engaged Drug Shortage Task
Force for prioritization
scheme
Developed and sent out
Communications given
limited supply and
restrictive criteria
June 2020: Remdesivir
supply opens up lending to a
transition to Stewardship
only approval
Tracking sheet developed to
communicate between Health Care
Quality and Stewardship team
Last COVID
Admission Date
Test
MV at Enrollment
Priority
05/11/2020
05/11/2020
No
3
05/09/2020
05/08/2020
Day 1
1
05/03/2020
05/03/2020
DAY 9
2
05/11/2020
04/26/2020
DAY 2
1
05/11/2020
05/02/2020 Not at enrollment, now intubated 3, now 1
05/12/2020
05/10/2020
DAY 2
1
05/10/2020
05/12/2020
dAY 1
1
05/11/2020
05/11/2020
DAY 3
1
5/15/2020
5/15/2020
No
3
5/15/2020
5/15/2020
No, O2 sat<94%
4
5/14/20
5/15/20
Day 3
1
5/16/20
5/16/20
No, 02 sat <94% RA, 3L
4
5/15/20
5/16/20 No, 02 sat <94% RA, oximizer 10L
3
5/17/20
5/17/20
Date
Approved
05/12/2020
05/12/2020
05/12/2020
05/12/2020
05/12/2020
05/14/2020
05/14/2020
05/14/2020
5/16/20
5/16/20
5/18/20
5/17/20
5/17/20
5/18/20
Consent
Completed
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Planned
RegimEn
(day)
5
10
10
10
10
10
10
10
5
5
5
5
5
5
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
June 2020
BILH Network Remdesivir EUA review
done
FDA approves Remdesivir fully
and it earns a brand name
Approval is broadly permissive
for inpatients with CoVID-19
A more transparent and
functional tracking system of
remdesivir developed for
Performance Manager
Examination of ethnic/race
diversity
OMR Macro development
to ensure data integrity and
documentation
Stewardship group engages in a full review of remdesivir trial
publications, local experience and FDA submission to present to
treatment collaborative, local and system P&T
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Final recommendations for approval with restrictions
Formulary Review: Study Details
Lessons Learned
Fielding the “in time” trajectory of drug research, compassionate use access, expanded use access and translation of published
experience to best practice requires collaboration and human resources to avoid unintended consequences and optimize
efficiency.
Education, intensive tracking and communication are key to meeting regulatory compliance and optimizing care
Open discussion and collaboration during an acute stressful surge allows for more transparent decision making and engagement
Remdesivir Stewardship across the Network
Next Steps
High utilization at low volume hospitals
High demand and utilization necessitated
network shifts of supply
Use the experience from remdesivir to build upon future Emergency Use Guidance
Continue to steward remdesivir to gain benefit in the early infection stage of viral replication
Optimize Stewardship resources for the network to build upon experience and higher level controls
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Jamie Levash
Katy Stephenson
Ryan Chapin
Julius Yang
Howard Seth Gold
Christopher McCoy
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Quality and Safety
Infectious Diseases
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Remdesivir: From Research to Emergency Use to FDA Approval and Stewardship
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/8c3cf010b56fccf6495e21fb86001593.pdf?Expires=1712793600&Signature=dWn0Owc6u0s-eDFvDIE3k52Ot-3MxxNUmRvePm9cY%7EjnBFQ0NoirZTQiHpJDtSVAidvdwqRIlsaZFsDAky7i7m6LBESug32e0LQcoB0lKfgyYwYVHWWrhO4OxzS69s3pbIFZ%7Er1dnq%7EAFkGORedHAdfdHRK14c15PHQlVtgQO32ZPxZwaOIwix6wnmIestfMGtXccGPAMOipiHGVuc7sBnLZNmrcSM51JpRSKBFTiWOqclqq6hS7d20fWolvoOWAeGYmA5tMHVh5uPlDQov1m-z6rq4LRfaUZuZCJRmPtEKMLuWeIPTgNUwyvAn%7EzUPVp%7EmCTJn1GHWOiYv-Xq5uww__&Key-Pair-Id=K6UGZS9ZTDSZM
39171dfad4e8ec20a27153eae4f10b9e
PDF Text
Text
Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
With the impending pandemic and its unclear impact, we convened a multidisciplinary workgroup across
Pharmacy, Infectious Diseases, Research, Transplant, Hematologic Malignancy, Critical Care and Health
Care Quality and others to begin to plot out a treatment guideline for CoVID-19.
The unknowns were many given the lack of approved treatments, the lack of peer reviewed published
literature and unclear trajectory for the breadth and depth of care at our institution.
The need for a rapid response and clear guidance became increasingly pressured during the first surge as
our census for those infected went from 3 to 192 from March to April 2020 with a high percentage of patients
requiring ICU level care and many remaining here for weeks.
Sources of data were limited to a World Health Organization outline, preprints from China and Italy and basic
science reviews of agents thought to have antiviral activity.
Early guidance were often completely refuted by well controlled trials, e.g. recommendation to given empiric
antibiotics to all patients with SARI, avoidance of systemic corticosteroids.
Over 273 medication shortages were making broad treatment recommendations difficult.
Active research protocols had to be introduced to promote systematic exploration
Aim/Goal
To provide a central and locally balanced resource for clinicians for the treatment of CoVID-19 bifurcated by
disease severity and predictors for advanced disease based on an ever evolving evidence base.
To grade therapeutic modalities and frame experimental therapies with risk considerations and newly
launched local research.
The Team
Roger Shapiro, MD
Attending Physician-HIV researcher
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Diseases
Sabrina Tan, MD
Attending Physician- Viral Researcher
Margaret Hayes, MD
Attending Physician- Critical Care Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
CoVID 19 Treatment Collaborative
Infectious Diseases
Infectious Diseases
Pharmacy
Infectious Diseases
Critical Care Medicine
Health Care Quality, Infectious Diseases
Pharmacy
Built a multidisciplinary team with incorporation of the network and representation from key clinical areas
Developed a review process for preprints through MedrxIV, national guidelines (NIH, IDSA)
Scribed a treatment algorithm by severity of disease presentation.
Continuously evaluated and incorporated best practice for collection and interpretation of biomarkers and
laboratory values as well as comorbidities for risk stratification
Reviewed investigational therapeutics for linkage to local research studies (e.g., remdesivir, favipiravir)
Researched and provided dosing, drug interaction, screening and place in therapy guidance for all agents
Facilitated weekly data/literature summary meetings across a BILH network collaborative to build consensus for
guideline changes.
Reviewed drug shortage updates to alter treatment guidance toward a prioritization scheme
Directed restrictive criteria/clinical provider order entry guidance for therapeutic agents to promote safe and
evidence based utilization of scarce resources
Results: Data Review
Early but
continuous
review of
prepublished,
published
and
guideline
data.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Most basic outline created Feb 2020
Basic tenets from WHO and CDC
Ongoing trial of remdesivir
Weblink guidance for early therapeutics
From basic science to WHO guidance to
National guidelines
US Clinical trial
development and linkage
HIV Antiviral adaptive
research
Agents not recommended
Earliest treatment algorithm
incorporating a single experimental
agent
First iterative
multidisciplinary multisite
algorithm: March 20
Early investigational
Agents with unknown utility
Severity graded guidance
Lab and Imaging guidance
Risk analysis for progression
Special Populations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
Late March 2020
Began populating an ever growing
annotated citation list
Held first in a series of
Network Meetings
April 2020
Invited content experts and leaders
across the BILH network to build the first
Network treatment algorithm
Introduced Nephrology research on
niacinamide and conditional framework
Expanded sections on
Immunomodulators
Worked with EP/Cardiology
to enhance guidance
evaluation of therapeutic
agents with QT prolongation
concern
Built links to ongoing trials to boost
enrollment
Tocilizumab guidance
Hydroxychloroquine utilization
Hydroxychloroquine +/- Azithromycin
Adverse Event Investigation
JAMA Cardiology Publication
Did quality review of local tocilizumab
utilization and infectious complications
Added more evidence based guidance
for patients who may benefit from IL-6
modulation
Linked ICU teams with ongoing IL6
modulation trial-sarilumab
Identified hydroxychloroquine and
azithromycin utilization as concerning
Removed darunavir-cobicistat from
therapeutic recommendations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
April 2020
Anticoagulation Prophylaxis and
Treatment Guidelines
Convalescent Plasma considerations
added
Tocilizumab Plan
Tocilizumab shortage management
Remdesivir approved for
EUA utilization: need for
local guidance and
separation from clinical
May 2020
trials
National allocation was
small for MA hospitals
requiring prioritization
scheme
July 2020
Communications to staff regarding
remdesivir
June 2020
Network Remdesivir Experience
Exploration
Presented and added dexamethasone
to treatment guidance
Removed hydroxychloroquine and
azithromycin as treatment agents
Lack of HCQ benefit
Added additional sections on
culture based antibiotic
utilization with rapid tailoring
for negative cx
Based on study data, limited
treatment duration to 5 days
Identified population with
benefit with moderate 02
requirements
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
July 2020
Baicitinib initial review
August 2020
October 2020
Convalescent Plasma considerations
clarified given Mayo closes enrollment
BIDMC local abx utilization
and collateral damage
review published
FDA opens Remdesivir to all inpatients
Concern about Bamlanivumab
launch
Remdesivir EUA ends: FDA
approved
November 2020
First CoVID monoclonal Ab
Approved via EUA process
Guidance prepared
Baricitinib EUA guidance prepared
Dec 2020
Resources turn towards vaccine
approvals and EUA rollout
Incorporation of NIH figures
Remdesivir EUA supplies dwindle
prompting network utilization review
% utilization growth
50%
45%
40%
35%
30%
25%
On hold for vaccine launch
20%
15%
10%
5%
0%
Despite high census, BIDMC has strict
control on remdesivir use
For more information, contact:
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Milestones
Ivermectin review
Jan 2021
Infographics for antibiotic overuse
Continued tocilizumab evidence evaluations REMAP-CAP redirecion
February – November 2021
Outpatient and Employee vaccine rollouts
Vaccine recommendations for immune compromised host
Third dose and half dose boosters launched
Monoclonal Antibodies reviewed and infusions begun in June 2021
Additional antibody combinations reviewed and added given variants of interest
Regulatory reports for EUA allocation established and submitted
Tocilizumab shortage addressed with introduction of baricitinib via EUA and other
mitigation processes
Vaccine AE warnings added to screening documents for selection
Lessons Learned
Therapeutic review and guidance for an entity and a pandemic not seen before requires significant human resources to vet
hundreds of citations and build consensus.
A network wide guideline posted to institution specific intranet sites to accommodate resources of size and demand is an
achievable goal with regularly scheduled meetings.
Version control and edits can be daunting
The process of review and utilization reports revealed the potential for reflexive prescribing
Next Steps
Continue network collaborations across the CoVID 19 trajectory, vaccines and preventive therapies.
Determine ways to communicate more broadly and efficiently
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Roger Shapiro
Katy Stephenson
Ryan Chapin
Sabrina Tan
Margaret Hayes
Howard Seth Gold
Christopher McCoy
COVID 19 Treatment Collaborative
Department
Any departments listed on the poster or identified in the spreadsheet.
Infectious Diseases
Pharmacy
Critical Care Medicine
Health Care Quality and Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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Title
A name given to the resource
Development of a Living Guidance Document for the Therapeutic Evaluation and Treatment of Patients with COVID-19
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/47d07ae0897abff317ec841a89f78ebb.pdf?Expires=1712793600&Signature=d05lXgLtDTlC6M%7EUKaj0loIxB6yYQcgyAV%7E3F1UOMbQqRS2yEukmrsmbyzYjhG7FOLh6HtXrKeRUXOEGeCzXqZft38tZrG4VBUOQrTwE0i75wAjgNSOHXWWh9S3wQKSTK9qcSI3Hmai0UCHNtw6pvJ%7Ehoe796rs8MOI50oJbP62WU18M08JIYAFCboVJtUl18bv6sDXrmMKdOoCoq7tR3nvDkeCLqE5SYMNKHq0WmjltWfEjfYvdRb7BXOCjf1jw9b1dAdFBSv6M5imiYnR%7EXs3BBflMmcvTvW0Z-CCS9wF51MFmjlVzbbd3hoiHZqKCrvKnN29GCWliE%7EIregd70w__&Key-Pair-Id=K6UGZS9ZTDSZM
983b2fde039858475cc30617371dfc59
PDF Text
Text
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
Introduction/Problem
When the COVID-19 Pandemic began, obtaining essential supplies from existing supply chain channels
became an urgent challenge due to significant shortages in supplies. At the same time, there was an
influx of support from community volunteers and alternative manufacturers that needed and wanted to
pivot from their traditional products and apply a variety of technologies and skills to producing products in
response to COVID-19. The volume of innovations coming to the surface required a team and a process
to effectively catalogue, test, source, and ultimately add alternatively sourced products to supply chain for
purchasing.
Aim/Goal
The goal of this work was to alleviate the shortages of essential supplies that were in short supply during
the COVID-19 surges, and create processes to be more prepared with alternative supply changes for
subsequent pandemics or other major public health emergencies.
The Interventions
Coordinated BILH system-wide sourcing & testing of alternative PPE
Developed and implemented BILH evaluation algorithm for PPE sourcing
Provided business and legal guidance for alternative RT-PCR kit sourcing
Provided business and legal guidance for open source 3D printed swab project
Communicated BIDMC PPE needs to COVID-19 Massachusetts Manufacturing Emergency
Response Team (M-ERT)
Brought >20 alternatively sourced products into the BILH supply chain
Results/Progress to Date
The Team
Administrative Project Team
• Emilie Downing, BS; Director of Market Analytics & Intelligence, BILH
• Catherine Gill; Senior Research Administrator, BIDMC
• Andi Hernandez, BA; VP of Research Operations, BIDMC
• Olivia Potvin, PhD; Research Program Manager, BIDMC
• Gyongyi Szabo, MD, PhD; Chief Academic Officer, BIDMC and BILH
• Eleanor Torrey, MPH; Senior Project Manager, BIDMC
• Tod Woolf, PhD; Executive Director of Technology Ventures Office, BIDMC
Research, Clinical, and Administrative Contributors
• Ramy Arnaout, MD, DPhil; BIDMC
• Sana Ata, MD; Lahey Hospital
• Alana Dale, BA; BIDMC
• Abby Flam, MCP; BIDMC & Atrius Health
• Heung Bae Kim, MD; BCH
• James Kirby, MD; BIDMC
• Jeffrey Lamson, BS, RN; BIDMC
• Stanley Lewis, MD; BILH
• Chip McIntosh, NP, PhD; BILH
• Phillip Mears, MHA, JD; BILH
• Christopher Minette, MBA; BIDMC
• Peter Shorett, MPP; BILH
• Thomas Siepka, RPh, MS, FASHE; BIDMC
• James C. Weaver, PhD; Wyss
• Marten H. Wolckenhaar, MD; Lahey Hospital
• Sharon B. Wright, MD, MPH; BILH
• Mark Zeidel, MD; BIDMC
1. COVID -19 Innovation Hub. Alternative manufacturing and methods project categories:
1) PPE Products, 2) PPE Sterilization for Re-Use, 3) Ventilators (parts, repair and novel simplified
designs), 4) Assays (COVID PCR and serological assays), and 5) Therapeutics and Vaccines (discovery
research and clinical trials).
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
2. Community Support Overview.
3. BILH Evaluation Algorithm for PPE Sourcing. The BILH COVID-19 Innovation Hub 1) organized the
flow of PPE donations, and had the PPE evaluated for suitability, and 2) consolidated requests and
sources of PPE from pivoted manufacturers and tracked which items could be cleared for use at BILH.
4. Covid-19 Diagnostics. 1) James Kirby at BIDMC quickly developed a Q-PCR assay with a local
company that was used early in the pandemic and other area hospitals for clinical diagnosis of COVID-19
when CDC tests were unavailable (not shown here). 2) A multidisciplinary team of experts led by Ramy
Arnaout at BIDMC collaborated with 3D printing companies and other Medical Centers to develop open
source 3D printable swabs used for COVID-19 testing (above).
5. Alternative N-95 Elastomeric Respirator from BCH/Wyss/BIDMC. This alternative respirator was
developed with readily available locally sourced filter modules and a 3D printed adaptor. The product was
found to be effective, but was not deployed as it was not NIOSH approved.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
6. Massachusetts Manufacturing Emergency Response Team (M-ERT). Mark Zeidel and Tod Woolf
communicated BIDMC PPE needs on weekly M-ERT conference calls. Our work with the Covid-19 MERT had an impact in Massachusetts and beyond, and the M-ERT has been cited by government officials
as a model for innovative manufacturing responses to emergencies.
8. Summary. Our Innovation Hub reviewed over 156 alternatively sourced items, with >20 items passing
the evaluations and being approved to enter the BILH supply chain. We have established work flows for
evaluating novel supply chains during future emergencies.
Lessons Learned
7. Alternative Manufacturing of Disposable Face Shields from Lacerta. James Weaver from the Wyss
Institute led this project (https://wyss.harvard.edu/news/seven-million-face-shields-and-counting/). These
masks were produced at very large scale (millions) by local manufacturer of food packaging (Lacerta).
We coordinated with environmental health at BIDMC to have these evaluated and they were added to the
BIDMC supply chain.
We learned that making products which require governmental approval is quite challenging, and
requires input from regulatory agencies, engineers, environmental safety and end users. Some
items, like face shields and ethanol hand sanitizer, were relatively easy to find alternative sources,
but complicated items like the specialized materials used in N-95 masks was much more difficult and
time consuming to obtain from alternative manufacturers.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tod Woolf <a href="mailto:%20">woolf@bidmc.harvard.edu</a>
Project Team
Emilie Downing
Catherine Gill
Andi Hernandez
Olivia Potvin
Gyongyi Szabo
Eleanor Torrey
Tod Woolf
Ramy Arnaout
Sana Ata
Alana Dale
Abby Flam
Heung Bae Kim
James Kirby
Jeffrey Lamson
Stanley Lewis
Chip McIntosh
Phillip Mears
Christopher Minette
Peter Shorett
Thomas Siepka
James C. Weaver
Marten H. Wolckenhaar
Sharon B. Wright
Mark Zeidel
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Tech Ventures
Dublin Core
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Title
A name given to the resource
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5883bcb04f1dcd626ff8b9172e55989f.pdf?Expires=1712793600&Signature=jS0BLvDiOrwUewEtSvSi-JSzqmpowE-DIApB6VXGhpESXjv8ATV9vrn4TdkM%7EHUr4IzCY-C3SZfKfFRhiY66ZQ6SdqscejEhhWJMncylzf9%7EJAJ9kq8jheaTH4WDwBomRHHOfm2s3jFMDupSscjvsw9D0MgPn4P5FlzFGVpoO5AxdeGS0LR3VZCUcD6efSGyLSM4qOFkFTzyR7WohPeoiwPDd2xmx98RIDQP6kWuFjddPEHkCG101RYfwjIY7LZmC9jX-pixQdaFOUc7TQelYUNFMsNHyJDA%7EM2G4Y3JcCM3ryKPrX64QfGkCXpIXzV7I7rS3j3WevdnxktiMiZn6Q__&Key-Pair-Id=K6UGZS9ZTDSZM
2a5d2341b474e6d90f263bcb78f8c782
PDF Text
Text
Addressing the Gap in NAFLD Screening
Nathan Sairam, MD1; Eddy Leung, MD1; Hirsh Trivedi, MD2, Jonathan Li, MD3; Michelle Lai, MD2
Department of Medicine1, Liver Center2, Health Care Associates3
Beth Israel Deaconess Medical Center
Introduction / Problem
Methods
● Non alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease that causes steatosis of the
liver in the absence of alcohol consumption.
● 50% of cases of advanced fibrosis from NAFLD are not discovered until they present with
decompensated cirrhosis, which has an 85% 5 year mortality without transplant.
● The incidence of NAFLD is projected to increase significantly by 2030 and will cause increased
incidence of NASH cirrhosis, HCC, and associated complications.
● NAFLD currently leads to $103 billion dollar in medical expenses annually.
● Diabetics have very high rates of NAFLD, with some studies showing 71% of diabetics having NAFLD.
● 23.1% of diabetic patients have F3-F4 fibrosis, which would warrant HCC and variceal screening.
● The American Diabetes Association currently recommends screening patients with diabetes for NAFLD
with yearly LFTs.
● 50% of diabetics with NAFLD and 56% of diabetics with NASH actually have normal LFTs.
● Fibroscan screening has the potential to identify patients with F3/F4 fibrosis with higher sensitivity
allowing for more early identification of HCC and varices.
● Using Arcadia, we generated a list of 101 diabetic patients seen at HCA clinic by three of our study
members.
● All patients were manually chart reviewed to determine whether or not they were getting yearly LFT
screening. Any patients with a 2 year or greater gap with no LFTs starting from the time of their
diabetes diagnosis was considered to not be getting yearly LFTs.
● All patients were chart reviewed to determine if they ever had persistently abnormal LFTs on at least 2
consecutive checks at any point in time.
● We reviewed prior imaging to determine if patients ever had incidental findings of steatosis of the liver.
Results
37% of patients with
diabetes were not being
screened yearly with LFTs
Aim / Goal
● Identify patients with F3/F4 fibrosis prior to presentation with decompensated cirrhosis and enroll
these patients into HCC and variceal screening pathways.
● Retrospectively review a cohort of patients with diabetes in the primary care setting to determine how
well we are currently adhering to the ADA’s current guideline of yearly LFT screening.
● Determine how often fibroscans are ordered for patients with abnormal LFTs or steatosis on imaging.
● Determine feasibility of direct to fibroscam screening strategy.
59% of patients with
diabetes had past or present
abnormal LFTs or imaging
showing steatosis but had
never received fibroscan
Conclusions / Next Steps
At HCA clinic, there is poor adherence to the current ADA guideline recommendation for yearly LFTs to
screen for NAFLD among diabetic patients. Furthermore, the majority of diabetic patients have had
abnormal LFTs or incidental steatosis of the liver on imaging at some point in their care but have not been
ordered for fibroscan to follow this up. Offering one-time fibroscan may therefore be a superior screening
strategy. We developed a call outreach effort to offer fibroscan to these patients. The outreach effort and
our results are described on the following slide.
For more information, contact:
Nathan Sairam (nsairam@bidmc.harvard.edu)
�Patient Perceptions about NAFLD and its Screening
Eddy Leung, MD1; Nathan Sairam, MD1; Hirsh Trivedi, MD2, Jonathan Li, MD3; Michelle Lai, MD2
Department of Medicine1, Liver Center2, Health Care Associates3
Beth Israel Deaconess Medical Center
Aim/Goal
Results continued
• Ascertain patient-related barriers to NAFLD screening by gauaging knowledge and interest in NAFLD
screening in patients by outreach calls
• Implement a direct-to-fibroscan approach to NAFLD screening for those patients who agree to be
screened with this approach
Methods
79%
A subset of patients were identified
through Arcadia and sorted with
exclusion criteria. The remaining
patients were contacted with outreach
calls using a standardized script
Number of Responses
Results
Number of Responses
What Patients had to say:
● “My liver numbers (liver function tests) are excellent. What else would
justify doing it (fibroscan)?”
● “Do my [diabetes specialists] know about this? None of them mentioned
anything about fatty liver disease.”
● “I have an appointment with my primary care doctor tomorrow. I want to
talk to [them] about it instead.”
● Patient was afraid the call meant she had fatty liver disease because nobody
had mentioned it to her before.
● Patient stated she was nervous about the [fibroscan] results because she
knows diabetes is bad and it “puts you at risk for everything.”
Conclusions
• Knowledge and awareness about NAFLD are low among patients with T2DM. For many, it had not
been discussed by their primary care doctors or specialists.
• Most patients intuitively believe that fatty liver disease is serious and warrants screening.
• Patient hesitancy regarding NAFLD screening may be improved by discussions initiated by the primary
care doctor as part of healthcare maintenance.
• Outreach calls using a standardized script may be an effective method in improving rates of NAFLD
screening in patients with T2DM.
Next Steps
1-10 scale where 1 is not serious at all and 10 is among the most serious
medical conditions
• Follow up on fibroscan completions rates in three months from the time they were ordered to
determine adherence
• Follow the results of fibroscans ordered. This may inform whether a direct-to-fibroscan approach
identifies advanced fibrosis in those who otherwise would not have been screened according to
guidelines that recommend liver function testing.
For more information, contact:
Eddy Leung (eleung3@bidmc.harvard.edu)
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Nathan Sairam (<a href="mailto:nsairam@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">nsairam@bidmc.harvard.edu</a>)<br />Eddy Leung (<a href="mailto:eleung3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">eleung3@bidmc.harvard.edu</a>)
Project Team
Nathan Sairam
Eddy Leung
Hirsh Trivedi
Jonathan Li
Michelle Lai
Department
Any departments listed on the poster or identified in the spreadsheet.
Department of Medicine
Liver Center
Health Care Associates
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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Title
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Addressing the Gap in NAFLD Screening
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/055f07d74179b83ef0282d00dad2ad2f.pdf?Expires=1712793600&Signature=e-bWGwcI-RazVxL0s1RWVrPt2DMEy9OZajf9mEhso3y9T3r0P1I2Kov0yNCHbSnSXjZJS2E6BS3HwbM78RGVcSoZab%7EMuilG5R5zXt5HXgnk4baaeoX6izM-dPBWR1rtvDCC25o26pgPf9-8UnkoYu2bA2UimvugSKXmL9y8TfYbnB1jEGZMbgqFKNeb33SVvZIhsAj%7EcU-p9Y7bygyluE2tmj9nMIoTQk5UUzTzc2Zx0Es0ZPQ1PTix5rnwFEjIFgoDOY2sNQg4ep%7EIq5JZDFSi1b5lfObg7hbhdWm9vpHRiPUFOyiDnQ2pYxqdYnN8Ok6H-yUnxBCOsO0dXZiUrw__&Key-Pair-Id=K6UGZS9ZTDSZM
ee276e8f612864b4542a40aceed958bd
PDF Text
Text
JUST-IN-TIME IN-SITU SIMULATION REFRESHER TRAINING FOR THE PERIOPERATIVE CARE OF COVID-19 PATIENTS
SS Obeidat1, MJ Needham1, Jeffrey Keane1, Michael Chen1, L Zucco2, N Levy1, John Mitchell1, & SK Ramachandran1
1Beth Israel Deaconess Medical Center & 2Guy’s and St. Thomas’ NHS Foundation Trust
Introduction/Problem
Results
In-person
Virtual
Grand Total
Our just-in-time in-situ simulation training program, initially developed and implemented during the first
surge in March 2020, was reformatted in order to deliver refresher training to perioperative staff
members, from anesthesia, nursing and surgery staff members.
Anesthesia
199
73
272
In order to keep our practice of safe COVID-19 patients care in the perioperative setting and in
anticipation of the second surge of COVID-19, we provided in-situ training to “refresh” staff members on
the hospital updated specific workflow.
Surgery
12
4
16
Nursing
129
29
158
Grand Total
340
106
446
Feedback
Aim/Goal
The goal of the training was to assure staff readiness to safely provide care for COVID-19 patients,
minimize viral exposure and reduce the risk of transmission of COVID-19 to healthcare workers in the
perioperative setting.
Feedback reflected an appreciation for the brevity, the ability to complete training using the
preferred modality of the participant and the timeliness.
Feedback from staff members who were involved in the perioperative care of COVID-19 patients,
confirmed that appropriate protocols were followed in nearly 90% of all COVID-19 cases.
The Interventions
Refresher training was delivered over the course of 5 days in late November 2020, it was available to
each hospital site within the BI network. Attendance at each station/simulation scenario was tracked
using a QR code, which also contained a post-training question to assess knowledge of key concepts
within each station.
Given routine operating continued during the second wave, (staff members not readily available and
operating rooms would be occupied), we reformatted our COVID-19 training program to include
several modalities; online learning using a video recording, in-person training using drop-in stations
and didactic sessions through joint town hall meetings and grand round presentations.
Training Focused on donning & doffing of personal protective equipment (PPE), performing a COVID19 specific pre-operative huddle, and the use of appropriate infection control measures when
intubating or extubating.
For more information contact:
anesthesiaqsifellows@bidmc.Harvard.edu
For more information, contact:
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
SS Obeidat <a href="mailto:%20">sobeidat@bidmc.harvard.edu</a>
Project Team
SS Obeidat
MJ Needham
Jeffrey Keane
Michael Chen
L Zucco
N Levy
John Mitchell
SK Ramachandran
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Nursing
Surgery
Anesthesia
Nursing
Surgery
Dublin Core
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Title
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Just-in-time In-Situ Simulation Refresher Training for the Perioperative Care of COVID-19 Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
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97407b648f0d094740f60e3a33e0b96e
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Text
Allocation of Scare Resources Lead to Developing a Crisis Standard of Care
By Michael Cocchi, MD, Jaime Levash, and Deborah Stepanian
Beth Israel Deaconess Medical Center
Introduction/Problem
COVID-19 was spreading rapidly across the country. The number of patients coming to hospitals was
increasing at an alarming rate. Does BIDMC have enough life saving equipment? What are we going to do
if we run out of ventilators? BIDMC laid out an approach following Massachusetts Department of Public
Heath (DPH) Crisis Standards of Care (CSOC) guidelines. The goal of the CSOC is to maximize benefit to
populations of patients, often expressed as doing the greatest good for the greatest number.
Model/Indication for CSOC
As described by the National
Academies, the need for
healthcare surge capacity in a
disaster occurs along a
continuum based on demand
for health care services and
available resources.
Aim/Goal
The goal was to develop and operationalizing a fair assessment tool and efficient process for each patient
to be consistently and frequently evaluated and scored in alignment with Massachusetts DPH CSOC
guidelines.
The Team
Michael Cocchi, MD
Mary Beth Cotter, RN
Michelle Doherty, RN
Nicole Johnson, RN
Jaime Levash
Deborah Stepanian
Kimberly Voto, RN
Mary Ward, RN
The Interventions
Developed a guideline and scoring tool in alignment with state guidelines using the Sequential Organ
Failure Assessment (SOFA) in combination with patient comorbidity status.
Rolled out education on the scoring process and tool to staff conducting the assessments
Created tracking tools and reporting systems to follow patients daily to multiple times a day
Reviewed scores to determine if SOFA assessment was capturing the patient correctly
In alignment with and due to scoring methodology updates to the MA DPH CSOC, implemented
different scoring tools mid-process, shifting from evaluation/scoring related to patient comorbidity status
to a life expectancy score.
Incident demand/resource imbalance increases
Risk of morbidity/mortality to patient increases
Conventional
Contingency
Crisis
Space
Usual patient
care space fully
utilized
Patient care areas repurposed (PACU,
monitored units for ICU-level care)
Facility non-patient care areas
(classrooms, etc.) used for patient
care; Physical space no longer
available for clinical care
Staff
Usual staff called
in and utilized
Staff extension (brief deferrals of nonemergent service, supervision of broader
group of patients, change in responsibilities,
documentation, etc.)
Trained staff unavailable or unable to
adequately care for volume of
patients even with extension
techniques
Supplies
Source: Massachusetts
Department of Public Health
Crisis Standards of Care
Planning Guidance for the
COVID-19 Pandemic
Recovery
Cached and usual Conservation, adaptation, and substitution of
supplies with occasional reuse of select
supplies used
supplies
Standard of Usual care
Care
Functionally equivalent care
Normal operating
conditions
Indicator:
potential for
crisis standards
Critical supplies lacking, possible
reallocation of life-sustaining
resources
Crisis standards of care
Trigger for Crisis
Standards of Care
Along the continuum of
care, strategies to
maximize healthcare
resources include
Substitution,
Adaptation,
Conservation, ReUse
and Optimize Allocation.
OPTIMIZE ALLOCATION:
Allocate resources to
patients whose need is
greater or who are more
likely to survive the
immediate crisis.
Extreme operating
conditions
Lessons Learned
It is important to create a multidisciplinary team with strong collaboration and rapid responsiveness.
Continuous awareness of critical care resources available in a rapidly changing environment is essential .
With the introduction of daily scoring needs expected by a provider, clear communication to providers
explaining the expectations in advance is needed and embedding within their existing workflow is optimal.
Testing of the tool/process important both for feasibility but also to evaluate for risk of inequity
It is important to have a tracking tool where multiple people can be accessing and recording data
simultaneously.
Next Steps
Through monitoring of COVID-19 patient volume and availability of critical care resources, once it became
evident that supply would meet demand, the Massachusetts Crisis Standards of Care (CSOC) was
deactivated to the relief of many.
For more information, contact:
Jaime Levash, Senior Project Manager Health Care Quality
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jaime Levash (<a href="mailto:jlevash@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jlevash@bidmc.harvard.edu</a>)
Project Team
Michael Cocchi
Mary Beth Cotter
Michelle Doherty
Nicole Johnson
Jaime Levash
Deborah Stepanian
Kimberly Voto
Mary Ward
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Allocation of Scare Resources Lead to Developing a Crisis Standard of Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Equality
Safety
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5427a0dda52e48e396dd92acb2d5e622
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Text
Management of a COVID-19 patient in the endoscopy suite
Joseph D. Feuerstein, MD, Nadav Levy, MD,,∗ Liana Zucco, MBBS, MSc, Lior A. Levy, MD, Mandeep Sawhney, MD
and Satya Krishna Ramachandran, MD2 Presenter: Mitra Khany MD
Introduction
Since the COVID-19 pandemic started in December 2019, gastroenterologists
have had to rapidly evolve their endoscopy practice to ensure the safety of
endoscopy team members and their patients. Because the virus is transmitted via
droplets and potentially via airborne inhalation of aerosolized particles,
endoscopic procedures performed on patients with confirmed or suspected
COVID-19 increase the risk of transmission to healthcare providers. To minimize
the risk of exposure among healthcare workers and patients, protocols and
algorithms to reduce inadvertent transmission of the disease is critical. In this
article, we review the workflow that was developed by the coordinated efforts of
the Department of Anesthesia and the Division of Gastroenterology at Beth Israel
Deaconess Medical Center in Boston available.
GI procedural algorithm for COVID-19. PPE, Personal protective equipment; ICU, intensive care
unit; SOP, standard operating procedures.
Aim
To keep providers safe during endoscopic procedures during the COVID19 pandemic, it is critical that protocols are developed to maintain proper
PPE and limit the risk of exposures. Simulations and flow diagrams are
important tools to train staff on how to perform endoscopy safely.
For more information, contact:
�Management of a COVID-19 patient in the endoscopy suite
Pre-procedure Considerations
To reduce the risk and time of exposure of healthcare personnel to patients with COVID-19, consider
obtaining all procedure consent verbally.
all nonessential equipment should be removed from the room
Any equipment essential to the procedure or nonessential equipment that cannot be moved should be
covered in clear plastic drapes to minimize potential contamination of the equipment.
Once equipment is brought into the endoscopy room, it should be discarded, even if unopened.
Alternatively, equipment can be kept in a double bag; then, if the equipment is not used, one can discard the
outer bag only.
One should consider intubation for all endoscopic procedures (especially upper endoscopic procedures) to
reduce the risk of droplet exposure
A safety officer should be identified; the safety officer will be responsible for ensuring proper donning and
doffing of PPE and monitoring the outside door to the endoscopy room to make sure no one enters the
room without proper PPE.
Discussions during the huddle should include the following: which personnel will be in the room versus
outside the room, what procedure is planned and what equipment will be needed in the room or prepared
outside the room, patient disposition, and whether any additional resources are needed (eg, environment
services).
Donning PPE
Remove all nonessential/personal equipment.
Perform hand hygiene: wash your hands with soap and water or hospital-approved hand
sanitizer.
Apply head cover.
Apply N95 respirator and ensure adequate seal.
Apply eye protection (or a secondary facemask with eye shield over the N95 respirator).
Perform hand hygiene.
Apply shoe covers (option to apply leg covers, if available).
Don and secure impermeable gown.
Don 2 sets of gloves on each hand, ensuring wrists are cover
Confirm with safety officer that all PPE is donned correctly.
Patient arrival
COVID-19 patients should be brought directly into the procedure room while wearing a surgical facemask.
Shared spaces should be avoided
Procedure
1: A timeout should be performed, and all nonessential personnel should exit the room during intubation to
limit the number of people exposed during intubation
2: Once intubation is complete, the nurse in the room can open the door, allowing re-entrance to the
room
3:During the procedure using gauze to cover the instrument channel on removal may be helpful. Once the
procedure is nearing completion, the endoscopist should advise the team that the scope is being
withdrawn. Using gauze to cover the endoscope, suctioning secretions on withdrawal, and having the
nurse cover the mouth with gauze are all advisable
Doffing of PPE
Remove shoe covers (and/or leg covers if present).
Remove gown and gloves and then perform hand hygiene.
If wearing an eye shield, remove eye shield and perform hand hygiene.
Remove outer facemask and perform hand hygiene.
Remove N95 while leaning slightly forward, discard N95, and perform hand hygiene.
Remove bouffant and perform hand hygiene.
Apply a clean facemask and perform hand hygiene.
Ensure the safety officer is supervising the doffing sequence.
Post Procedural Consideration and Special Events
After the procedure, the room should be left closed for 30 minutes to reduce any exposure to
procedure-related droplets that might remain aerosolized. The room and endoscope can then be
disinfected using routine hospital/institutional protocols for cleaning rooms and endoscopes
In case of adverse event the provider’s safety is the priority. Making sure that responders to CODE call
For more information, contact:
do not enter the room if PPE is not appropriate.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mitra Khany <a href="mailto:%20">mkhany@bidmc.harvard.edu</a>
Project Team
Joseph D. Feuerstein
Nadav Levy
Liana Zucco
Lior A. Levy
Mandeep Sawhney
Satya Krishna Ramachandran
Mitra Khany
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Critical Care
Pain Medicine
Gastroenterology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Management of a COVID-19 Patient in the Endoscopy Suite
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/06af63b82e7567aea9f359021d47aee5.pdf?Expires=1712793600&Signature=v8IoMRwJP4lgBZdyWUSObVxAJ0EOzKvWE8CtZxGy4mHNgROHNNg1xXWb3DtOFkuDkhJpSMt5AF76geyPR-qVC3JN1sDC5ngygNLHwopdSjvrqzK6hVt2gsFXTqzvm7RpycOjvys9iz1y%7EcqLynBSTm1uj2Zt3%7EmQEiZUIloaY7WMaNPbYAs3byDRkMq1U8392ebeBjXf6tJOskk2AfZ5Fb41%7EjAUO%7ETUSqsJKXKRKeDzq7LGlMMKbPproq00FN5qIKjVY2mIaUC9HKAiZgA4ELl6fS74LoHixXtT6HijB76NTAA7f1GLo9yzA3nDqbel4G557m-m7NSSQuyrpFC5DQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ed0bec646b7220e530ede69b6281d757
PDF Text
Text
Collaboration Between Departments to Identify a Gap in a High Risk, Low Volume Safety Process
Susan Holland, EdD, MSN, RN, NEA-BC, HealthCare Quality, Aya Sato-Dilorenzo, BSN, RN, OCN, BMTCN, Cancer Center Quality Improvement,
Christine Powers, MPH, MBA, Director of Environmental Health and Safety, and Deb Crowley, Telecommunications Manager
Problem
A Chemotherapy spill occurred in an Outpatient Treatment Area. The spill was determined to be larger
than could be contained as described in the BIDMC Policy, 1200-17, Nursing Practice During a
Hazardous Drug (including chemotherapy) Spill.
The nurse called, 2-1212 and informed the MASCO Operator that they were calling a Code Orange and
answered the questions asked by the Operator. Soon after, one of the Pharmacists came to the treatment
area with limited supplies for spill management as the East Campus Pharmacy was notified to respond to
the Code Orange.
The nurses were then told to call the Service Response Center (SRC) which they then did , and they
deployed Environmental Services/ housekeeping staff (EVS) to the treatment area. However, their
seemed to be a knowledge deficit of the EVS staff and cleaning chemo spills (for example those who
responded, did not know that they should wear gloves or a gown during the process). The nurses guided
the EVS staff so they were properly protected, and were instructed to assist EVS in the spill
management.
An RL Safety Report was entered regarding the Code Orange and as the event was reviewed, it was
discovered that the BIDMC Policy, EC-43, Hazardous Spill Response Program, (“CODE ORANGE) did
not match actual practice, and a larger investigation began.
Goal
To review the EC-43, Hazardous Spill Response Program, (“CODE ORANGE) policy and identify
breakdowns in communication so that the appropriate and most knowledgeable team members would be
notified when a “CODE ORANGE” was called.
The Team
Deb Crowley, Manager of Telecommunications
Susan Holland, EdD, MSN, RN, NEA-BC, Patient Safety Coordinator and Risk Manager
Christine Powers, MPH/ MBA, Director of Environmental Health and Safety
Aya Sato-Dilorenzo, BSN, RN, OCN, BMTCN, Cancer Center Quality Improvement
Members of: Emergency Management, Materials Logistics, Shapiro 9 Nursing Staff, Pharmacy,
Environmental Services and MASCO
Investigation
Discovered that instructions that MASCO was given did not match our current policy of EC-43,
Hazardous Spill Response Program, (“CODE ORANGE)
When a staff member dialed 2-1212 and reported a CODE ORANGE, the Operator was instructed to
ask if the Code Orange was related to a medication or blood/ body fluid:
If YES to a medication, then the East Campus Pharmacy would be notified to respond to that
location/ caller
If YES to blood or body fluid, then SRC/ EVS would be notified to respond to that location/
caller
AND if YES to either of these questions, the notification process would stop and the CODE
ORANGE page would never go out to Environmental Health and Safety (EHS) or others.
However, if NO to either of these questions, then the CODE ORANGE page would go out to
EHS and others
Interventions and Outcomes
Communication with MASCO to ensure they have the correct information: when a CODE
ORANGE is activated, a page is always sent to the pager distribution list including EHS
Environmental Health and Safety and Emergency Management now have automatic access to,
and receive notification of Facilities, Environment of Care, and Safety related RL Reports
Anticipate improved staff satisfaction with the level of support and expertise when Code Orange
events occur.
Anticipate a more accurate account of Code Orange events which possibly may help inform
EHS work in the future
Completed
Completed
Ongoing
Ongoing
References:
Centers for Disease Control (CDC). (2014). National Institute of Occupational Safety and Health (NIOSH)
Study Provides Insight into Healthcare Worker Training & Handling of Hazardous Chemicals.
Occupational Safety and Health Administration (OSHA) (2012)Hospital-wide Hazards- Hazardous
Chemicals, United States Department of Labor
BIDMC Policy, EC-65, Hazardous Waste Collection
BIDMC Policy, NPM 1200-16, Chemotherapy Safe Handling
For more information, contact:
Susan Holland, RN, HealthCare Quality, sholland@bidmc.Harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Susan Holland (<a href="mailto:sholland@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">sholland@bidmc.harvard.edu</a>)
Project Team
Susan Holland
Aya Sato-Dilorenzo
Christine Powers
Deb Crowley
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
Telecommunications
Cancer Center
Environmental Health and Safety
Emergency Management
Materials Logistics
Pharmacy
Environmental Services
MASCO
Shapiro 9 Nursing Staff
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Collaboration Between Departments to Identify a Gap in a High Risk, Low Volume Safety Process
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
Timeliness
-
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02c8ba701cd379801c96ddcbad970895
PDF Text
Text
Clinical Research Response during COVID
Gyongyi Szabo, MD, PhD, Andi Hernandez, Tanya Santos, Michelle Beck, Kim Chun, Chris Botte, and Angela Lavoie
BIDMC
Introduction/Problem
Research Operations needed to quickly prepare a coordinated and safe response to the reduction of
hospital activity in the early response to COVID. It was important to ensure that the safety of research
participants on ongoing therapeutic trials while enabling a rapid implementation of COVID-related
therapeutic trials. Clinical research is conducted across the medical center. Implementing change would
need to be coordinated with department leadership and communicated through different mechanisms.
With guidelines being instituted from hospital leadership, statewide restrictions, and a developing
understanding of SARS-CoV-2, it was essential to have a working group to understand the impact on
clinical research and create guidelines that would align with developing institutional policies.
Aim/Goal
The goal was to effectively manage conducting research during a period of constrained resources and a
statewide lock-down. To address this, research operations instituted several measures to protect
participants and research staff and support important initiatives for COVID research. Just as important as
the response to reduce the research activity to focus on therapeutic trials and COVID was the
resumption of activity in a staged way to allow for a controlled return and coordinated with departments,
clinics, and research teams.
The Interventions
Development of guidelines for the restriction of research activities on-site during the COVID lockdown
Creation of an Urgent IRB Committee for rapid review of COVID research.
Establishment of a Scientific and Institutional Research Review Committee to review the impact of PPE, lab,
nursing, and other clinical resources from research activities.
COVID-19 Steering Committee was established to review new COVID research proposals to promote
collaboration and reduce duplicative efforts and maximize data and biospecimen collection.
Creation of a Return to Clinical Research workgroup to develop a phased re-opening for non-COVID
research. The group was charged with developing a staged plan to reopen clinical research.
Results/Progress to Date
Creation of a COVID dashboard to eliminate patients from being repeatedly approached to participate in
research studies. The dashboard provided real-time updates with impatient data and whether the
participant was approached and/or enrolled into a COVID research study.
The Team
Gyongyi Szabo, MD, PhD, Chief Academic Officer, BIDMC and BILH
Andi Hernandez, Vice President of Research Operations
Tanya Santos, Director, Research Operations
Michelle Beck, Administrative Director, Clinical Research Programs
Kim Chun, Project Manager, Research Operations
Chris Botte, EDC Support Specialist, Academic and Research Computing
Angela Lavoie, Director, Human Research Protection Program
REDCap dashboard created with Academic and Research Computing to facilitate recruitment
communication between different study teams.
For more information, contact:
Andi Hernandez, Vice President of Research Operations
�Clinical Research Response during COVID
Gyongyi Szabo, MD, PhD, Andi Hernandez, Tanya Santos, Michelle Beck, Kim Chun, Chris Botte, and Angela Lavoie
BIDMC
COVID PROTOCOL REVIEW FOR 2020
10, 4%
14, 6%
25, 11%
More Results/Progress to Date
1, 1%
Ceded Review to another IRB
30, 13%
Emergency Use
Exempt
Expedited
Full Board
150, 65%
Privacy Board/Decedent Research
During 2020, the IRB reviewed 230 new research protocols about SARS-CoV-2.
All research staff were assigned a return to research training in myPATH. All key information was shared
in an email announcement, Town Hall meeting, myPATH training and on the research portal page.
Lessons Learned
Any guidelines developed by clinical research needed to align with guidelines from hospital incident
command.
Communication was key to ensure that the information was shared with all the individuals that conduct
clinical research throughout the medical center.
The committees that were established were essential for ensuring that the impact of clinical research
activities was not going to impede clinical operations while allowing for important research to be conducted.
Next Steps
A recruitment postcard was created and handed out at BIDMC COVID testing sites to eliminate the
requests for flyers and recruitment handouts for specific studies. The QR code on the postcard displays all
the current COVID research being conducted at BIDMC and contact information for the study team.
Develop an Emergency Preparedness plan for clinical research using the foundation developed from
these activities.
AAHRPP, accreditation agency for human research protections, has indicated that emergency
preparedness will be a new standard for institutions to meet. We will use our plans used here to
develop our policy and response.
For more information, contact:
Andi Hernandez, Vice President of Research Operations
�Clinical Research Response during COVID
Gyongyi Szabo, MD, PhD, Andi Hernandez, Tanya Santos, Michelle Beck, Kim Chun, Chris Botte, and Angela Lavoie
BIDMC
Steering Committee Members
Steering Committee Members:
• Gyongyi Szabo, MD
• Mark Zeidel, MD
• Richard Schwartzstein, MD
• Howard Gold, MD
• Daniel Talmor, MD
• David Avigan, MD
• Peter Weller, MD
• Kathryn Stephenson, MD
• Michael Yaffe, MD
• Ai-ris Collier, MD
• Nathan Shapiro, MD
• Shahzad Shaefi, MD
• Michelle Beck
• Angela Lavoie
Return to Research Workgroup Members
Re-Opening Workgroup Committee Members:
Andi Hernandez
Michelle Beck
Janet Mullington, PhD
David Avigan, MD
Daniel Press, MD
James Rodrigue, PhD
Peter Weller, MD
Angela Lavoie
For more information, contact:
Andi Hernandez, Vice President of Research Operations
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Andi Hernandez (<a href="mailto:ahernan1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ahernan1@bidmc.harvard.edu</a>)
Project Team
Gyongyi Szabo
Andi Hernandez
Tanya Santos
Michelle Beck
Kim Chun
Chris Botte
Angela Lavoie
Janet Mullington
David Avigan
Daniel Press
James Rodrigue
Peter Weller
Mark Zeidel
Richard Schwartzstein
Howard Gold
Daniel Talmor
Kathryn Stephenson
Michael Yaffe
Ai-ris Collier
Nathan Shapiro
Shahzad Shaefi
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Clinical Research
Research Operations
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Clinical Research Response During COVID
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5cddf11d65df7bd8a0122d52ac48e7db.pdf?Expires=1712793600&Signature=RXKNqJa2ztI03ENJSeNaMZUjSTKiJoualVS4KuPLddkR6JdUAZ80C7K7ipdic4VvrKWoowSky5L4B49jIOV8Cul%7EZDFaTqAcCAvJdqgtIDzX3Miw0ur9nXLvIF81FmhzvYTy543d2GeiaEsdhDOWwsoOehvi-FYJ6ouvEZ-AMfpOZgLuGltreRV7XeQiXekkqB1lJ4gYQwege1rm3d938xZJNS5uXv40UIS4wqB0B14noLX3OvOI2Yd0Hts7scmFkoyq1zO1fnkmta1Ztb7wKNCroSUreWJv-FSu3Yy4bdF%7EyQ4Ksqrnq8vMl7JxZIDEMsBPoCTQciLqQdnxfaWiTw__&Key-Pair-Id=K6UGZS9ZTDSZM
5f348c840976e5bc84f853f4a8c94461
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Text
Adapting Interpreter Services to a Hybrid Model during COVID
Shari Gold-Gomez, Jordan Ellis, Interpreter Services Supervisor Team, and the entire Interpreter Services department
Introduction/Problem
In January 2020, Interpreter Services moved from a long-time paging system to a just-intime interpreter request software.
Two months later, in March 2020, Interpreter Services used this just-launched system to
enable appointment dispatching to approximately 50 interpreters, representing over 15
languages. We quickly increased to over 30 languages representing 100 interpreters,
including staff, per diem and non staff.
This quick transition to a hybrid model within 48 hours allowed BIDMC to maintain
communication and service delivery to LEP patient population.
Aim/Goal
The goal of this work was to provide seamless service delivery to the LEP patient population
in virtual, ambulatory, and inpatient settings during the COVID-19 pandemic.
The Team
Ø
Ø
Ø
Ø
Ø
Shari Gold-Gomez, Director, Interpreter Services
Jordan Ellis, Project Manager, Improvement & Innovation
Stephanie Baumeister, Operations Manager, Interpreter Services
Supervisors: Ana Torres, Janice P Chung, Ernestina Damoura Moreira, Rina Levin
The entire Interpreter Services department
The Interventions
Ø We first piloted remote interpretation with large
language teams in the weeks leading up to
March 13, 2020. We then had a proof of concept
that it was possible to provide interpreter
Ø
services remotely.
Ø We then changed protocols and began taking
hospital-issued devices home to be prepared for
remote work prior to March 13,2020.
Ø After the March 13th announcement that clinics
were closing, Interpreter Services changed their
configuration to base a minimal number of staff
on site with the balance of interpreters at home
ready to work remotely via the dispatching
software. The outcome was successful to adapt
the dispatching software to allow interpreters to
safely work from home while maintaining an onsite presence for complex patient interactions.
Donated clinical iPads were configured for ease
of use with Starleaf and interpreters on selected
inpatients floors for video interpreting.
Year
2019 (scheduled
interpreters)
2021 (hybrid model,
dispatching software)
Average Response Time
(Minutes)
15 minutes
5 minutes
Results
40,000 more encounters since FY18 with the
This project allowed a hybrid model to both
same staffing.
allow a key on site presence of interpreter,
with the balance of 100 interpreters to work
remotely: providing video and telephone
interpreting which had never been done
before by BIDMC interpreters.
This current models allows Interpreter
Services to serve 18% more encounters for
LEP patients and providers with the
efficiencies gained by not traveling and waiting
in a just-in-time model compared with FY 18
levels. This equates to supporting more than
For more information, contact:
Shari Gold-Gomez
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Shari Gold-Gomez (<a href="mailto:sgomez@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">sgomez@bidmc.harvard.edu</a>)
Project Team
Shari Gold-Gomez
Jordan Ellis
Stephanie Baumeister
Ernestina Damoura Moreira
Ana Torres
Janice P. Chung
Rina levin
Interpreter Services Department
Department
Any departments listed on the poster or identified in the spreadsheet.
Interpreter Services Department
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Adapting Interpreter Services to a Hybrid Model during COVID
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/a86bd448db799fafeebd312ac7452175.pdf?Expires=1712793600&Signature=R8MLmIS5Zo%7EKXfD%7EHg6JzsnECw7K0v-XH48kuRRmk5ye6lT1ppLZoJBo1Yi1Kyvlv2VplUZnkydoLjcmsol2f4pq9qaMp4yukLQp0hp3e8Hae5CJnjBtHD94O9EBxFnFe%7EIDeONc9kWHPKqrI4rEq9ThDQPqMsoyKohfR6hAF92lF-iBeq9Ycfh6Qrbx9MrKaeMCJXyLU80PSEegF5mhMHzY5eB5x-Futj11o64TYRa%7EGSqKN%7EbzYFXxagqRQrhQO9QbuLkF5P35GwA7Y7HO70h0VUXaqMx1FcXKS1FinZIShVDXF0J7L6UnA9EUt0zWDzhOXKL-UgkiNUD6D57UqA__&Key-Pair-Id=K6UGZS9ZTDSZM
b9fca4d4357ea9cb58f1400fc5f1eae0
PDF Text
Text
GIFTS: Geriatric Inpatient Fracture Trauma Service
Chahal, Karen; Lipsitz, Lewis; Olveczky, Daniele; Rodriguez, Edward K.; Salamon, Suzanne; Whyman, Jeremy; Berry, Sarah
BIDMC: Beth Israel Deaconess Medical Cen
Introduction
Aims & Goals
• Hip Fractures are often emergencies in the elderly and threaten independence and quality of life.
• Hospitalizations for hip fracture should address both acute complications (e.g., delirium) and chronic
underlying conditions related to this event (e.g., osteoporosis, falls, underlying neurocognitive
impairment, and lack of appropriate support and caregiving.
• A Co-Management Model between Orthopedic Trauma and Geriatric Medicine has been implemented
at selection institutions worldwide and proven to improve the following outcomes: time to surgery, the
incident and severity of post-operative delirium, other post-operative complications, length of stay and
readmission rates.
• Collaboration and coordination from admission to discharge between Orthopedics, Geriatrics and
Nursing IDT teams as well as, PT/OT, SW, Case Management and Pharmacy teams ensures
improvement in the quality of care and outcomes in this vulnerable population.
• population.
The Team
Orthopedic
Trauma
Geriatric
Medicine
Nursing
& Allied Health
Edward K. Rodriguez, MD, PhD:
Chief of Ortho Trauma Surgery,
BIDMC & GIFTS Champion
Jack Wixted, MD:
Ortho Trauma Surgeon, BIDMC
Karen Chahal, MD:
Director, BIDMC GIFTS Program
Kelley Parziale, Kerri Cellucci &
Naomi Stone, RNs:
Nursing Leadership, BIDMC/CC6
Deborah Adducci &
Brian McDonnell:
OT/PT Leadership, BIDMC
Christina Wang, LCSW:
Social Work, BIDMC/CC6
Paul Appleton, MD:
Ortho Trauma Surgeon, BIDMC
HMS Orthopedic Surgery
Interns & Residents & PAs
Advanced Fellow in Geriatric Medicine
Lewis Lipstiz, MD:
Chief of Gerontology, BIDMC
& GIFTS Champion
Sarah Berry, MD:
Geriatrician, BIDMC/HSL &
Principle Investigator QI Research
Daniele Olveczky, MD; Suzanne
Salamon, MD; Jeremy Whyman,
MD: Geriatricians, BIDMC
Maryellen Cronin & Case
Management Teams, BIDMC
Pharmacy Leadership, BIDMC
• Implement a Pilot Program for Co-Management with Orthopedic Trauma & Geriatric Medicine at
BIDMC for patients aged 65 and older with Traumatic Hip Fracture or Femur Fracture
• Identify Key Interdisciplinary Stakeholders to create a welcoming and collaborative environment to
improve communication, define challenges, improve care & workflow, develop new innovations
• Describe characteristics of patients enrolled in pilot program
• Track outcomes via QI Research comparing similar cohorts before Implementation of CoManagement and after Implementation of Co-Management
• Provide Geriatrics expertise for fracture patients at Harvard Hospitals with GIFTS program – already
in place at BWH & MGH
The Interventions
Preclinical Planning (6 weeks):
–
Design and implement infrastructure to sustain clinical work (i.e. Consult Order, Census
tracking, Pager, Order Sets, Standardized Geriatric Assessment)
–
Automate frailty assessment into clinical care using the Frailty Index (score 0.0-1.0,
greater numbers indicate greater frailty)
–
Geriatrician to observe/shadow existing orthopedic work flows
–
Identify, meet with key Interdisciplinary Stakeholders (Nursing, PT/OT, SW, CM)
–
Determine outcomes to measure
–
Submit QI proposal to IRB for waiver
Pilot Launch (August 16th, 2021):
–
Conduct a Comprehensive Geriatric Assessment for patients with hip/femur fracture
–
Work directly with Orthopedic Intern to optimize patient care & discharge
–
Coordinate care with Nursing, CM, SW and PT/OT Teams and help with disposition
–
Track patient census and outcomes as part of QI work
For more information, contact:
Karen Chahal, MD - Director of GIFTS – kchahal@bidmc.harvard.edu
�GIFTS: Geriatric Inpatient Fracture Trauma Service
Chahal, Karen; Lipsitz, Lewis; Olveczky, Daniele; Rodriguez, Edward K.; Salamon, Suzanne; Whyman, Jeremy; Berry, Sarah
BIDMC: Beth Israel Deaconess Medical Center
Case Example
• 78 year old community-dwelling female with history of recurrent falls, mild cognitive
impairment, HTN, anxiety and IDDM admitted to BIDMC following unwitnessed fall,
found to have Left Femoral Neck Fracture admitted for definitive surgical management.
• Patient initially CAM (-) and scored 1/5 on Mini-Cog screen. Patient lives alone at home
and manages her own medications including insulin, anti-hypertensives and PRN Ativan
for anxiety. She does not recall the circumstances for her falls and endorses falling often.
• Post-operatively patient develops delirium thought to be multifactorial re: possible
Benzodiazepine withdrawal, pain, anesthesia and hospitalization. Patient also found to be
retaining urine. Antihypertensives held to monitor for post-operative hypotension.
GERIATRIC MEDICINE INTERVENTIONS:
1. Mini-Cog screen suggests advanced Neurocognitive Impairment . This impacts overall
clinical picture and treatment plan including disposition.
2. Patient managing meds at home– concern medication/insulin error could contribute to
falls
3. Identify and de-prescribed high risk medications: HCTZ for HTN, Ativan for Anxiety
4. Patient suffers post-operative delirium managed with interdisciplinary non-pharmacologic
methods without the use of physical or chemical restraints
5. Disposition planning on Admission Day 1 ensures smooth transition to STR on POD 3
6. Family discussions regarding patient living at home alone = plans for added formal
supports and transition to Senior Housing
• Discussions with Family & CM: disposition to STR and transition to Senior Housing
Areas of Greatest Impact
Deprescribe high risk medications associated with falls and injury
Consistent medication reconciliation
Prompt disposition planning and case management support
Delirium prevention, diagnosis, and management
Communication, planning with family members/proxies
Engage deeply in Goals of Care and Advanced Care Planning discussions with
patients & health care proxies
Next Steps
Curriculum development for Nursing Staff and Orthopedic Residents
introducing key Geriatric Medicine content
Participation in BIDMC Trauma Council Committee to tackle health system
issues
Analysis of QI Research outcomes: 12 weeks prior to beginning PILOT, weeks
1-12 weeks after PILOT launch
Present a Business Plan to support full-time funding of GIFTS Service to
BIDMC Administration
For more information, contact:
Karen Chahal, MD - Director of GIFTS – kchahal@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Karen Chahal <a href="mailto:">kchahal@bidmc.harvard.edu</a>
Project Team
Karen Chahal
Lewis Lipsitz
Daniele Olveczky
Edward K Rodriguez
Suzanne Salamon
Jeremy Whyman
Sarah Berry
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Geriatric
Nursing
Pharmacy
Orthopedic
Social Work
OT/PT
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
GIFTS: Geriatric Inpatient Fracture Trauma Service
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Equality
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/1b9bdbbdd36d376205365639359bb6d4.pdf?Expires=1712793600&Signature=cnyHL4V-UR1EMc-ZgbeOvjlXp0ydTruJrLoLA3zJFYzSKptJp-9ScwQSMe7GbnMatbPsFaxB4QkxCT5qGWDrGm9%7ExnPBTIxKSVLe3k2RLjbQv5GuqL7%7EZIZI6asS6Ldf-gcQyCaD-DCkbRtf42MexLe0trx9iqnhktSdQcpGW4fN0zVvK2x0rlnuDlIzGKHPmMqCsSzuM1GWVB6FPPZWSCRIZlnEkFiDTMAlZxfXy9nYVGU6TnOAwYT%7EHje5RCshOnRuPIfnAW0NpfT8cdcO2tKVDPISrhpTz7RVKK03Tmk%7E315Ik3jfRareLP0vwRmwhU0iPQn3c-gUrsJnxFBdAQ__&Key-Pair-Id=K6UGZS9ZTDSZM
2b8e7223ed93807b89f21b50693c2f1a
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Text
Pregnancy Screening Before Chemotherapy Administration
Melis Celmen MHA, Aya Sato-DiLorenzo, BSN, RN, OCN, BMTCN, Poorva Bindal MD, Brian T. Halbert MD, Jonathan W. Wischhusen MD,Jessica A. Zerillo MD, Meghan E. Shea MD
BIDMC- Cancer Center
Introduction/Problem
According to the American Society of Clinical Oncology (ASCO) Chemotherapy Administration Safety
Standards, a documented pregnancy screening before chemotherapy administration is recommended for
patients with childbearing potential. At BIDMC Cancer Center, we do not have a standard way or policy
for pregnancy screening before chemotherapy administration. Currently, our patients are educated on the
importance of pregnancy screening during the initial visit with their provider along with being verbally
screened. However, there could be cases in which the patient may be pregnant without their knowledge.
Administrating chemotherapy to patients during pregnancy has potential to be teratogenic.
Our target population: Women </= 40 years starting a new chemo (either as a new patient or switching
regimen).
Methods/Interventions
➢
➢
➢
➢
Gathered pregnancy screening data from the period between 1/1/21 and 3/31/21
Performed chart reviews to establish pregnancy screening baseline
Prepared structured interview scripts for conducting interviews with clinical teams
Conducted interviews with oncology providers and nurses to gather qualitative data about the best
practices and barriers to screening
➢ Established a new lab order set that includes urine HCG screening for Initial visits, and added urine
HCG screening to Solid Tumors and Heme Malignancy order sets to make pregnancy screening
more convenient for providers
Results/Progress to Date
Aim/Goal
Baseline chart review results: Pregnancy screening
Our initial goal was to assess our baseline performance of pregnancy screening for patients with
childbearing potential within ten days of starting their first chemotherapy.
•
•
Inclusion criteria: Women with solid malignancies who are starting IV antineoplastic immunotherapy/biotherapy,
cytotoxic chemotherapy, or targeted therapy at an outpatient clinic in BIDMC Boston.
Exclusion criteria: History of hysterectomy, oophorectomy or salpingectomy. Patients only receiving oral chemo,
hormonal therapy, other modality of cancer treatments such as XRT/Surgery. Patients enrolled in clinical trials. Patients
starting chemo treatments as inpatient.
Data timeframe: 1/1/21-3/31/21
25
ELIGIBLE NEW PATIENTS FOR SCREENING
Upon reviewing our initial data and the results of interviews with our providers, we currently aim to
improve the rate of documented pregnancy screening by 50% by June 2022. Our end goal, as we
monitor the data, is to reach maximum compliance.
The Team
➢
➢
➢
➢
➢
➢
➢
Poorva Bindal MD, Brian T. Halbert MD, Jonathan W. Wischhusen MD, Hematology/Oncology Fellowship Program
Melis Celmen MHA, Quality Improvement Project Manager, BIDMC Cancer Center
Katarina Oleszkiewicz, Program Coordinator, BIDMC Cancer Center
Sharon Renzi RN, Nurse Coordinator, Medical Oncology
Aya Sato-DiLorenzo BSN, RN, OCN, BMTCN, Quality Improvement Nurse Specialist, BIDMC Cancer Center
Meghan E. Shea MD, Medical Director, Quality Improvement Director, Medical Oncology, BIDMC Cancer Center
Jessica A. Zerillo MD, Director of Quality, BIDMC Cancer Center, Senior Medical Director of Patient Safety, BIDMC
16% Baseline Screening Rate
4
PATIENTS SCREENED
0
5
10
15
20
25
30
Figure1. Baseline data: Women </= 40 years who started a new chemo (either as new patient or switched
regimen) in the period of 1/1/21- 3/31/21 and had HCG screening within 10 days of chemo treatment.
For more information, contact:
Melis Celmen, MHA, Project Manager, mcelmen@bidmc.harvard.edu
�Pregnancy Screening Before Chemotherapy Administration
Melis Celmen MHA, Aya Sato-DiLorenzo, BSN, RN, OCN, BMTCN, Poorva Bindal MD, Brian T. Halbert MD, Jonathan W. Wischhusen MD,Jessica A. Zerillo MD, Meghan E. Shea MD,
BIDMC- Cancer Center
Results/Progress to Date
Figure 3. Intervention:
We have created the Initial
Treatment Start order set in Online
Medical Records. It includes urine
HCG to make it more convenient for
providers to screen eligible patients
before chemotherapy.
The new Initial Treatment Start
order set is expected to go live on
November 1st, 2021.
Lessons Learned
➢ Based on the qualitative and quantitative data, there is a lack of standardization and no prompting in
the provider’s workflow.
➢ Without having a specific policy for pregnancy screening before chemotherapy, providers screen
patients on ad hoc basis.
Next Steps
Figure 2. Fishbone Diagram: Low rate of documented HCG screening before Chemotherapy based on the
Qualitative interviews.(Fishbone Diagram template credit: Abdel Latif Marini, MSN, CPHQ, CPPS).
➢ Establish new workflows and standardize documented HCG screening prior to chemotherapy
➢ Educate staff about the importance of HCG screening prior to chemotherapy and establish new
workflows that will include pathways for false positive results
➢ Conduct quarterly audits to ensure improved HCG screening adherence
➢ Establish HCG screening policy prior to the first dose of chemotherapy
For more information, contact:
Melis Celmen, MHA, Project Manager, mcelmen@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Melis Celmen (<a href="mailto:mcelmen@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mcelmen@bidmc.harvard.edu</a>)
Project Team
Poorva Bindal
Brian T. Halbert
Jonathan W. Wischhusen
Melis Celmen
Katarina Oleszkiewicz
Sharon Renzi
Aya Sato-DiLorenzo
Meghan E. Shea
Jessica A. Zerillo
Department
Any departments listed on the poster or identified in the spreadsheet.
Hematology/Oncology Fellowship Program
Medical Oncology
BIDMC Cancer Center
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Title
A name given to the resource
Pregnancy Screening Before Chemotherapy Administration
Compliance
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ad36879767228372da943e4331eccc5.pdf?Expires=1712793600&Signature=DJYWHgsgyCutIgMpLq7LmOsOP0JjF4jKBbvZ65raCPV07SsfWXK6K9CweXJXoa-IC2%7EPsfiR5%7EbxSWngn6xevOt2u-dBZK8YugN5rON-oqsT6Je6CMcjxeyudvBje3ZFzdHzvFPDOs-LydgRmiWWy8GF-9S3femNZZgBuDShys-NsPOj4K7itEMcO8kRZmQeiHL2dGS84oLmrM9F-hH5MRUbzxoDgn%7EDGtbZrV0GS1nvC5wegWuoINt6d6SyWFlAHw%7E8cZwrUxecnXrs2V6xo46rcOX5izyKVxBONkb1CT4JU58DE3Lq%7EV5wiHmzoyta7NuEzn4IOWqrPRkuhWwHaQ__&Key-Pair-Id=K6UGZS9ZTDSZM
b55842d930b9ddb5251c5f4f3441f8de
PDF Text
Text
Implementation of Disorders of Consciousness (DoC) Pilot Program
Shannon Carlson PT, DPT, NCS, Jill LaRoche OT, MS,
Sarah MacKenzieS, CCC-SLP, CBIS
Introduction/Problem
When reviewing cases of patients with severe traumatic brain injuries, the following patterns were
observed:
● Goals of Care conversations were occurring early in severe traumatic brain injury cases
● Prognosis was nearly universally described as grim, but no data presented to support prognosis
○ Feedback from patients/families was that this was one of the worst parts of their ICU admission
● Rehab staff had lack of competency and limited training regarding performance of Coma Recovery
Scale - revised (CRS-R) impacting reliability
● Lack of knowledge of CRS-R on medical teams
New Practice Guidelines / Recommendations for DoC care were released in August 2018
● “Clinicians should use standardized neurobehavioral assessment measures that have been shown
to be valid and reliable (such as those recommended by the ACRM) to improve diagnostic
accuracy for the purpose intended”
● “To reduce diagnostic error in individuals with prolonged DoC after brain injury, serial standardized
neurobehavioral assessments should be performed with the interval of reassessment determined
by individual clinical circumstances”
● “When discussing prognosis with caregivers of patients with a DoC during the first 28 days post
injury, clinicians must avoid statements that suggest these patients have a universally poor
prognosis.”
Aim/Goal
To improve interdisciplinary care for patients with severe traumatic brain injuries and ensure care is
consistent with most up to date practice guidelines by performing earlier and more frequent CRS-R
administrations for prognostication purposes and predicting recovery trajectory for use during goals of
care conversations.
The Team
Jaimee Cathers, NP
Shannon Carlson, DPT, NCS
Jill Laroche, OT, MS
Sarah MacKenzie, MS, CCC-SLP, CBIS
Dr. Alexandra Stillman, MD
Dr. Martina Stippler, MD
The Intervention Plan
● Identified key stakeholders within the neurology, neurosurgery, and rehab departments
● Collaborated to create a protocol to identify patients, perform the exam, and document
in OMR with use of standardized prognostic statements based on the most current
literature
● Educated key stakeholders in both formal and information settings to maximize buy-in
Progress to Date
Created a Protocol to Standardize Care
● Appropriate patient criteria identified for pilot program:
○ Acute severe traumatic brain injuries
○ GCS of </=8
○ Significantly impaired arousal
● Prognostic statements created from most recent literature in collaboration with TBI-specializing
neurologist
● Workflow process map established for consistent performance of CRS-R 2x/weekly at differing
times of day based on practice guidelines
● OMR macros created for consistent documentation with input from all stakeholders
● Physiatry now consistently consulted for patients on DoC census
● TBI pathway updated to include DoC consults to PT, OT, and SLP earlier in stay
● Evidence based prognostic statements to include in notes to assist in prognostication during
GoC discussions
● Created macro for documentation to aid in consistency and ease of reference
Education:
● Created training protocol for more streamlined performance and training of inpatient rehabilitation
staff
● Facilitated journal clubs, presentations with neurosurgery, rehabilitation services, trauma
services
● Incorporated patient and family feedback to improve ongoing care
For more information, contact:
Shannon Carlson : scarlso4@bidmc.harvard.edu
�Implementation of Disorders of Consciousness (Doc) Pilot Program
More Results
Results and Progress Indicators
● Earlier initiation of PT/OT/SLP consults for patients with DoC
● Improved communication and teamwork between disciplines and care providers
● Improved appropriateness of discharge environment, including education to case
managers regarding specific DoC programs in the nearby rehabs
● In alliance with practice guidelines, established consistent interval assessment of
CRS-R throughout inpatient stay (across 18 patients <=3 years)
● Standardized time from admission to first CRS-R administration (<=72 hours)
● Improved reliability and use of data to guide GOC discussions about
prognostication and recovery
Lessons Learned
● There is a need for interdisciplinary collaboration for a successful quality improvement
project
● A distinct value exists among differing areas of expertise and clinical application
● Ongoing barriers addressed to efficiently and effectively capture all appropriate patients
● Consistent therapy and care team leads to better medical management of patients with
DoC
● Consistent and easily accessible documentation results in increased reliable measures for
prognostication purposes
● To maintain good communication and adequate education across the care team a
considerable amount of time and resources are required
● It is possible to effectively carry out a DoC program in acute care
Next Steps
●
●
●
●
Continue to work collaboratively with neurosurgery to identify all appropriate patients
who fit inclusion criteria within 72 hours of admission
Continue to seek out opportunities to provide interdisciplinary education
Expand work group within rehabilitation department to include more therapists
○ Completion of observations and training modules
Expand into other diagnostic groups supported by the literature (i.e., anoxic brain
injury, stroke)
○ Provide education to primary teams (e.g., general neurology, stroke neurology,
cardiology)
References:
●
●
●
Katz, D. I., Polyak, M., Coughlan, D., Nichols, M., & Roche, A.. (2009). Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-2 year follow-up.
Progress in Brain Research, 177, 73-88. https://doi.org/10.1016/S0079-6123(09)17707-5
Lucca, L.F., et. al. (2019). Outcome prediction in disorders of consciousness: the role of the coma recovery scale revised. BMC Neurology, 19, 68. https://doi.org/10.1186/s12883-019-1293-7
Whyte, J., et. al. (2013). Functional Outcomes in Traumatic Disorders of Consciousness: 5-Year Outcomes From the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Archives of Physical
Medicine and Rehabilitation, 94, 1855-60.
For more information, contact:
Shannon Carlson : scarlso4@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Shannon Carlson <a href="mailto:%20">scarlso4@bidmc.harvard.edu</a>
Project Team
Jaimee Cathers
Shannon Carlson
Jill Laroche
Sarah MacKenzie
Alexandra Stillman
Martina Stippler
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Physical Therapy
Neurology
Neurosurgery
Dublin Core
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Title
A name given to the resource
Implementation of Disorders of Consciousness (DoC) Pilot Program
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0963f11bdf19d73fb632d0850140f779.pdf?Expires=1712793600&Signature=udHRK2W4rmYnZ5zdil3GnG251eY7MTlnFKNkM1unZ66vzAr32P005Hu8ecdKMUS0Kjk6M4V0aEIVRNnVCQLYFPGR-uE6uDHYoBrExu2p5t9vVDX664it5DOI4ySVXnJpnI9jrQkl3yLYh4ycP5Q3jvq%7E4LWZ-wcDU-ipI7IF5xFhyOjqbsCfGi7iDEabdMI1RBNRsuNRwvlJwNJnmCK-L3DO79KWU3nRGAKsNGloxA3OQCscr2VXXVevEmsMwDcfhgV1bltldNUZecJxFO0xjHm1AR0mPhPU1Rr2vrpogEf5LxEgSw6WQP7NPCCh3NfX3JEm9jSPhGDLkV6ot1-xRg__&Key-Pair-Id=K6UGZS9ZTDSZM
7b8d68ef90fb640bbb03c121ec5c5366
PDF Text
Text
Conducting clinical trials from home: The implementation of a remote work model in CARE
Krystal Capers, MPH , Valerie Banner-Goodspeed, MPH, Maximilian Schaefer, MD
1Department
of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
Methods
Background
Challenges
The Center for Anesthesia Research Excellence (CARE) was established in October
2014 to facilitate all aspects of clinical research within the Department of Anesthesia,
Critical Care and Pain Medicine, with an emphasis on in-hospital, 'boots on the
ground' assistance for researchers.
CARE participates in various research domains including:
Interventional trials
Simulation research
Physiologic studies
Quality Improvement research
Epidemiologic studies Outcomes research
Education research
Communication was vital while we worked remotely. Our team utilized various group
chats (mobile devices), worked simultaneously on shared documents (google drive),
and attended various team meetings (zoom).
We utilized a number of new web applications to communicate within our teams and
to keep our tasks on track, relying particularly on Smartsheet and Asana.
CARE research is also represented in various divisions including Critical Care,
Cardiothoracic Anesthesia, Pain Medicine, Obstetric Anesthesia, General Anesthesia,
and Education / Quality Improvement.
On March 11,2020 CARE implemented an effective remote work model due to the
COVID-19 pandemic, and was able to carry out 11 COVID research studies.
•
•
•
•
Meet the Team
Asana
Asana is a desktop and mobile app that
was designed to help teams organize,
track, and manage their work.
Each research study had an associated
list of tasks that were assigned to
members of the team.
Team members were able to mark
action items as complete and team
managers were notified in real time.
Asana also has a chat function that can
be utilized to communicate within the
team for each individual task that has
been assigned.
Results
•
•
•
Front Row (left to right): Trishna Sadhwani, Melisa Joseph, Valerie Banner-Goodspeed (Program
Manager), Maximilian Schaefer (Program Director), Krystal Capers, Aiman Suleiman Back Row (Left to
Right): Andrew Toksoz-Exley, André De Souza Licht, Evynne Gartner, Danny Le, Ariana Saroufim,
Lauren Kelly, Najla Beydoun, Peter Santer, Felix Linhardt, Tim Tartler, Omid Azimaraghi
Acknowledgements
•
We are particularly indebted to former CARE Project Manager Julia Dwyer for shepherding the group through
the transition to remote teamwork by setting up our electronic platforms, and providing boundless support.
•
We would like to thank the many physicians, nurses, and respiratory therapists who conducted the necessary
on-site work for our research trials in extremely challenging conditions. Of particular note, Elias Baedorf Kassis
MD, Chris Barrett MD, Somnath Bose MD, Joe Previtera RRT, Lenny Rabkin RRT, and Sharon O'Donoghue, RN
A heartfelt thank you to the CARE team, who pulled together, worked long hours, and tackled new projects
during a time of tremendous stress and anxiety. Thank you to former CARE Medical Director Bala Subramaniam
MD MPH for your support during CARE's transformation.
•
Smartsheet
Smartsheet is a web-based
project management program.
It can be used to assign tasks,
track project progress, manage
calendars, and share documents
We utilized Smartsheet primarily
for onboarding new team
members and for project start up
tasks.
Zoom
Zoom was the primary video
teleconferencing program used for our
remote work model implementation.
Our research team members were
accustomed to working alongside each
other, but the video feature allowed us to
see each other from our respective
locations.
The screen share function was utilized to
show our meeting agendas, and also to
navigate study documents and
applications together.
We were successfully able to enroll patients into 11 clinical trials and
observational studies while operating in this remote work model, including:
7 Interventional Trials
3 COVID drug trials
1 non-COVID drug trial
3 device trials
4 Observational Trials
3 Epidemiological Studies
1 Survey Based Study
The rapid conversion to fully remote with solid communication strategies allowed
us to have 3 of the first 5 IRB applications for COVID-specific human subject
research protocols at BIDMC.
Conclusion
Strong communication and technology solutions allowed us to remotely support
departmental research throughout the pandemic.
Demonstrable productivity and continued high work quality enabled us to remain
fully staffed, with no team members placed on furlough or redeployed.
While our team has returned on site, we have adapted this remote work model with
flex remote days and continued electronic project management support.
.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Krystal Capers (<a href="mailto:kcapers@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">kcapers@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Krystal Capers
Valerie Banner-Goodspeed
Maximilian Schaefer
Trishna Sadhwani
Melisa Joseph
Aiman Suleiman
Andrew Toksoz -Exley
André De Souza Licht
Evynne Gartner
Danny Le
Ariana Saroufim
Lauren Kelly
Najla Beydoun
Peter Santer
Felix Linhardt
Tim Tartler
Omid Azimaraghi
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia, Critical Care, and Pain Medicine
The Center for Anesthesia Research Excellence (CARE)
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Conducting Clinical Trials From Home: The Implementation of a Remote Work Model in CARE
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/931246a69776e32060b7afd8d55b831a.pdf?Expires=1712793600&Signature=q%7EwgZJ7Z71fVH87-2NMShO90%7E04ZpBtt24N8uwOl6N%7EayIKmkwVzHVOpa21Fyte1zxM8k0%7EQW4J5v3CFHII%7EsSFz0518uPtr4DKxAYqIc6eD2oZU928NANMqUQvm2NrgvMGLJ-KGTOPfaegCLkW4VN9lHQirxBnN5sll3zqCg181kU-1cnpc-m8CyTZNeCv6ljx%7EJ%7EDcsk4OpMqHgdyrn3iRgDk25ihR2QHJ2kclIyQvaKwNT5Hx4e7rV9lAjkrGrZhPALF-dLd%7EAySerbko6UFQpJfuwgh4n2%7EBxTzPDFp%7ENzZvbGCw6FARi97FlrJaclyxATElTHkJr4%7EoepeCdg__&Key-Pair-Id=K6UGZS9ZTDSZM
a2a8175207d35b305ebf620d4f6c7146
PDF Text
Text
Annual Review of Anticoagulation Management:
Keeping Patients Current, Connected, and Safe
Amber Rollins, PharmD, BCACP; Gina Di Guardi, MS, RN, CNE; Patricia Glennon, BSN; Maria Lee, PharmD; Keshane Williams, LPN; Diane Brockmeyer, MD
Beth Israel Deaconess Medical Center, Anticoagulation Management Service (ACMS)
Introduction
• In 2020-2021 the BIDMC Anticoagulation
Management Service implemented a new
initiative for annual physician reviews of
clinical care for patients on warfarin
Results
133
Warfarin Annual Reviews
Reviews Sent
365
524
• Ensure up-to-date components of warfarin
management including indication of therapy,
INR goal, bridge requirements, annual labs,
and general patient updates from physicians
• Confirm patients maintain active care with
managing anticoagulation physician
• Identify patients who may have transferred
care to a new provider
• Maintain compliance for medication refills
and INR order renewals
Methods
• An “Annual Physician Anticoagulation Review”
form was sent to each provider, totaling 524
reviews
• ACMS staff members supported physicians in
ordering, retrieval and assessment of overdue
annual labs as identified by the review
• Upon receipt of completed form from
providers, ACMS staff entered updated order
within OMR
• Changes selected by provider were updated
within patient's anticoagulation care plan in
OMR
Completed Reviews
Received
517
Overdue labs completed to
date, n (%)
193 (93%)
Updated appointments
made with warfarin
provider to date, n (%)
46 (76%)
Average time to receipt of
completed form (median)
20 days
Healthcare Associates
Gerontology
Clinical Updates to Warfarin Management
Change in Subtherapeutic INR
Management Plan
30
Change in Peri-Procedure
Bridge Requirements
19
4
Change in INR Goal
Initial Assessment of Compliance With
Annual Provider Appointment
11%
7
Change in Indication
0
5
10
15
20
25
30
Labs Ordered by ACMS
3
50
89%
Seen by provider within 1 year
Overdue for annual appointment
• Forms contained individual data specific to
each patient and their current
warfarin management
• Last (kept) appointment with warfarin
provider
• Patient annual time in therapeutic range
(TTR)
• ACMS concerns with patient INR
compliance over last 12 months
• Annual Labs:
Conclusion
o CHEST guidelines recommend annual
CBCs for patients managed on warfarin
therapy
o Patients utilizing low molecular weight
heparin require creatinine levels checked
a minimum of annually (more frequently if
patient has chronic kidney disease)
23
Cardiology
Purpose
Components of Review
Managing Provider Office
154
Both CBC and Creatinine
35
Conclusion
• There are gaps in communication between
patients, physicians and ACMS. The “Annual
Physician Anticoagulation Review” is a useful
tool to improve care coordination
• The annual reviews ensure patient’s safety
while on warfarin and enhance compliance to
ACMS and BIDMC protocols
Acknowledgements
CBC only
Creatinine only
•
The ACMS team would like to acknowledge Anh
Nguyen, PharmD candidate 2022 for her
assistance in the creation of this poster
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Diane Brockmeyer (<a href="mailto:dbrockme@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dbrockme@bidmc.harvard.edu</a>)
Project Team
Amber Rollins
Gina Di Guardi
Patricia Glennon
Maria Lee
Keshane Williams
Diane Brockmeyer
Department
Any departments listed on the poster or identified in the spreadsheet.
Anticoagulation Management Services (ACMS)
Dublin Core
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Title
A name given to the resource
Annual Review of Anticoagulation Management: Keeping Patients Current, Connected, and Safe
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/074411c6c4c5bc5ee401715f488156cd.pdf?Expires=1712793600&Signature=S6aT2V5R7isI7E-FUw9Q82cOpsXDxCy3%7EYeOdTeiQoz9rRtYX8LdZWzGzu2HqEGf8VwzwGjjyO%7EcbAwqbd9AzyvXV1BCQ8QqnrAlv9QQ0LgqM2cA-73wOuGUaaBFhOu89niCudP2NoBmg%7ESF8x9wjnStDBgMnsmTrSXcPmaiv5gSzRPexUW9cCzpzD1vOWxNnMrzNsv4lyl8o3rmtHcWm5FrIPU4x7m%7EbY95u1BUOae5RAShsYWE%7EzgrS1jqKgKtPYTUI4KmEuFBRrSMYbTYBfO-h61CucMtYZq04wqHpXy-Nmp48BozpjwV3tll%7EcGAvMvJeaNawp03zMQV9%7ERDDg__&Key-Pair-Id=K6UGZS9ZTDSZM
6cfbc09af4df0dd3096394683a8f3f2c
PDF Text
Text
Another arrow in the quiver of care: PCP perspectives on telemedicine for adults 65+
Gianna Aliberti MD; Roma Bhatia MD; Laura Desrochers MD MPH; Elizabeth Gilliam MA; Mara Schonberg MD MPH
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
Themes
Introduction
•
•
•
Use of telemedicine for delivery of primary care has
increased, particularly for adults >65 years
Little is known about how to best operationalize
telemedicine for the primary care of older adults
Aimed to learn from primary care clinicians (“PCPs”)
their thoughts on the use of telemedicine in the care
of adults >65 years
1) Optimization of telemedicine
Nation
Health System
Design and Setting
•
•
Assurance of continued reimbursement
Opportunities to improve patient-centered high
value care via telemedicine
Cross-sectional web-based REDCap questionnaire
of all PCPs affiliated with one large health system in
Boston between Sept. 2020 and Feb. 2021
Received a list of all 383 PCP emails from the
health system
PCP
Effective telemedicine platform
Virtual rooming process
More IT and administrative support
Ease with greater years in practice and
comfort/experience with technology
Varying effects on doctor/patient relationship
Ease depends on visit type
Family
Methods
•
•
•
•
•
Assistance with visit preparation
Presence during visit may help for some
Questionnaire included both open-ended and
closed-ended questions about PCPs’ experiences
providing telemedicine to adults 65+
This study focused on PCP responses to the 5
open-ended question
Conducted a thematic analysis to identify themes in
participants’ open-ended comments
Codes emerged from the text
Organized codes to reflect major themes
Sample Characteristics
Female
n (%)
67 (58%)
Non-Hispanic White
93 (81%)
Community-based
87 (76%)
>20 years in practice
83 (72%)
Total
115 (100%)
Patient
Age-related (age, sensory and/or cognitive changes)
Literacy, socioeconomic status, language barriers
Digital divide, access to computers/internet
Need for home equipment (e.g., blood pressure cuff)
2) Integration of telemedicine
Better for chronic “This is a useful modality for maintenance
disease
and surveillance of chronic conditions,
management than however without in person care, new
acute care
diagnoses are difficult to assess fully”
Needs to be more “Implementation needs to be simple, single
efficient
click sign on with minimal technology
knowledge required”
Video is essential “Video essential for all [telemedicine] visitscompared to
enhances understanding and trust and
phone
collaborative care to make eye contact,
note body language, also [assessing] home
[background is] helpful”
Opportunities to
“This [has] been an incredible convenience
make care more
for patients who can't travel to the practice
patient-centered
or are fearful of coronavirus”
Advance prep
“Would be helpful to have patients fill out
needed for
forms and get vital signs done prior to visit”
Medicare AWV
Need for continued “It will have to be appropriately reimbursed
reimbursement
and supported by office staff”
3) PCP attitudes vary towards telemedicine
Effects Strengthens:
Weakens:
on
“I have enjoyed seeing people “It is not good
doctor- through video. The visits are
medicine. You can’t
patient more likely to start on time so I take care of the whole
relation find them less stressful than in patient without laying
-ship
person visits. More relaxed.
hands on them and
Also, I love to see patients in listening to their heart
their homes”
etc.”
Limitations
Conclusions and Future Implications
•
•
•
•
Multiple levels at which to improve the provision of telemedicine in primary care for older adults
Opportunities for integrating telemedicine in primary care, particularly with chronic disease management
Future work should aim to improve telemedicine for: specific visits types, older adults who have transportation
challenges, and/or PCPs who are interested in continuing to use telemedicine
Need to ensure patients receive the training they need for telemedicine and have video capability
•
•
•
One geographic location
Perceptions may be quickly
changing
We surveyed PCPs at one
point in time
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Project Team
Gianna Aliberti
Roma Bhatia
Laura Desrochers
Elizabeth Gilliam
Mara Schonberg
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Gianna Aliberti <a href="mailto:galibert@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">(galibert@bidmc.harvard.edu)</a>
Department
Any departments listed on the poster or identified in the spreadsheet.
Telehealth
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Another Arrow in the Quiver of Care: PCP Perspectives on Telemedicine for Adults 65+
Format
The file format, physical medium, or dimensions of the resource
pdf
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e3b058811cf24a948ed8d64936675610.pdf?Expires=1712793600&Signature=VAM8sfAqt2Ic8DONMRgroH3NOApi-Ctrb6tdUMSruI9MOLoEFl5yXSlSqCsXBIEJjnHDvGMe117j8EYyRV5aGuL-HJl3cUwH0L%7EXGLO6vJMggK34SUw37hvnfUDWeehJjd%7E85Gm1JbrxNKHKyLaFKkS6PMCdP2XKt5QFucpoqiKjIqK9DmFd55s-GORMesmGp0DDd-Twyoxl-KiXc38LC9zo%7EwiaOzFRCcM20LAlsz%7ExVWx5W0fBbEFRMfZdW1BKrgn8qtW018adV6F7UJykF5rg4gL6mmb29QhegJnSj7o2X4VSeQnLNK9Mgo-i9VMaEn7eVH92Z9LaXeq2uNxJ5Q__&Key-Pair-Id=K6UGZS9ZTDSZM
ec045ae320f3645e9afdfdf8dfefdebd
PDF Text
Text
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TO KIOSK MENU
Effects on Employee & Medical Staff Engagement/ Culture of Safety Survey Responses from Implementing the I-PASS Safer Patient Handoff Process
Angela Sims, MHSA, MBA
The Problem
The Team
Joint Commission Sentinel Event data between 1995 and 2018 strongly confirms that ineffective
communication between care providers is a primary contributing factor in preventable patient harm
events. Consecutive Engagement/Culture of Safety surveys conducted at BID-Milton in 2016 and 2017
revealed staff concern about information being lost during transitions in care. Two questions on the
survey specific to information sharing scored unfavorably in comparison to other survey questions.
➢ An I-PASS Steering Committee was formed consisting of representatives from Senior
Hospital/Medical Staff Leadership, Nursing, Health Care Quality & Patient Safety, Professional
Development, Communications/Marketing, Information Systems and direct patient facing care
providers. Each member assumed roles specific to process implementation, coordination, advisory,
local champions, education and communications.
The Interventions
Aim/Goal
The hospital’s aim was to effectively respond to staff and physician concerns by implementing strategies
to increase confidence/perception that the risk for information loss had been reduced (as evidenced by
improved Culture of Safety survey scores) and consequently, mitigation of potential/actual patient harm.
An identified goal to address the risk of information loss was to implement a resilient, evidence based,
standardized “Hand-Off” process throughout the organization. In February 2018, the hospital selected the
I-PASS Safer Handoff Bundle methodology. This model incorporates 5 key elements deemed essential
for an effective hand-off process:
I Illness Severity
P Patient Summary
A Action List
S Situational Awareness and Contingency Planning
S Synthesis by Receiver
An effective patient handoff provides a mechanism for transferring information, primary responsibility, and
authority from one or a set of caregivers, to oncoming staff.
➢ In 2018, BID-Milton implemented IPASS as a pilot with four specific care provider teams:
–
Surgical Physician Assistants
–
Nursing Staff (Intensive Care Unit)
–
Medical Intensivists
–
Hospitalist Nocturnists
➢ The following interventions were part of a structured, mentored and piloted roll out plan:
–
Review of BID-Milton’s Employee Engagement/ Culture of Safety Survey surveys in
2016 and 2017 – specific to handoff communication.
–
Creation of a multidisciplinary I-PASS steering committee with a structured reporting line
to the hospital’s Board of Directors.
–
Identification of clinical champions to promote understanding and act as local subject
matter experts.
–
Collection of baseline data: Direct observation by trained staff of pre-I-PASS hand off
processes to determine the presence or absence of the 5 key components of I-PASS.
–
Extensive education to key stakeholders as to elements of I-PASS with direct feedback
to learners (Included: TeamSTEPPS©, 1:1 training, didactic presentations, videos, selfdirected study opportunities and simulation exercises).
–
Development/utilization of communication templates and tools (electronic and paper);
including implementation of handoff documentation tools within the hospital’s new
Electronic Medical Record “Meditech Expanse” that went “Live” on October 1, 2018.
–
Post-education and pilot implementation data collection; including the 2019 Employee
Engagement/ Culture of Safety Survey.
For more information, contact:
Angela Sims, MHSA, MBA, Manager, Performance Improvement angela_sims@bidmilton.org
�Effects on Employee & Medical Staff Engagement/ Culture of Safety Survey Responses from Implementing the I-PASS Safer Patient Handoff Process
Angela Sims, MHSA, MBA
Results/Progress to Date
The data above compares medical staff and hospital employee staff responses to two questions on BID-Milton Engagement/ Culture of Safety
Surveys between 2016/2017 and 2019 specific to the transfer of clinical information during care transitions. In addition, the data also shows
performance specific to areas of I-PASS pilot implementation (Surgical PA & ICU Nurses). The survey responses were taken one year postimplementation.
Scores for both questions on the 2019 Engagement/Culture of Safety hospital employee staff survey specific to I-PASS pilot implementation units
increased between 2016/2017 (pre-I-PASS) and 2019 (piloted I-PASS implementation); additionally, a general lift in the scores was seen across the
entire employee survey, as well as across the separately administered medical staff survey.
Most notably, when reviewing responses specific to the ICU nursing pilot implementation for questions #6 and #26 respectively, safety culture
scores increased from 3.17 to 3.63 (a 14.5% increase) and 3.74 to 4.00 (a 6.95% increase) over pre-IPASS implementation baseline data.
Therefore, nursing staff in the ICU felt that handoff communication had improved on their unit.
The Surgical PA team’s responses were captured within the hospital employee staff survey. A review of their pilot specific scores also showed
increased scores post implementation of I-PASS on questions 6 & 26; respectively, an increase from a baseline of 3.63 to 4.0 in 2019 (a 10.2%
increase) and from 4.00 to 4.11 in 2019 (a 2.75% increase). It should be noted that Surgical PAs provide care in both pilot (ICU) and control
(Med/Surg) units.
The constraints of piloting in the ICU limited the number of physicians exposed to the I-PASS Handoff Program. Across the board, medical staff
score increases were not as notable, but still favorable in comparison to 2016/2017. Based upon improvements identified in the Surgical PA and
ICU pilot groups, it is expected that physician scores will continue to increase upon further expansion of the program.
The 2019 Engagement/ Culture of Safety Survey findings at BID-Milton, as well as the continued adherence to the I-Pass Safer Handoff Program
bundle, demonstrate success in the program, ultimately enhancing patient handoffs through a standardized process.
Next Steps
➢ Further planned pilots in identified areas as a means of spreading and sustaining the I-PASS program, including education and
implementation with the Hospitalist group and additional nursing units.
➢ Ongoing data collection and real-time provider feedback to promote adherence.
➢ Further analysis of future Employee and Medical Staff Engagement/Culture of Safety Survey responses.
For more information, contact:
➢
Angela Sims, MHSA, MBA, Manager, Performance Improvement angela_sims@bidmilton.org
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Angela Sims (<a href="mailto:maito:angela_aims@bidmilton.org" target="_blank" rel="noreferrer noopener">angela_sims@bidmilton.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Health Care Quality and Patient Safety
Communications / Marketing
Professional Development
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Angela Sims
I-PASS Steering Committee
Medical Intensivists
Hospital Nocturnists
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Effects on Employee Engagement / Culture of Survey Responses from Implementing the I-PASS Safer Patient Handoff Process
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4f7c6bbfa1adeebacdf788ef57b3ad13.pdf?Expires=1712793600&Signature=fm6ryUZH1vDixaUge6lWTJuXxv5bA75CWVdbRjmanRcQMAzd88jEAeeU5BlMYQw-Tak4XSIe7Py4yA1UuezDjVDj0Nssrqm04xL7D84Lv-4V1bevHEDeoKkBBMTZjohHdEKKMJVVq6M4pN4Z6w%7EXeILTsufufjl-pBN2zqqMU7az3ZeqUcii5fUJZs46tqujkP7H4FldJ64AWf5pdGQXgmglwgZDYEsnvltn-dFl64psFWVZ6wPVEGO6mNU4SMMK7eH3fSvNKBTOI9b80y6F3TbS19uuURvRsi%7EEUaHz1nynvg2qmANxhafGQEW6CPjmPPwsRZR9ceE5j9k8sgi41w__&Key-Pair-Id=K6UGZS9ZTDSZM
d42dbcd4060369128fcfe953f47226cd
PDF Text
Text
TAP TO GO BACK
TO KIOSK MENU
Workplace Violence Can’t Be the Norm
Taj Qureshi, MPH; Pat Folcarelli, RN, MA, PhD
Beth Israel Deaconess Medical Center
Introduction/Problem
Health care workers are increasingly facing significant risks for workplace violence (WPV). The National
Institute for Occupational Safety and Health defines WPV as any physical assault, threatening behavior,
or verbal abuse occurring in the workplace. Studies indicate that the effects of WPV are far reaching and
include decreased perceptions of safety, increased employee leave time, decreased employee
satisfaction, and increased employee turnover, all of which may have effects on patient satisfaction and
patient outcomes. In 2014, BIDMC formed the Prevention of WPV Committee to create and implement a
well-informed WPV prevention program. To date, committee members have collected reports of violence
from various sources to understand the prevalence and severity of the problem at BIDMC. They have
also collaborated to plan and launch various interventions aimed at improving reporting practices and
reducing episodes of WPV across BIDMC.
Aim/Goal
BIDMC is committed to improving the safety of its employees, patients, and visitors. The aim/goal of the
Prevention of WPV Committee has been and continues to be to mitigate the risk of verbal and physical
WPV through education, access control security enhancements, and development of an improved Safety
Reporting System (SRS).
The Interventions
➢ Event Reporting
• Continued to track WPV events using a dashboard
• Simplified reporting forms in the SRS
• Rebranded and promoted the SRS for improved reporting practices and single source capture
➢ Event Response
• Continued to activate the Threat Assessment Team during times of threat
➢ Training and Education
• Implemented the myPATH training on de-escalation techniques for all employees
• Conducted a thorough review of patient and visitor polices as they related to workplace safety
• Created a policy for prevention of WPV
• Launched a portal page for prevention of WPV
➢ Access Control
• Improved the myAlert emergency notification system
• Implemented priority changes identified through security assessment, such as security of
onsite/offsite facilities and visitor management
Results/Progress to Date
Staff to Patient
2%
Patient to Patient
4%
The Team
Pat Folcarelli, RN, MA, PhD (HCQ); Taj Qureshi, MPH (HCQ); Chris Casey (Public Safety); Meg Femino,
HEM (HCQ); Andrew Zaglin (HR); Leslie Ajl, RN, MS (PCS); Joanne Devine, RN, MS (PCS); Matt
Rabesa (EOHS); Kirsten Boyd, RN, MS (ED); Barbara Sarnoff Lee, LICSW (Social Work); Lisa
Lachance, LICSW (Social Work, CVPR); Catherine Mahoney, RN, JD (Legal); Susan Holland, RN, MS
(PCS); Alison Small, RN (PCS); Karen Waldo, RN (PCS); Danielle Souza, RN (PCS); Dave Hoffman
(Public Safety); Julius Yang, MD, PhD (HCQ); Jane DuFresne, RN (ED); Ellen Volpe (Ambulatory);
Cheryle Totte, RN, MS (HCQ); Melissa Doyle, LICSW (Social Work, CVPR); Gina Murphy, RN (PCS)
Visitor to Patient
1%
Visitor to Staff
3%
Staff to Staff
7%
Patient to Staff
83%
Populations at risk in FY18.
For more information, contact:
Taj Qureshi, MPH, QI Project Manager, tqureshi@bidmc.harvard.edu
�Workplace Violence Can’t Be the Norm
Taj Qureshi, MPH; Pat Folcarelli, RN, MA, PhD
Beth Israel Deaconess Medical Center
More Results/Progress to Date
Lessons Learned
160
140
➢ Episodes of violence are still grossly underreported because staff often feel like violence “is part
of the job”
➢ We must work on reminding staff that along with reporting, they must escalate serious events to
their local managers
➢ Over 12,000 employees completed the myPATH training on de-escalation techniques
Inconsiderate/Rude/Hostile/Inappropriate - 23
Verbal Disrespect/Harassment/Bullying - 110
Suspicious Behavior - 1
Reported Sexual Harassment - 6
Reported Sexual Assault - 7
Physical Threat by Weapon - 11
Physical Threat - 153
Physical Assault by Weapon - 1
Physical Assault - 135
120
100
80
60
40
20
0
Q1
Q2
Q3
Next Steps
Q4
Total number of events in FY18: 447.
Location of Events
General
Location
No. of
Events
EOHS Reported Events
Source of Data
Inpatient
351
76.5%
Emergency
41
214
138
16
$17,926.60
60
47.9%
12.4%
SRS
$8,558.80
2
ACS Reports
QTR
Total
Expected
Cost
OSHA
Total
Days
Lost
1
Data
Source
% of Total
Events
Reported
No. % of Total
of
Events
Events Reported
30.9%
34
8.4%
Outpatient
21
2.7%
Total
447
100.00%
TCC Reports
16
3.6%
3
$38,014.08
72
Public Safety
25
5.6%
4
$17,728.05
10
EOHS
Psychiatry
➢ Event Reporting
• Monitor Threat Assessment Team activations per quarter (this information can be reflected
on the quarterly dashboard)
• Update the Safety/Security form in the SRS so that Threat Assessment Team activations
data can be recorded and trended over time
➢ Training and Education
• Implement more consistent debrief and analyses of staff harm events to determine
preventability and to identify opportunities for improvement or need for further education
• Trend data by practice area to determine if additional focused education is needed to
mitigate future risk
➢ Access Control
• Develop signage for all exterior entrances related to "no trespassing/weapons/solicitation“
• Prioritize capacity to secure inpatient units and security upgrades for ambulatory areas
• Rebadge all employees
54
12.0%
Total
447
100.00%
Total $82,227.53
158
For more information, contact:
Taj Qureshi, MPH, QI Project Manager, tqureshi@bidmc.harvard.edu
�For more information, contact:
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Taj Qureshi (<a href="mailto:tqureshi@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">tqureshi@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
Public Safety
Human Resources
Patient Care Services
Employee Health Services
Emergency Department
Social Work
Legal
Ambulatory
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Taj Qureshi
Pat Folcarelli
Chris Casey
Meg Femino
Andrew Zaglin
Leslie Ajl
Joanne Devine
Matt Rabesa
Kirsten Boyd
Barbara Sarnoff Lee
Lisa Lachance
Catherine Mahoney
Susan Holland
Alison Small
Karen Waldo
Danielle Souza
Dave Hoffman
Julius Yang
Jane DuFresne
Ellen Volpe
Cheryle Totte
Melissa Doyle
Gina Murphy
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Workplace Violence Can't Be the Norm
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/7264603303d2bc585726fff4cf929300.pdf?Expires=1712793600&Signature=Nuw9ozTWdbOvme1cEiEYGsVoOPhCJqhCJSveEyJuTE01wA4qZN7rAwURqQTQncIsrf-TvDUBDPgXsFlk4pkudKHY5j09ie2R-lC801mFks9OkVOu4VfPuun7uv0wCjA6Pp69gO7NlyH-jo3mQz7sr2A-87Ibggk28jhwcvs46vzCQyaLCZd4IrfFpBY6quZouJ1OsOZod4-4g5eSNuiMQD1tOMSk8xNg5y3QKSpNIJ6nuRCv6EPewu-UahuXdOVvdtl70Szke%7E%7ErRkjS1Ny%7ENI4PZp-E0AG3MMDd7LAk0kMHy1-ThgkckJkU5bjlu91OKIhgmXi3xG14p52dZSQNWQ__&Key-Pair-Id=K6UGZS9ZTDSZM
0a1c6e3c27af9afc83797285db3cf23e
PDF Text
Text
Visualizing Patient Safety Impact of Collection Error
Pamela Stravitz, Yigu Chen MPH, Yael Heher MD MPH
Acknowledgements: Pam Hulme, Adele Pistorino, Cheryl Demeo, Monique Mohammed, Lorinda Longhi, Gina McCormack, Lynne Uhl MD
Beth Israel Lahey Health
Background
Collection errors for clinical pathology lab tests continue to be a major source of
patient safety risk and inefficiency. Improving labeling error rate has been a safety goal
set by the Joint Commission for several concurrent yearsⁱ. Patient harm ranges from
the inconvenience of having to return to the medical center for specimen recollection
to a mismatched blood in tube, which can lead to transfusion errors and physical
harm. To partner with treating clinical teams, our phlebotomy manager sent out a
spreadsheet containing the previous month’s collection errors across the BI hospital
network. However, because of underreporting and design inadequacies, clinical
partners were unable to gauge perspective, such as error trends or comparison of
patient safety impact on their units to the performance on other units, making it
difficult to initiate change. Our estimates showed that two thirds, or approximately
450 errors per month were collected via alternative methods, were not recorded in the
spreadsheet, and therefore were not being fed back to the floors.
Materials & Methods
In the design phase of this project, we prioritized ease of use and included as many
interactive elements as possible. Image A is the front page, which shows trends in the
number of patients affected by month and unit. We also highlighted the option to
view all error details by double clicking the right-hand values.
A
TAP TO GO BACK TO KIOSK MENU
The people icons shown on images A and C were also included to increase visibility
and accountability, emphasizing that one error affects at least one patient, regardless
of harm incurred. Designing icons of our representative community was also integral
to making this dashboard all-user friendly. Tabs include:
• Unit Drilldown – Images A and B. Shows total errors by month and unit.
• Unit Data – Only available once unit is selected from tab in Image C. Comes preformatted as a table, only containing relevant columns from the raw data.
• Unit Monthly – Image C. Unit errors shown by service levels, error type, source.
• High Level Monthly – Total errors shown by service levels, error type, source.
• FAQ Page – Accessible through linked images on all other tabs.
• Error by Site – Color codes error to compare units within same service type.
• Data – Standardized category options with as little free text, including:
the date and medical record number columns are formatted text, only
allowing dates in 2019 and text 7 strings long, respectively.
the location, error type, and source columns feature drop-down lists and
therefore can only contain pre-selected responses.
the only free text columns are those for the collector identification, because
each unit IDs labels and requisitions differently, and comments.
B
Results
The first release of the dashboard in early Feb. 2019 was met with new clarity and
excitement on data performance. Clinical partners and pathology team members
praised its design, organization, and ease of access to individually important data.
Next Steps
Though the design phase was successful, the dashboard has many opportunities to
expand and eventually be used for goal setting and monitoring. Its purpose is to
reduce the number of errors through visibility and awareness of errors, though the
act of retraining or educating staff lies with each of the unit managers. The Quality
Improvement team will continue to monitor the effectiveness of the dashboard with
outreach surveys or focus groups. The next phase of the project is to standardize the
process of collection error recording within each clinical pathology lab subset .
Currently there is little or no feedback loop closure for these errors, largely in
hematology and the blood bank, whose collection errors are not noted at lab control.
It is important that we feedback these errors as well so the unit leaders have a true
perspective of and goal for collection errors.
References
i: The Join Commission NPSG.01.01.01
C
Image A shows the dashboard front page on which the user can narrow unit choices using the green buttons and then select the desired unit to visualize the number of patients affected in the bar chart. They can also view a different, more
generalized chart by clicking the grey button with red text, shown in image B. Image C shows a unit’s individual errors by its proportion of the corresponding service area errors, specimen type, and collection error type.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Pamela Stravitz (<a href="mailto:pstravit@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">pstravit@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Pamela Stravitz
Yigu Chen
Yael Heher
Acknowledgments:
Pam Hulme
Adele Pistorino
Cheryl Demeo
Monique Mohammed
Lorinda Longhi
Gina McCormack
Lynne Uhl
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Visualizing Patient Safety Impact of Collection Error
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
Safety