2
20
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75752262bdb033bcbea59d0776080417
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Text
Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Pre-Intervention Survey
Effective Use of Time (Offgoing)
Post-Intervention Survey
Effective Use of Time (Offgoing)
Strongly disagree
(11%)
Disagree (49%)
Strongly disagree
(8%)
Disagree (15%)
Neither agree nor
disagree (4%)
Agree (32%)
Neither agree nor
disagree (0%)
Agree (39%)
Strongly agree (4%)
Strongly agree (39%)
Effective Use of Time (Oncoming)
Strongly disagree
(0%)
Disagree (10%)
Neither agree nor
disagree (17%)
Agree (62%)
Neither agree nor
disagree (0%)
Agree (50%)
Strongly agree (8%)
Strongly agree (40%)
A lot less (23%)
Neither agree nor
disagree (11%)
Agree (43%)
About the same
(8%)
More (15%)
Figures 1-3. Survey responses regarding preexisting signout process. N=47.
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
Opportunities
Likely to Contribute ___ to Burnout
Strongly disagree
(2%)
Disagree (9%)
Strongly agree
(36%)
•
Effective Use of Time (Oncoming)
Strongly disagree
(2%)
Disagree (11%)
Contributes to Personal Burnout
Key Results
Less (54%)
A lot more (0%)
Figures 4-6. Survey responses regarding
piloted signout process. N=10-13.
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
Next Steps
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Pre-Intervention Survey
Post-Intervention Survey
Average 37 Minutes per Patient
Average 25 Minutes per Patient
>60 (20%)
>60 (15%)
50-60 (7%)
50-60 (0%)
40-50 (4%)
40-50 (8%)
30-40 (26%)
30-40 (15%)
20-30 (30%)
20-30 (31%)
10-20 (13%)
10-20 (23%)
0-10 (0%)
0-10 (8%)
0
5
10
Key Results
15
0
1
2
3
4
5
Figure 7. Estimated time per patient completing entire
signout process. N=47. Typical census of 8 patients = 5
hours.
Figure 8. Estimated time per patient completing entire
signout process. N=13. Typical census of 8 patients = 3.5
hours.
Things Fall Between the Cracks
Important Missed Information
FREQUENTLY (9%)
•
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
NO (50%)
Opportunities
SOMETIMES (47%)
NOT SURE (30%)
INFREQUENTLY (45%)
YES (20%)
0
5
10
15
20
Figure 9. Estimated frequency of missed
information with pre-existing signout process.
N=47.
25
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
Next Steps
0
2
4
Figure 10. Oncoming providers’ report of later
discovered important information not covered
with modified signout. N=10.
6
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Provider Preparedness and Preferences
Key Results
Felt Prepared to Start on Service
Strongly disagree
(0%)
Disagree (10%)
Neither agree nor
disagree (0%)
Agree (40%)
•
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
Prefer Verbal Signout (Offgoing)
Strongly agree (50%)
Figure 11. Oncoming providers’ perceived
preparedness after receiving modified signout. N=10.
Yes (69%)
Not Sure (8%)
Prefer Verbal Signout
(Oncoming)
Yes (70%)
Not Sure (20%)
No (23%)
Figure 13. Offgoing providers’ preferences for or
against modified signout. N=13.
Opportunities
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
No (10%)
Figure 12. Oncoming providers’ preferences for or
against modified signout. N=10.
Next Steps
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Warm Handoff Guidelines
SHOULD
SHOULD NOT
Focus on the most complex patients
Simply repeat information already written
Express uncertainty: what’s unknown
and/or undifferentiated
Explain deviation from standard of care
Read directly from abbreviated written
signout without adding context
Require the receiver to take notes
Include questions and clarifications
Be a one-way or lopsided conversation
Mention nuanced social issues
Be rushed or inconveniently timed
Ideally occur with medical record in view
Last more than an hour in most cases
Identify follow up communication needed
�
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Title
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Handoff Redesign to Reconnect and Reduce Burnout
Date
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2021
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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.
Mitchell Ross (<a href="mailto:mwross@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mwross@bidmc.harvard.edu</a>)
Project Team
Mitchell Ross
Susan McGirr
Justine Blum
Rachel Hensel
Alicia Clark
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Hospital 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
Handoff Redesign to Reconnect and Reduce Burnout
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
Effectiveness
Efficiency
Safety
Timeliness
-
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7b4e46f599997aab95ba2cd140ac7392
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Text
Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube
Placement Improves the Confidence of Decision-Making
Liubauskas R. MD, Litmanovich D.E. MD, Chakrala N.L. MBBS, Oren-Grinberg A. MD, Eisenberg R.E. MD
INTRODUCTION
•
•
•
•
Following intubation, a frontal chest
radiograph (CXR) is obtained to
assess endotracheal tube (ETT)
position by measuring the ETT tip to
carina distance1
ETT tip location changes with neck
position, but it can be determined by
assessing the position of the mandible2
Since the mandible usually cannot be
visualized on standard CXR, we
developed a new protocol where the
mandible is seen in the CXR
We compared the confidence of
decision-making using new and
standard protocols for post-intubation
CXR to assess ETT position
WHY CARE?
•
•
An excessively distal ETT position
could lead to endobronchial intubation,
which may result in serious
complications such as3,4:
• Atelectasis of the
non-ventilated lung
• Hypoxemia, hyperinflation,
and barotrauma of the
ventilated lung with possible
development of pneumothorax
A too proximal ETT position may lead
to its displacement – caudal migration
and even self-extubation5, the
development of vocal cord injury,
resulting in permanent hoarseness and
significant airway obstruction3 and
ETT-related tracheal rupture resulting
from an overinflated ETT cuff
METHODOLOGY
Retrospective and prospective, single-center, IRBapproved study, which consisted of patients
undergoing CXR following intubation to assess the
position of the ETT-tip relative to the carina.
Two parts of the study:
• Part I- retrospectively assessed images obtained
with the standard protocol. Patients underwent a
routine supine AP post-intubation CXR for the
assessment of ETT position, in which the upper
margin of the image typically was in the lower neck
• Part II– prospectively included all consecutive CXRs
acquired using the new post-intubation protocol.
The radiology technologists palpated the mandible
to ensure that 1-2 cm of this bone would be
included within the upper margin of the image
What the heck is with the neck?
The position of the ETT depends on the
position of the neck2:
• If the neck is extended, the ETT ascends
• If the neck is flexed, the ETT descends
• Potential movement of the ETT tip can be up to
3.8 cm in cases where neck position changes
from flexed to extended or vice versa
• If the neck changes position between flexed
and neutral, or between neutral-extended, the
potential movement of the ETT tip is ~1.9 cm
In the study2,6:
• The neck is considered extended if the
mandible projects over C4 or higher
• The neck is considered neutral if the mandible
projects over C5 or C6
• The neck is considered flexed if the mandible
projects over C7 or lower
Where do we want the ETT to be?
The desired position of the ETT depending on the neck position6 (Figure 1; A, B, C):
• With the neck flexed – the ideal position of the ETT tip is 3 ± 2 cm above the carina
• With the neck neutral – the ideal position of the ETT tip is 5 ± 2 cm above the carina
• With the neck extended – the ideal position of the ETT tip is 7 ± 2 cm above the carina
We can be uncertain sometimes
We established “gray-zone” values (Figure 1) at which the
CXR are difficult to assess whether the ETT is in a satisfactory
position if the mandible is not visible:
• If the ETT tip-carina distance is >9 cm, then the ETT is too
high, regardless of the neck position
• If the ETT tip-carina distance is <1 cm, then the ETT is too
low, regardless of neck position
• If the ETT tip-carina distance is 6.0–9.0 cm, then the ETT is in
a high gray-zone position
• Rationale: if the neck is extended at the time the CXR was
obtained, the ETT is positioned appropriately. If the neck is
flexed, the ETT may move upwards with the neck in a neutral
or extended position, resulting in a too high ETT position
• If the ETT tip-carina distance is 1.0-4.0 cm - the ETT is in a
low gray-zone value
• Rationale: if the neck is flexed at the time the CXR was
obtained, the ETT would be positioned appropriately. If the
neck is extended or neutral, the ETT may potentially move
Fig. 2 – Algorithm to assess the ETT position downward, resulting in a too low position of the ETT
Making a confident decision
Algorithm for assessing the ETT position (Fig. 2):
Step 1 – is the mandible is visible on the CXR?
• If so, the position of the neck, and therefore
the ETT position, can be confidently
assessed. No additional steps
• If the mandible is not visible, go to step 2
Step 2 – is the tip of the ETT is in one of the
clear-zones?
• If so, the ETT position can be confidently
assessed regardless of the neck position
• If not, the ETT position cannot be
confidently assessed
Other times we’re sure
• Based on the “gray zones” - only when the
ETT tip-carina distance is 4.0-6.0 cm, can the
reader be confident that the ETT position is
satisfactory regardless of the neck position
• When the ETT tip-carina distance is either
>9.0 cm or <1.0 cm, the reader can be
confident that the ETT position is
unsatisfactory regardless of neck
• We established these ranges (<1.0, 4.0-6.0,
>9.0 cm) as “clear-zone” values, because
the reader can confidently recommend
moving or leaving the ETT in the current
position
Fig. 1 – Summary of different ranges of the ETT tip – carina
A – appropriate range of ETT tip when neck extended (5-9 cm)
B – appropriate range of ETT tip when neck flexed (1-5 cm)
C – appropriate range of ETT tip when neck neutral (3-7 cm)
X – Gray zone of the ETT being potentially too high (6-9 cm)
Y – Gray zone of the ETT being potentially too low (1-4 cm)
Z – Clear zone regardless of the neck position (4-6 cm)
Which zone is what now?
“GRAY ZONE” – ETT tip–carina distance, at which
it is difficult to assess whether the ETT is in a
satisfactory position if the mandible is not visible
“CLEAR ZONE” - ETT tip–carina distance, at which
the reader can confidently recommend retracting,
advancing or leaving the ETT in the current position
NB! - clear zone does not mean that the ETT position is
satisfactory, but that the reader can distinctly determine
whether the position is satisfactory or requires adjustment.
�Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube
Placement Improves the Confidence of Decision-Making
Liubauskas R. MD, Litmanovich D.E. MD, Chakrala N.L. MBBS, Oren-Grinberg A. MD, Eisenberg R.E. MD
RESULTS
•
•
•
•
There were 308 patients in the study with post-intubation CXR –
155 using the standard technique and 153 using the new protocol
Based on the mandible position, the neck was in neutral (45%;
78/173), extended (45%; 77/173) or flexed (10%;18/173) positions
There was a significant increase (p<0.001) in visualization of the
mandible on post-intubation CXR obtained with the new protocol
(92%; 141/153) compared to those with the standard technique
(21%; 32/155).
The distribution of mandible visibility and zones is summarized in
table 1 and figure 3.
ETT*
position
Certain
Standard
Protocol
32 (21%)
New
Protocol
141 (92%)
Mandible
Visible
Mandible
Clear zone 48 (31%)
7 (5%)
Not Visible Gray zone 75 (48%)
5 (3%)
Total
155 (100%) 153 (100%)
EXAMPLES FROM YOUR PRACTICE TODAY!
RESULTS
•
There were two acceptable ways to determine whether
the ETT was is in the appropriate position: by visualizing
the mandible, or by observing the ETT in the clear zone.
Combining both
measures, we
have estimated
that a confident
decision can be
made in 96.7% of
cases using the
new protocol,
compared to
51.6% of cases
using the standard
protocol (p<.001)
(Figure 4).
Table 1 Overview of
the study
results
Fig. 4 - Decision confidence rate when assessing
ETT position (new vs standard protocol)
CONCLUSION
Figure 3 - Using the standard protocol, there was an unconfident
decision rate of 48%, compared with only 3% using the new protocol.
•
When the mandible was visualized, it most commonly projected
over the C5 (32%; 56/173) or C4 (25%; 44/173) vertebral body,
with a range of C1-T2, suggesting that the neck is usually in a
neutral or slightly extended position (Figures 5 and 6).
Figure. 5 – Inaccurate interpretation of the ETT
position based on shape and angle of the
mandible. 55-year-old woman following
intubation with ETT tip 2.1 cm above the carina.
Recommendation to retract the ETT was not
made. Based solely on the shape of the
mandible, the neck may appear flexed.
Assessing by the relationship of the vertebral
body to the mandible, neck may be extended
(mandible projects over C4), introducing the risk
of ETT descending by approximately 2-4 cm
depending on neck movements, and possibly
intubating the right bronchus.
Fig. 6 – Inaccurate interpretation due to failure to
assess the relationship of the mandible to the
vertebral bodies. In this 66-year-old man following
intubation with ETT* tip 7.0 cm above the carina, it
was recommended to advance the ETT. However, in
assessing the relationship of the mandible to the
vertebral bodies, the neck appears to be in an
extended position (mandible projects over C3-C4),
making the position of the ETT appropriate, as it may
descend 2-4 cm depending on neck movements
To our knowledge, this study is the first study to
demonstrate that mandible inclusion on post-intubation
CXR is a simple and cost-effective method to ensure
proper assessment of the ETT position, sparing the
patients from unnecessary additional imaging and
almost doubling the level of certainty of the decisions
made by the radiologist.
REFERENCES
1.
2.
3.
4.
5.
6.
Godoy MC, Leitman BS, de Groot PM, Vlahos I, Naidich DP. Chest radiography in the ICU: Part 1, Evaluation of
airway, enteric, and pleural tubes. AJR Am J Roentgenol. 2012;198(3):563-71.
Conrardy P, Goodman L, Lainge F, Singer M. Alteration of endotracheal tube position. Flexion and extension of
the neck. Crit Care Med. 1976;4(1):8-12.
Mathew R, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Lines, tubes, non-cardiac
medical devices and materials. SA J Radiol. 2019;23(1):1729.
Owen RL, Cheney FW. Endobronchial intubation: a preventable complication. Anesthesiology. 1987;67(2):225-7.
Kearl RA, Hooper RG. Massive airway leaks: an analysis of the role of endotracheal tubes. Crit Care Med.
1993;21(4):518-21.
6. Goodman L, Conrardy P, Laing F, Singer M. Radiographic evaluation of endotracheal tube position. AJR Am J
Roentgenol. 1976;127(3):433-4.
�
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.
Rokas Liubauskas (<a href="mailto:rliubaus@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">rliubaus@bidmc.harvard.edu</a>)
Project Team
Rokas Liubauskas
Diana Litmanovich
Nahara Chakrala
Achikam Oren-Grinberg
Ronald Eisenberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
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
Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube Placement Improves the Confidence of Decision-Making
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
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3ef6f52c68111d35033bb010b8e189c3.pdf?Expires=1712793600&Signature=AvLsU5rC%7E6FRL%7EoRoiqdf99DPZdgeZOVZdkLdpDYMRYlnxfGdgU9WEVv4-RXvuv2ecH2i8xH5QO-wgvVyQ74GaXGeTkHZrrv-GZ7GAsVdodk3ZLo%7EEWzahfYGF2H5cJ1Pup1Sb8qzbIVWvpUgBksJOYYCIlRKDpXkvpngqIensa2Usf0Ov5uHcKbwUuLVZ4GwZz8FVobkeZoSdCNw-qKp-nLLPoxG6%7EuisRCgC%7EJh5tlqbmk2PWCe8PScw1sowHKkVZ1fTbUepM5u5lSVs09HofjogTNQhwYjhDvcFJ8-2i6xkWla6Oqe0mG472neOaCVmIRGQkgwdYGZ6awR15nVQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ef8016f83c23c61c81d3f3c0b98ddffe
PDF Text
Text
"I Got the Shot: The Story of COVID Vaccine Clinics in the Community"
Ellen Volpe, Kristin O’Reilly, Katelyn Rick, Jordan Ellis, Jaime Levash, Jasmine Cline-Bailey
BIDMC
Results/Progress to Date
Introduction/Problem
Total Doses given by BIDMC
47672
Axis Title
In December of 2020, nearly one year into a global pandemic that had killed over
300,000 Americans the world was looking for something to be hopeful about. On
December 13, 2020 Pfizer Biotech received the initial EUA approval for a two
dose COVID-19 Vaccine that had promising results in clinical trials. Shortly
thereafter Moderna and J&J were also approved and BIDMC’s mission shifted to a
widespread vaccination campaign.
31109
Aim/Goal
The goal of this work was to provide access to life saving vaccines to as many
patients as possible and focus our efforts on the communities where our patients
were disproportionately impacted by the pandemic.
14926
The Interventions
Reviewed data that showed where the highest concentration of COVID cases were by zip
code
Worked with facilities to identify potential clinic locations in those areas: Dorchester, Chelsea,
Boston
Our IT team developed a worklist of our patients based on eligibility criteria
We used that email/ text patients directly to schedule their appointment
Outlined a process for how the clinic would flow: outreach, scheduling, perform check in,
documentation, and future scheduling
Outlined safety protocols for vaccine sites with multiple vaccine types
Created staffing and throughput models to maximize capacity
Recruit, train, and staff each location
Strategized to ensure we used an equitable approach to outreach, scheduling, booking, and
administering of vaccines
Engaged with Interpreter Services to ensure we were adequately serving our LEP patients
CHELSEA
DORCHESTER
TEMPLE ISRAEL
Total Doses
In total, BIDMC’s site administered 93,707 doses of COVID-19 Vaccine. This accounts for 28% of all doses
administered through BILH. BILH administered 338,457 doses.
We collected data on patient experience throughout the clinics being open which helped us to gain
some good insight into what could have improved the experience for patients.
Vaccine Site
Chelsea
Chelsea
Dorchester
Dorchester
Chelsea
Patient Response to what could have been better
This was so easy, clean, and well organized. So much better than I
expected.
Your Chelsea Team deserves a patient care award.
Could not have been any easier or better than what I experienced
to today all was 100%
3-Mar-21
3-Mar-21
2-Mar-21
Someone playing the piano in the fellowship room would be lovely 3-Mar-21
The directions to the location should of been more clear because
the whole plaza is 1100 revere Beach parkway in Chelsea and it
For
more
brings you to a buffet when put
in the
gps information, contact:
2-Mar-21
Katelyn Rick, MSN, RN Manager, Improvement and Innovation krick@bidmc.Harvard.edu
�“I Got the Shot: The Story of COVID Vaccine Clinics in the Community"
Ellen Volpe, Kristin O’Reilly, Katelyn Rick, Jordan Ellis, Jaime Levash, Jasmine Cline-Bailey
BIDMC
More Results/Progress to Date
The Team
Ellen Volpe, Vice President - Ambulatory Services
Mary LaSalvia, Associate CMO, Infectious Diseases MD
Peggy Stephen, Chief Pharmacy Officer
Jarrod Dore, Director of Capital Facilities
Mo Ortega, Project Manager, Emergency Management
Sherry Calderon, Director, Ambulatory Services
Shari Gold-Gomez, Director, Interpreter Services
John Casavant, Manager, Telecommunications
Katelyn Rick, Project Manager for Chelsea
Kristin O’Reilly, Director Improvement and Innovation
Bridgid Joseph, Program Director ECC & Training Center Coordinator
Barbra Blair, Infectious Disease MD, Medical Director of Vaccines
Kyle Franko, Internal Communications Manager
Elise Porter, Site Director for Chelsea
Kerry Falvey, Site Director for Dorchester
Sandi Leitao, Site Director for Temple Israel
Larry Markson, Vice President of Information Systems
Divya Narayan, Project Manager IS
Jordan Ellis, Project Manager for Temple Israel
Jaime Levash, Project Manager for Dorchester
Jasmine Cline-Bailey, Project Manager
Sarah Moravick, Vice President- Organizational Planning
Julie Lanza, Pharmacy Compliance Specialist
Katie Scalzulli, Project Manager, Vaccine Staffing
Kerry Carnavale, CNS Nursing Educations for Vaccine Clinics
Kate Willetts, Nursing Educator
Paula Sterling, APP for Vaccine
Lessons Learned
The team learned to be flexible and pivot quickly when vaccine supply changed or was reallocated.
Leveraging relationships the clinics (Bowdoin, Chelsea internal medicine) have with their patients
proved to be an effective strategy to broaden our outreach and work through vaccine hesitancy.
We worked with IT to include patient language data and message a second time to all patients in their
primary language.
The BIDMC team created a “playbook” for how to open a vaccine site that was given to the BILH
system for the future.
Next Steps
The team is working towards rolling out a booster clinic for 3rd dose Moderna and 2nd dose J&J
For more information, contact:
Katelyn Rick, MSN, RN Manager, Improvement and Innovation krick@bidmc.Harvard.edu
�
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.
Katelyn Rick (<a href="mailto:krick@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">krick@bidmc.harvard.edu</a>)
Project Team
Ellen Volpe
Mary LaSalvia
Peggy Stephen
Jarrod Dore
Mo Ortega
Sherry Calderon
Shari Gold-Gomez
John Casavant
Katelyn Rick
Kristin O’Reilly
Bridgid Joseph
Barbra Blair
Kyle Franko
Elise Porter
Kerry Falvey
Sandi Leitao
Larry Markson
Divya Narayan
Jordan Ellis
Jaime Levash
Jasmine Cline-Bailey
Sarah Moravick
Julie Lanza
Katie Scalzulli
Kerry Carnavale
Kate Willetts
Paula Sterling
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID Healthcare - Chelsea
Community Health Center
Department
Any departments listed on the poster or identified in the spreadsheet.
Improvement and Innovation
Infectious Diseases
Ambulatory Services
Pharmacy
Information Systems
Organizational Planning
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
"I Got the Shot": The Story of COVID Vaccine Clinics in the Community
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
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/be1f907a04c91c807fc1ce39f85eef92.pdf?Expires=1712793600&Signature=Be2PZ1s0osXruxhnEenGxDoKIsqbT32MMffl3mpWf6To2cshxEiYdf44J%7E591O%7E%7ERq8jScq3Pb2X7m0SZRECpJWQARuKhr0YEN-CHKsxeflAhisA2zcErjZSXNwNQrXClK7477f5eFoEKItzTOHwzCdAy9gKtoFQ-p%7EpzbLx1KBWIvEhAnocsmDy3WbB6X-0hm5uloMUVWJBfcb7KIrdPc1TFFyYshMCNvpzXOPuia14%7EQW6PRHwKbJ7NVLyvDJ7r9hWvuXH6ueoenQLeorziZSzQL4xce5%7ExsCL1odICmY0L3bpT34maXlS8B6SaIhDLpJr97Xn%7EfaoE%7EUTosVbcg__&Key-Pair-Id=K6UGZS9ZTDSZM
794912fc492e34746e80144908a715f2
PDF Text
Text
Facing the Unknown with Data:
Strategies to Maximize Care Capacity for Resurgence of COVID-19
Aya Sato-DiLorenzo, RN, BSN, OCN, BMTCN; Jo Underhill, RN, BSN, OCN; Christine Flanagan, RN, MSN;
Matthew Weinstock, MD; Mary Linton Peters, MD; and Meghan Shea, MD
Ambulatory Hematology & Medical Oncology
Introduction
Hematology/Oncology Respiratory
Evaluation Emergency Extension Site
(Hem/Onc REEES) was established
in March 2020 with the following
goals:
•
To care for hematology and
oncology patients with respiratory
or other symptoms associated
with COVID-19.
•
To minimize delay in oncology
care delivery due to COVID-19.
•
To minimize unnecessary patient
visits to the emergency
department.
Problem
As we prepared for the winter of 20202021, the prevalence of COVID-19 was
expected to increase. With expected
patient influx at Hem/Onc REEES, there
was an urgent need to understand our
practice patterns and identify
improvement strategies to maximize our
care capacity.
Methodology
April 2020 Data
This project was conducted in the fall of 2020. We reviewed the unit log
from April 2020. It represented a period of high clinical acuity along with
the first wave of COVID-19 in our state.
Nursing interventions were identified by reviewing the billing data.
Furthermore, we analyzed appointment scheduling and duration on
selected days.
Based on the April 2020 data, we implemented Interventions likely to
promote high-quality, efficient care.
Structure
• Revised orientation plans
for deployed nurses with
focus on commonly given
interventions
• Planned to book 2-3
hours for patients
requiring urgent symptom
evaluations
• Lead-RN to oversee daily
unit operation and patient
flow
• A weekly “chemotherapy
day” with chemotherapy
competent nurses on site
• Weekly huddle between
clinic nurses and
leadership
Based on the Donabedian Framework
Results – January 2021
Total Clinic Encounters = 114
Average Visit Duration = 2hrs 32 min
Common Nursing Interventions:
• Nasopharyngeal specimen collection (n=100)
• Lab evaluation (n=52)
• Intravenous fluid administration (n=16)
• Blood products administration (n=2)
Many visits were added on the same day for
urgent patient evaluation.
Process
• Nursing processes as
per hospital policy
• Fidelity to REEES unit
SOPs
• Communication and
teamwork
Outcome
•
•
•
•
Maximize care capacity
Minimize care delay
Evidence-based care
Minimize nursing
burnout
Total Clinic Encounters = 95
Nursing Interventions Provided:
• Nasopharyngeal specimen collection
(n=76)*
• Lab evaluation (n=63)
• Chemotherapy/immunotherapy
administration (n=16)
• Intravenous fluid administration
(n=10)
• Injections including Leuprolide
Acetate, Octreotide, Cyanocobalamin,
& Pegfilgrastim (n=9)
• Blood products administration (n=9)
• tPA instillation (n=3)
• Non-chemotherapy IV therapeutics
including Belatacept, Ferumoxytol, &
Eculizumab (n=3)
• PK/PD draw for clinical trial (n=1)
* Decrease in the specimen collection at
Hem/Onc REEES was a result of more
patients using BIDMC drive thru testing
sites.
Winter 2020-2021: Unanticipated Challenges
Many other departments continued to operate for patient care.
• A smaller space available for the Hem/Onc REEES clinic.
• A fewer number of nursing staff who were deployed from other departments.
• No dedicated nursing assistants or administrative support on site.
• Patients with complex medical histories including those who had stem cell
transplant & chimeric antigen receptor T-cell therapy and those on clinical trials.
Conclusion
We were successful at expanding the
scope of Hem/Onc REEES. The clinic
utilization data showed the provision of
more complex, oncology-specific care
in January 2021 despite the smaller
physical space and a smaller number of
nursing staff.
�
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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
Project Team
Aya Sato-DiLorenzo
Jo Underhill
Christine Flanagan
Matthew Weinstock
Mary Linton Peters
Meghan Shea
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.
Aya Sato-DiLorenzo <a href="mailto:%20">asato@bidmc.harvard.edu</a>
Department
Any departments listed on the poster or identified in the spreadsheet.
Ambulatory Hematology
Medical Oncology
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
Facing the Unknown with Data: Strategies to Maximize Care Capacity for Resurgence of COVID-19
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/bb47978d029e8ce272c5839b360ec759.pdf?Expires=1712793600&Signature=aUem1dQwzuTkgp3bS7eZPfdFrB82WemY2bn8DYJ0JDTmrNwD4BeiQQ%7Eh8ddl2z%7EiXJKCYP5xBXRKs%7E6rF7FABV8PtfiSJ1G0S0Qw2g%7E7eg%7ExA49RPBcMbAi3F8mGc-Wirl1BYN-pwoBKwmj6IUX-AvOaaoqDznMAr5xioSA-UBR1z4opBSCVSM7jkYglddjshUeCYO0cG%7E9CnP0dIVBsbigXi3uXVUUsA59FmCx2T8RtnjtEagwMDfs0a5dKNqq0KwmyeCcF%7EO2RN1wf1nvcsoroYjFo7orV2IyRQfiZEtVA922Pw0xbXTUhTH3l6sdcZ5SjC27U27oiKMwPt6jQbA__&Key-Pair-Id=K6UGZS9ZTDSZM
ed73b3c2a0bd82c41897ed01744307e5
PDF Text
Text
The Implementation of the Graduate Nurse Role to Support Nursing Staff during the COVID-19 Pandemic
Cassandra Plamondon, MSN, RN., Kym Peterson, MSN, RN, CNL., Kathy M. Baker, MSN, RN., Jenny Barsamian, DNP, RN., Ann Marie Grillo
Darcy, MSN, RN, ACNS-BC., Lynn Mackinson, MS, RN, ACNS-BS., Andrea Milano, MSN, RN, CCRN, CMC., & Lauren B. Mills, BSN, RN
Introduction/Problem
• Recognized critical staffing needs during the COVID-19 pandemic
• Governor Baker passed an executive order authorizing nursing graduates and senior nursing students
to practice with a limited capacity
• Current process did not support the role of the graduate nurse (GN) practicing in the clinical setting
Aim/Goal
• Increase the nursing workforce by implementing the GN role
• Swiftly create an orientation program that supported the GN amid the COVID-19 pandemic
The Team
Unit-Based Educators, Nurse Specialists, and Nursing Directors from inpatient medical-surgical and
specialty care units
The Interventions
Three phased approach tailored to the individual GN:
Phase 1
Phase 2
Phase 3
• Safety, basic assessments, documentation, prevention of harm, and use of basic equipment
• Advanced assessment skills, medication administration, emergency care, telemetry, and ECG monitoring
• Occurred once GN passed the NCLEX-RN exam and transitioned to the entry-level clinical nurse role
• Continued focus on medication safety, in addition to prioritization of care and evaluation of critical thinking
GNs were surveyed upon completion of orientation and their transition to the entry-level RN role to
assess comfort levels with various professional nursing roles and to identify knowledge gaps and areas
for improvement
The Outcomes
Fifteen of the 16 GNs successfully passed the NCLEX-RN and transitioned to an entry-level RN position with
12 responding to the survey. Six categories for discussion emerged:
Work experience
Communication and
feedback
Support
Clinical confidence
Workload
Transition challenges
• Ten had previous experience as a PCT, eight transitioned to a GN on the unit previously employed as a PCT
• GNs felt comfortable communicating with coworkers, physicians, and patients and their families
• Some reported a lack of communication regarding roles and responsibilities of the GN to other staff
• GNs reported seeking feedback for their performance
• Most felt supported on their units and felt the orientation process was well communicated with them
• Some stated that having several preceptors impacted the progression of their orientation
• Several GNs expressed lack of confidence in performing end of life care
• All felt they had adequate knowledge and experience to perform their job responsibilities
• Most felt comfortable with new situations and procedures
• Most GNs felt the workload was reasonable, feeling they could prioritize and organize patient care in a
timely manner and felt comfortable delegating tasks when necessary
• A lack of confidence and fear were challenges GNs identified during their transition to practice, followed by
perceived workload, role expectations, and how to use available resources
• GNs desired more experience with medication administration, eMAR, medical equipment, emergency
situations, and how to communicate efficiently with physicians
Implications for Future
• Improve communication with nursing staff to
increase the understanding of the roles,
responsibilities, and limitations of those in the
GN role
• Limit number of preceptors orienting a GN to
one or two key preceptors and ensure
communication occurs amongst those sharing
this role
For more information, contact:
Cassandra Plamondon, MSN, RN – cplamond@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.
Cassandra Plamondon (<a href="mailto:cplamond@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cplamond@bidmc.harvard.edu</a>)
Project Team
Cassandra Plamondon
Kym Peterson
Kathy M. Baker
Jenny Barsamian
Ann Marie Grillo Darcy
Lynn Mackinson
Andrea Milano
Lauren B. Mills
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.
Nursing
Dublin Core
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Title
A name given to the resource
The Implementation of the Graduate Nurse Role to Support Nursing Staff During the COVID-19 Pandemic
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
Effectiveness
Safety
-
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
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
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
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/151880e0917fd1e491b7aab5c7917f54.pdf?Expires=1712793600&Signature=WKZtUGZ7wU4qUpq4pJPO3pm6HQHpitUwOj8DdzYJR3EUu0pTBxME2jIw7flMyg4CoI9GRUfvXZPQRBxRVhBGJMmnl56bn9IP5LtOHcmjhnkTLk9Nj7lOtJOH4gIVvNXSVoXjLv88XlJyWl-DfjPGMsKaFFlHVRQ-tgQ5WkWhNCvWjXaklhhD-4eGKpFXuC0wHazX9glJqw0KsFsRalZQ5iwxtC%7EoYnkiDNSA4gwhohldPujCju1Y8eHGOX%7ENjcRVn9EZZvTb5OklxcW0i2DsLEQf%7EJ1QYMJSnL%7E3cg7JQFmEAUW9gMh-0ACbCzYFXC4TxStJRH6KFQmsFw-4SlrYBg__&Key-Pair-Id=K6UGZS9ZTDSZM
3b1d4200ecd2a6b5ddd6f0b3c05425fc
PDF Text
Text
Social Work Response to COVID
Mary McDonough, LICSW
Social Work Department, Clinical Manager of Med/Surg, ED and Transplant
Beth Israel Deaconess Medical Center
Introduction/Problem
How did inpatient social work team respond to needs presented by pandemic beginning March 2020
Initial concerns regarding safety, ability to meet needs of patients, families and staff.
The Interventions
Staffing
Work on units
Support to pts and families
Staff support
A whole new focus in our work in collaborating with teams to facilitate end of life visitation, working with
on line meetings, discussions of end of life decision making via ipads.
Readjusting to new world of resource needs, transportation, shelter limits, dialysis unit limitation, court
closures.
Providing support to staff, informal and formal support modalities, in person vs remote,
groups/individuals, bringing in resources.
Aim/Goal
Results/Progress to Date
Immediate response
What worked
Pulling team together immediately, 3/13 met w/ whole team in person, didn’t have
tools yet for zoom, etc.
Decision made to work 50/50 onsite/remote
To respond to needs of patients, families, and staff during differing stages of COVID pandemic
To adjust staffing to meet needs of patients, families, and staff.
The Team
Medical Surgical Social Work Team
Safety concerns
Remote vs onsite work
Working in teams to provide response to inpatient units
Requirement daily “pod” check ins to make sure that patient needs addressed
What didn’t work
Unclear message to patient care units,
Interpreted as we “went home” altho more than half the staff and both leaders were
here on site 100%
Eventually developed on site requirement, but created more flexible schedules with 10 hour days to allow for some
social distancing and address staff exhaustion. Still evaluating effectiveness
Collaboration throughout the medical center, often standing with spiritual care colleagues.
For more information, contact:
�Social Work Response to COVID
Mary McDonough, LICSW
Social Work Department, Clinical Manager of Med/Surg, ED and Transplant
Beth Israel Deaconess Medical Center
More Results/Progress to Date
STAFF SUPPORT
WORK ON UNITS
Quickly became almost all COVID patients
ICU’s expanded beds to RB6, RB7
Primary role in end of life care
Strengths:
Formal and informal leadership within social work group
MICU/SICU Social Worker and RB 7 Social Worker became
interchangeable
Challenges:
Some staff unprepared for end of life work
Staff were not sufficiently cross trained to work in other units
Responding to the needs of the responders
Formal and informal support
Inpatient support groups, led by social workers (inpatient and outpatient) and chaplaincy
Inconsistent participation but some very powerful moments and times on patient care units
Mostly effective with/from social workers well known to units
Outpatient staff want to be helpful but hard to do by Zoom and hard to predict time that worked
Informal support most often what worked, staying late after a hard shift, debriefs after a hard death
Lots of tears, few hugs
Lessons Learned
SUPPORT TO PATIENTS AND FAMILIES
Became proficient in zoom, facetime, and other technologies
Coordinated arrival of IPADS on patient care units
Coordinated end of life visitation in collaboration with medical, nursing leadership, hospitality staff, public safety, and Spiritual Care
Prepared families for visits, escorted families from lobbies
Strengths:
Great collaboration to meet needs of families, everyone just picked up
whatever they needed to get it done
Challenges:
Guidelines kept changing, weekly meetings addressed outpatient and clinic
visits, cafeteria visits but not very clear about managing inpatient visits
Weekend staffing, late evening staffing
Social Work drop in time
Working in crisis mode, not best decision making
Changing guidelines really hard to keep up with
More cross training needed, internal shadowing
Need to evaluate effectiveness of changed schedules
Turn over of staff, pulled manager away from staff to cover for almost a year,
Next Steps
Reevaluate pros and cons of 4 day work weeks
Survivor mentality, grown in closeness, 9 new hires since beginning of pandemic, 30% turnover of
staff, redeveloping identity of group
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.
Mary McDonough (<a href="mailto:mmcdonou@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mmcdonou@bidmc.harvard.edu</a>)
Project Team
Medical-Surgical Social Work Team
Department
Any departments listed on the poster or identified in the spreadsheet.
Social Work
Spirtual Care
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
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Title
A name given to the resource
Social Work Response to 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
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c4f0bc4d64d50bfe1cac4a489f009d51.pdf?Expires=1712793600&Signature=wQgB5ThpesdwuivyLXX97kcAtVRLct6vCQeg26N0iDqAE6PpRdCqhb20032703J19B718khzhaFtqMWXNoW%7E3AwRDN%7EDErZS%7El1jrxx56fGtEJ4ATIfcLwX4QoJhKOCWVzvT9JLXWi6TNb18OCSlDnFgPFg-zkraXXFHLZ1gmCs7O-59yFGIpcTCnylZZFMDn33nRe1E%7EZE4AmQWVHUvZYJZKw9kqTrWfSkxgbBWrxGmTMWNTKIPTeHbGOTqszjMrFWv%7Ec60Vcn7fl3v5T0VAM-WuqTLvd7OHRjRG0f%7Er5qhLD-Px65egYYwdLtjuL486u5aQ5ZT804Yyx2hFTZv1Q__&Key-Pair-Id=K6UGZS9ZTDSZM
39123ce8be1dcde1e9d4e56e1a29de79
PDF Text
Text
Alicanto Consult as a clinical tool for virtual tumor boards, asynchronous dialogues and referrals across the BILH Cancer Care Network
Andrew C. Lyu, MD1; Jessica A. Zerillo, MD2,4 ;David J. Einstein, MD2; Robin Joyce, MD3; Melis Celmen, MHA4, Brian Russell, MD1;
Katherine Bloom5; Yuri Quintana, PhD5
1Department
Introduction/Problem
of Medicine, BIDMC, 2Division of Medical Oncology, BIDMC, 3Division of Hematology and Hematologic Malignancies, BIDMC, 4BID Cancer Center, 5Division of Clinical Informatics, BIDMC
Implementation and Design
With the COVID-19 pandemic and limited in-person
attendance at meetings, the Division of
Hematology/Medical Oncology saw a need to develop
and implement a clinical platform that would allow for
tumor boards to be conducted virtually. Such a platform
required the ability to easily upload, safely store,
organize and access clinical data by collaborators
across the BILH network.
At the same time, with the growth of the BILH care
network, patients have access to a wide variety of care
options, ranging from convenient community locations
with high-quality care to more specialized quaternary
care centers. Within Hematology/Medical Oncology,
patients are able to receive care close to home in their
communities and have the ability to be referred for
specialized care including clinical trials at BIDMC. To
provide the best, personalized patient-centered care,
patients are often referred from one BILH site to another.
Keeping track of patient referrals across a wide variety
of EMR systems has been a challenge with the growth
of the network.
Features and Advantages of Alicanto Consult:
Ø Allows users from all BILH sites (regardless of home EMR) to easily submit
and review clinical cases via an online interface
Ø Ability to upload, securely store, organize and access clinical data via an
online web interface or iOS application
Ø Workstation notifications via browser while logged into Consult system
Ø In-house team development team allows for customization and system
modifications to be made rapidly depending on clinical need
Ø
Ø
Ø
Aim/Goal
To develop and implement an online platform to allow
for virtual tumor boards, efficient, asynchronous clinical
discussions and electronic referrals across the BILH
cancer care network
Alicanto (https://www.alicantocloud.com) - an online platform with
tools to support group collaboration, such as web conferencing, document
sharing, and asynchronous discussion forums
Developed by Dr. Yuri Quintana and his team at the BIDMC Division of Clinical
Informatics
Alicanto BIDMC - launched in December 2019, initially to support collaborative
work across BILH within Hematology; can be accessed online at
https://www.alicantobidmc.org/ or with a mobile application.
https://apps.apple.com/al/app/alicanto-mobile/id1481350682
Ø
Ø
Alicanto Consult – part of Alicanto BIDMC; developed and preliminarily
implemented in March 2020 to support virtual tumor boards and “Difficult Cases
in Oncology COVID19 Forum”
In order to support referrals across the BILH Cancer Care Network, a pilot
program was launched in January 2021 between BIDMC and BI Plymouth
within the hematologic malignancies and genitourinary oncology disease
subgroups
Above: Alicanto Consult
Web interface
Right: Alicanto iOS mobile
application
For more information, contact:
Andrew Lyu, MD, Hospitalist, Division of Medical Oncology; alyu@bidmc.harvard.edu
�Alicanto Consult as a clinical tool for virtual tumor boards, asynchronous dialogues and referrals across the BILH Cancer Care Network
Andrew C. Lyu, MD1; Jessica A. Zerillo, MD2,4 ;David J. Einstein, MD2; Robin Joyce, MD3; Melis Celmen, MHA4, Brian Russell, MD1;
Katherine Bloom5; Yuri Quintana, PhD5
1Department
of Medicine, BIDMC, 2Division of Medical Oncology, BIDMC, 3Division of Hematology and Hematologic Malignancies, BIDMC, 4BID Cancer Center, 5Division of Clinical Informatics, BIDMC
Results/Progress to Date
Ø
(March 2020 – October 2021)
30
Ø
Total of 612 cases submitted by 62
unique users between January 2020 –
October 2021
Total of 198 users from:
–
–
25
–
20
•
•
•
•
•
•
•
•
15
10
5
<1/9/20
AJH
Atrius Health
Number
6
2
Oct
Sep
Aug
Jul
Jun
May
Apr
2020
BILH network referrals
(March 2020 – October 2021)
(March 2020 – October 2021)
14
12
10
8
6
4
2
0
Number of Submissions
4-week Rolling Average
Source: Google maps
2021
(%)
1.0%
0.3%
0.2%
1, 0%
3, 1%
17, 3%
11, 2%
13, 2%
2, 0%
GU
7, 1%
Gyn
1
BIDMC Cancer
Center
BID-Milton
558
1
0.2%
Sarcoma
BID-Needham
24
3.9%
Neuro-Oncology
BID-Plymouth
2
0.3%
LHMC
8
1.3%
MAH
10
1.6%
Key Points
Ø
Ø
13; 2%
GI
35, 6%
Beverly Hospital
91.2%
Alicanto Consult
Submissions by Type
Alicanto Consult
Submissions by Disease Group
Submissions by Location
Location
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
(blank)
0
Jan
–
BIDMC Medical Oncology
BIDMC Hematology and Hematologic
Malignancies
BILH Cancer Care network:
BID-Plymouth
BID-Needham
BID-Milton
AJH
MAH
Lahey Hospital & Medical Center
Beverly Hospital
Atrius Health
BIDMC Divisions of Radiation Oncology,
Radiology, Pathology, Surgical Oncology,
Urologic Surgery, Gynecology and more
GU Tumor Board Submissions
19
-M
ar
-2
0
19
-A
pr
-2
0
19
-M
ay
-2
0
19
- Ju
n20
19
- Ju
l-2
0
19
-A
ug
-2
0
19
-S
ep
-2
0
19
-O
ct
-2
0
19
-N
ov
-2
0
19
-D
ec
-2
0
19
- Ja
n21
19
-F
eb
-2
1
19
-M
ar
-2
1
19
-A
pr
-2
1
19
-M
ay
-2
1
19
- Ju
n21
19
- Ju
l-2
1
19
-A
ug
-2
1
19
-S
ep
-2
1
Number of new Alicanto Consult users per month
72; 12%
Tumor Board
Submissions
Ø
Thoracic
58, 9%
Breast
465, 76%
Melanoma
Hematologic
Malignancies
Other
BILH Oncology Forum for
Difficult Cases COVID 19
submissions
Next Steps
Ø
Ø
527; 86%
Referrals across BILH
sites
Alicanto Consult has allowed clinicians from across the BILH Cancer Care Network to easily submit clinical
cases for multidisciplinary review in an online, collaborative environment without the need for in-person
meetings during the COVID-19 pandemic
Through this collaboration, knowledge can be shared and brought to the patient, wherever that patient is being
cared for. When appropriate, this collaboration then encourages referrals of patients across BILH sites of care
to ensure that patients are receiving the highest quality of care, as close to home as possible
Alicanto Consult allows for efficient clinical communication, expedient clinical care, and the potential to
centralize and organize referrals from across the BILH network
Platform roll-out to additional disease subgroups interested in utilizing Alicanto
Consult for virtual tumor boards
Enrollment of additional BILH clinical care sites and disease groups to simplify
network referrals with the hope of minimizing administrative redundancies and
ultimately improving the overall clinical experience for patients across the BILH
Cancer Center network.
For more information, contact:
Andrew Lyu, MD, Hospitalist, Division of Medical Oncology; alyu@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.
Andrew Lyu (<a href="mailto:alyu@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">alyu@bidmc.harvard.edu</a>)
Project Team
Andrew C. Lyu
Jessica A. Zerillo
David J. Einstein
Robin Joyce
Melis Celmen
Brian Russell
Katherine Bloom
Yuri Quintana
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.
Department of Medicine
Division of Medical Oncology
Division of Hematology and Hematologic Malignancies
BIDMC Cancer Center
Division of Clinical Informatics
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
Alicanto Consult as a Clinical Tool for Virtual Tumor Boards, Asynchronous Dialogues and Referrals Across the BILH Cancer Care Network
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
Effectiveness
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/be26ada387978e266df6fd27aa9f4f25.pdf?Expires=1712793600&Signature=e3aY7zI9-LWGsS7vvlDIw9kK5mG-JmyH-QRi1g%7EE3866nupOUThUCS5qq2PcTN36ZwgmAZVBqutKJe%7ELMDBWL3YmDNWwceWvysWKKWSYUfZoT7tL1nDTfUpUpUfpAbGYDWCYclYPKZdkYgjq1iLx3Qo6uyenrtsDqGTJ547pZuur0UNsu7YMCaqsjxNjmzKALY93I3GAinxhvdoOtfbvR6akcsLS8j5K1k5WwzpqeZ53wWt3V9YQZYnTI2iR3oP%7E6lrLeFgDfN8ovu2djp3T6ujihy50sJEvEb3JXec5Rw2OEOKw0HsduWC2J4mEu6rVSEr7mj%7EC51DCI6YRB4IUtQ__&Key-Pair-Id=K6UGZS9ZTDSZM
3c6f5f0f9aaef4f2c74ff5f8136acce3
PDF Text
Text
Rolling Out Remdesivir Under EUA
By Julius Yang, MD and Jaime Levash
Beth Israel Deaconess Medical Center
Introduction/Problem
Results/Progress to Date
May 1, 2020 the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for
the emergency use of remdesivir for the treatment of hospitalized patients with severe COVID-19. EUAs
are a relatively new pathway that the FDA can utilize when there is a declared health emergency. During
the health emergency, things were moving quickly.
Aim/Goal
The goal was to understand the EUA and roll out the medication across the medical center as quickly as
possible to help save patients’ lives.
May Adra, PharmD
Michael Cocchi, MD
Mary Ifeoma Eche, PharmD
David Feinbloom, MD
Kyle Franko
Howard Gold, MD
Margaret Hayes, MD
John Hrenko, RPh
Mary LaSaliva, MD
The Team
Jaime Levash
Christopher McCoy, PharmD
Ari Moskowitz, MD
Ameeka Pannu, MD
Todd Sarge, MD
Roger Shapiro, MD
Lauge Sokol-Hessner, MD
David Sontag
Conor Stack, MD
Margaret Stephan, RPh
Kathryn Stephenson, MD
Kim Sulmonte, DNP
Daniel Taupin, MD
Cheryle Totte, RN
Julius Yang, MD
The Interventions
Created three working groups:
– An Oversight Committee has met to oversee guideline implementation, monitor drug supply, ensure
effective communication with staff and patients, and ensure adherence to ethical, regulatory, and
patient-centered best practice.
– A small Interdisciplinary Advisory Workgroup was developed a consensus allocation prioritization
guideline based on available evidence and experience regarding treatment of COVID-19 with
remdesivir.
– A Clinical Review Team met daily to review patients potentially eligible for remdesivir EUA allocation
per BIDMC guideline, and authorize release from Pharmacy for individual patients.
83% of patients treated with Remdesivir were
discharged home or still in the hospital. Only
17% of patients who agreed to treatment
expired.
Lessons Learned
Create a multidisciplinary team.
Clear communication to providers explaining the steps to communicate with their patient, order the
medication, and documentation needed.
Administration of remdesivir earlier in illness is more beneficial then later in illness.
Next Steps
The 3 workgroups dismantled. Remdesivir was approved by the FDA in early October 2020 which means no
longer a need to complete additional tracking on the amount of medication dispensed, no formal reaction
tracking to the FDA, and no prioritization amongst patients since supply was abundant.
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 (j<a href="mailto:jlevash@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">levash@bidmc.harvard.edu</a>)
Project Team
May Adra
Michael Cocchi
Mary Ifeoma Eche
David Feinbloom
Kyle Franko
Howard Gold
Margaret Hayes
John Hrenko
Mary LaSaliva
Jaime Levash
Christopher McCoy
Ari Moskowitz
Ameeka Pannu
Todd Sarge
Roger Shapiro
Lauge Sokol-Hessner
David Sontag
Conor Stack
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.
Pharmacy
Marketing and Communications
Infectious Disease
Healthcare Quality and Patient Safety
Nursing
Emergency Medicine
Anesthesia
Dublin Core
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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
Rolling Out Remdesivir Under EUA
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0fa49a0f310dd7b99d6ec818782fe93a.pdf?Expires=1712793600&Signature=WFTn7lLWnU6UulevzCkLwmCIq9tMDMecvaz1P2H1lCJnzi6EIm9LYEiayAsu1cC29cdg33a%7Ei6cJ-Oe%7EpFGIk0u14bOdGJMVchAqFq%7EaiH8ot-FPVKRh4f1lSPMyDsZeenE2LDW%7E3052mUOoSV%7EuhdXCEN0lWIWkU0NcIW1-mLr3%7ErZi-MNVl4uONEPxFXBUCNdiBxSmrGSoL60o-LqlhcPONABsqOoV29-qKJ-grYBdNI6Y1XmG1NZqeLGkrYBW9mNmCfYNSRoIJspWMNflu3dHfnEA9iqKwcu3CY4OX3yIDMQ3xE%7EtpaYejagoHewULzxUrBkWBftlU0YRJhS4Cg__&Key-Pair-Id=K6UGZS9ZTDSZM
28590d37b3dc0491bd013e2039a85384
PDF Text
Text
COVID-19 Monoclonal Antibody Therapy Implementation
By Mary LaSalvia, MD, Jaime Levash, Paula Stering, PA-C and Daniel Taupin, MD
Beth Israel Deaconess Medical Center
On November 13, 2020 the Massachusetts Department of Public Health (DPH) released a questionnaire to
determine which facilities had the capacity to treat COVID-19 positive patients in an outpatient setting.
BIDMC began preparing for an anticipated allocation of bamlivinimab (BAM) treatment. However, it was
decided implementing this treatment at BIDMC would not be feasible with uncertain drug allocation and the
challenge of bringing in COVID-19 positive patients into an ambulatory site. At the end of April, the group
moved forward with launching our ambulatory monoclonal Ab therapy clinic starting with casirivimab &
imdevimab which is under Emergency Use Authorization (EUA) by Food and Drug Administration (FDA).
Aim/Goal
The goal was to understand the rapidly-changing EUA and secure access to clinical space and resources in
order provide treatment to patients with COVID-19 who are at high risk for complications.
The Team
Jared Dore
Holly Creveling, PharmD
Kyle Franko
Howard Gold, MD
Michelle Knox, RN
Nicolas Kriketos
Mary LaSaliva, MD
Jaime Levash
Christopher McCoy, PharmD
Debra Melia, RN
Sara Montanari
Theresa Normile, RN
Margaret Stephan, RPh
Paula Stering, PA-C
Daniel Taupin, MD
Ellen Volpe
Julius Yang, MD
The Interventions
Worked with facilities to determine clinic location and ordering of equipment and supplies
Outlined a process for how the clinic would flow: referrals, documentation, scheduling, directions, and
communication with teams surrounding clinic
Outlined safety protocols in case of infusion reaction
Recruited and trained staff
Created a dashboard for team to review patients
Work with the drug shortage task force to develop a prioritization scheme
Worked with Lahey to open a second clinic to serve BILH patients
# Patients Treated
Introduction/Problem
80
70
60
50
40
30
20
10
0
Results/Progress to Date
Number of patients treated
172 patients (as of 10/27/21)
July '21
Aug '21
Sept '21
Oct '21
Lessons Learned
The multidisciplinary team learned to be flexible and pivot quickly when changes occurred with the EUA
and DPH allocation processes.
The importance of clear communication to providers explaining the steps to communicate with their
patient, order the medication, and provide necessary documentation.
The benefit and challenges of working across the network to provide equitable access to high-risk patients
across the city and state
Next Steps
Continue to expand treatment options; specifically for post-exposure prophylaxis for patients with severe
immunosuppression.
Finalize a shared electronic tracking system between Lahey and BIDMC.
COVID-19 positive test results will include information on monoclonal antibody therapy
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 j<a href="mailto:%20">levash@bidmc.harvard.edu</a>
Project Team
Jared Dore
Holly Creveling
Kyle Franko
Howard Gold
Michelle Knox
Nicolas Kriketos
Mary LaSaliva
Jaime Levash
Christopher McCoy
Debra Melia
Sara Montanari
Theresa Normile
Margaret Stephan
Paula Stering
Daniel Taupin
Ellen Volpe
Julius Yang
Margaret Stephan
Kathryn Stephenson
Kim Sulmonte
Daniel Taupin
Cheryle Totte
Julius Yang
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
COVID-19 Monoclonal Antibody Therapy Implementation
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
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ff83c850a99aee13ffa7a733f8918ddc.pdf?Expires=1712793600&Signature=do8HBM4PDHgjb5WVq7TIHCkkl%7E%7EyJmaCwpcz29won35pfmEInEKGnKcJS4lR8L%7ESBEG8ZHAGlN%7EnSd6%7EanAeHbidHxnRgFCNEnTg5I6QwyqVdvOJp1lmT5NknCCR0-uK6gpgOWF2L37su98J3muyvDoMphO9p8s9FMNEfEC8bcuP4hbBhvWh6B6S0X14vwb%7EC3hDA8gmYIC7wHhxEiFnK6q%7EvQ79o95fK46SUcTPFbaRuOnnpZe1hywNjwJd4nOXiz3RZnEBfiMYZLu7qaDAjkzSXq80wmpWiHyLHjHyhOlBoUufbHdnkWjCUqPudkjkDVtJEOGbBSzldtTopGqugA__&Key-Pair-Id=K6UGZS9ZTDSZM
97407b648f0d094740f60e3a33e0b96e
PDF Text
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
�
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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.
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
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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
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/6fb39b4bbfae13b2e30376d0129e9af5.pdf?Expires=1712793600&Signature=uDD1NNKMnCLIeNLF1PQfYfh5ylgzv80Je9-BmmQkiMGAU54FNCzpdaAbPT70rN2KaK9QtLQJFLoyEFI9DRZDsqTLs2Np2nbK6kAKSmfPtV-xNjQnBu1a90a9F80GffUVUQcjrpkbF2j1%7ECRdNDlrM6wjQAHj0og4sGWaLOQR7Up9UJExEyrr3zPUqvk9KYQ-%7EgpN8Q-SvyZzCwSYOlVE7dElELuQv435fHvIY48ktxzDvLWH4NJC%7ESPDrpzYaEBzdx7f4-8Jq2eGI9dotlgzbOcU2LaRSoc2LlqGx9rZ-64oAjqVpg8yDsaUStxuro%7E1cD6g%7EpGdAzphJLUm7Cxbwg__&Key-Pair-Id=K6UGZS9ZTDSZM
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
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/be4aacae76f5a02cbaf75135aba6da47.pdf?Expires=1712793600&Signature=MN-2G7XLoOCNbK-yD7H6UJ9ocOA8Zx0JP7dVqk7FoBRg-uSGZKf5MdL-DGMD-Mzxvdy2oUIpr6dWQUs0rCXKArhdtRSw7Z1l4pTKdBEVppR%7EcxFxM85wMTZ85hykrkebnI8WgltnmmEAS5dO85XHSId6TohcQ-GfG5JVAFbQY-7VpHKYzTX-uncy3PsWKn2RKiaOXjd-9Gs1HOedRaLZ47FNGO89TTYtSsvN7yNmeLbYUoi-Hnum7f5an%7EposAJGCk%7EANqJtGLZi-%7EWPf2TWw80kcieikWE4VU2FWVZAf3ElEKLwjgI7m2f7QTF7wTKNw8NCEKguApMVWUmmFvLSIA__&Key-Pair-Id=K6UGZS9ZTDSZM
02c8ba701cd379801c96ddcbad970895
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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/ae8ce55807183f1a5dd00c123e61dc3a.pdf?Expires=1712793600&Signature=hXFasUimCOzaCvVV11QbEUmWW801eyvJo3JApQjpV1VYbVBRkxGPgV%7Elpl-BwICjnVlIusEa5Ta7LtTEfHf55Z35mFbX4JQupdOW9-lhMzhFuQ7fZ2sFldXEAHstGbaTqFW1kyscJBhAFdfQOKQMwxME63Bqigbmd4zEEvE28yTnLViNXk6zD4AefkW-rmAV1vAJzi3iNNCK0zCUNMdBi%7E4DwpExBdtrHKFyOMqSReg7s8GNNd6Xp5TW5G9tPh3DbY2qBeZFHErvWZKWgmHmvDYzS-zg380THyix%7EA9NZ5TsituHP6jGJLtUSGlx0S2V7WhC54wu8S1-lddh9dhENg__&Key-Pair-Id=K6UGZS9ZTDSZM
b090ba29bfef97a2ac7b5dcce2071a9f
PDF Text
Text
Inpatient Rehab Services’ Response to COVID-19 Pandemic
Brigitte Greenstein, OT, OTD
Margaret Walkup, PT, DPT
Beth Israel Deaconess Medical Center
Introduction
With the onset of the COVID-19
pandemic, the rehabilitation services
team had to adapt to the changes in
patient caseload, visitor policy, and
infectious disease guidelines. This
poster aims to describe the process
changes and outcomes that the rehab
department implemented during the
pandemic.
The motivations for our process
changes included:
- Minimizing the risk of transmission to
ourselves, families, coworkers, patients
- Maintaining a high standard of patient
care
- Maintaining a supportive atmosphere
to reduce burn out amongst our
colleagues
- Learning about COVID-19, how it
spreads, and the long term effects on
function and cognition
- Patient preference for discharge home
over discharge to rehab given the higher
COVID-19 infection risk
Process Changes
Minimizing risk of transmission:
- Implementation of staggered start times
- Creation of a virtual huddle board
- Day neutral staffing split into two teams
- Identification of COVID OT/PT
- Purchase of portable stair for in-room use
- Creation of patient fact sheets about energy conservation,
staying active while in the hospital, and PICS
- Minimized 1:1 time with patients by calling into their rooms to
schedule visits and obtain social history
- Bundling tasks to reduce need for other care providers to enter room
Clinical resources:
- Team leaders summarized up to date literature about COVID-19 and implications
for rehab
- Clinical guidelines were developed to assist with decision making regarding timing
of OT/PT interventions
- Weekly case discussions to debrief and educate
- Redeployed per diem and outpatient staff
- Safe Patient Handling team’s role in proning team
- Disaster documentation
Discharge planning:
- Use of technology to facilitate family trainings during periods of limited visitation
- Assisted in identifying candidates for transfer to NEBH and Boston Hope to
facilitate discharge and throughput
- Increased the frequency of OT/PT visits to promote d/c home rather than rehab
when able
Staff comradery:
- Created homeward bound board as a visual representation of patients that rehab
services helped discharge home
- Created a pool of therapists to rotate in COVID units
- Runner shifts to support nursing staff
- Wellness rounds, including group yoga
Outcomes
- Continued use of virtual huddle board
- Development of COVID-19 Rehab
Intranet that includes fact sheets and up
to date clinical information
- Ongoing use of the portable stair
- Streamlined documentation
Conclusion
Rehab Services was able to adapt to
patient specific needs during the
COVID-19 pandemic, while maintaining
quality care, that continue to be utilized
to this day.
In the event of another pandemic,
Rehab Services now has structures in
place to improve communication with
patients, families, and staff, while
keeping transmission risk low.
Acknowledgements
We would like to thank all of our rehab
colleagues who worked tirelessly
throughout the pandemic to provide
quality patient 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
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.
Margaret Walkup (<a href="mailto:mwalkup@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mwalkup@bidmc.harvard.edu</a>)
Project Team
Brigitte Greenstein
Margaret Walkup
Department
Any departments listed on the poster or identified in the spreadsheet.
Inpatient Rehabilitation Services
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
Inpatient Rehab Services’ Response to COVID-19 Pandemic
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
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5cddf11d65df7bd8a0122d52ac48e7db.pdf?Expires=1712793600&Signature=RXKNqJa2ztI03ENJSeNaMZUjSTKiJoualVS4KuPLddkR6JdUAZ80C7K7ipdic4VvrKWoowSky5L4B49jIOV8Cul%7EZDFaTqAcCAvJdqgtIDzX3Miw0ur9nXLvIF81FmhzvYTy543d2GeiaEsdhDOWwsoOehvi-FYJ6ouvEZ-AMfpOZgLuGltreRV7XeQiXekkqB1lJ4gYQwege1rm3d938xZJNS5uXv40UIS4wqB0B14noLX3OvOI2Yd0Hts7scmFkoyq1zO1fnkmta1Ztb7wKNCroSUreWJv-FSu3Yy4bdF%7EyQ4Ksqrnq8vMl7JxZIDEMsBPoCTQciLqQdnxfaWiTw__&Key-Pair-Id=K6UGZS9ZTDSZM
5f348c840976e5bc84f853f4a8c94461
PDF Text
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
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.
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/2933ab53c63567380ca632fe78ec98d7.pdf?Expires=1712793600&Signature=lZv%7EP-ixmzqvMfI%7EVU34pNkiX%7EOrsuqOOUNeQnYQmHQQNTkNM0EmO%7EwLQ7SOx-WTnPSiS2Ny55foKjB5LMEpYl9-VkewpAKH-okjxZZNoAUqC7Ba7R9DlK0br7nH8Vn8ZI1n28et6uJ-sEOrOjwlQVrkcFWpXuwMj%7EP0RS%7E89mnZH7fg7SUTBfztCwHNRgdJBG7EGDat7sfpNTq9wQgxd7I78YM0gdh0a6LKvcN8gUW4wns-DmRefkEtDcuMIWBLqnqwHBZ5xbzDXQtIVnU7bCyJqR%7Eg-eqUMYGerh0ckBt85YNm%7E9LA1ib8ErHFkFZK7Lc92ZmUbbXg7dlXMnvGCA__&Key-Pair-Id=K6UGZS9ZTDSZM
45ef80f097b8059c0c2de939ba683ca6
PDF Text
Text
Multidisciplinary approach to increasing vaccination rates of
patients starting immunosuppressive therapies
Ruby Gibson, MD, Min Ji Her, PharmD, Monica Mahoney, PharmD, Diana Kim, BS, Paula Stering, PA, Simi
Padival, MD, Martina Porter, MD, Daniel Taupin, MD
Introduction
•
Patients on immunosuppressive medications are
at a higher risk for infection. Dermatology
frequently
prescribes
immunosuppressive
medications and found a need to ensure patients
are appropriately screened and have up-to-date
vaccinations.
Objective
•
Increase the vaccination rates and appropriate
infectious disease screening of patients starting
immunosuppressive medication through the PreImmunosuppressive Clinic.
Methods
•
•
•
•
Through a multidisciplinary approach, a PreImmunosuppression Clinic was created. The clinic
is through infectious disease (ID)
and is
specifically dedicated to patients starting
immunosuppressive medications. We created
consensus immunization and screening guidelines
prior to starting immunosuppression.
We educated dermatology and infectious disease
physicians, pharmacy staff, and administration on
the workflow process (Figure 1).
A retrospective chart review was conducted from
June –September 2021 for dermatologic patients
starting immunosuppressive medications. We
reviewed referrals, successful follow-ups in the
Pre-Immunosuppression Clinic, and
vaccines/labs ordered by ID.
This chart review was approved by our internal Committee for Clinical
Investigations (CCI)/IRB
Dermatology visitplan includes
starting
immunosuppressive
medication
Infectious disease
(ID) administration
schedules
appointment
Dermatology orders
screening labs.
Prior authorization
process begins (if
needed)
Dermatology
pharmacist informs
patient about PreImmunosuppression
Clinic.
PreImmunosuppression
Clinic appointment
with ID
ID pharmacist
updates
vaccination
history
Results
Dermatology
places referral
ID orders
vaccines or
screening labs
as needed
ID Note
forwarded to
referring
dermatologist
•
Of the patients referred to the PreImmunosuppression Clinic, 63% went to the clinic.
•
100% of the patients seen in the clinic were due
for at least one vaccination per our consensus
guidelines. All patients seen in the clinic received
at least one vaccine dose.
•
Several patients received additional screening
labs after going to the Pre-Immunosuppression
Clinic depending on individual risk factors.
Common labs ordered included HIV antibodies,
Hepatitis A antibodies, Hepatitis B viral loads,
purified protein derivative (PPD)/ repeat Interferon
gamma release assay (IGRAs).
•
Several patients had already started their
immunosuppressive medication before seeing ID.
Figure 1. The referral process workflow for patient evaluation at the Pre-Immunosuppression Clinic
Immunosuppressive n
medications
Results
n
Patients starting
immunosuppression
64
Patients referred to ID
32 (50%)
Patients went to PreImmunosuppression Clinic
20 (63%)
Patients that received
vaccinations
20(100%)
Average age of patients who
went to ID
44.2
Average number of days that ID
visit occurred after referral
placed
12.75
Adalimumab
Risankizumab
Methotrexate
Ustekinumab
Mycophenolate
Secukinumab
Cyclosporine
Upadacitinib
26
12
7
6
6
5
1
1
Vaccines
received/planned
PCV13/PPSV23
Shingrix
Hepatitis B
Hepatitis A
Tdap
HPV
MMR
COVID-19 booster
Influenza
n
17
9
5
5
4
2
1
1
1
Discussion
•
The Pre-Immunosuppression Clinic has the
potential to increase vaccination rates.
•
There were additional recommendations and
screening/monitoring labs ordered for patients
based on risk factors or results from initial
screening labs ordered by referring dermatologist
•
Patients were seen in the PreImmunosuppression Clinic soon after the referral
was placed. Referral process and attending the
clinic did not delay the initiation of
immunosuppressive treatment.
•
Future directions include informing and involving
other specialties
�
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.
Ruby Gibson <a href="mailto:%20">rgibson1@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
Ruby Gibson
Min Ji Her
Monica Mahoney
Diana Kim
Paula Stering
Simi Padival
Martina Porter
Daniel Taupin
Department
Any departments listed on the poster or identified in the spreadsheet.
Dermatology
Infectious Disease
Pharmacy
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
Multidisciplinary Approach to Increasing Vaccination Rates of Patients Starting Immunosuppressive Therapies
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
Effectiveness
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3c05e28c8a48c9d043a6beb0b657428c.pdf?Expires=1712793600&Signature=ZWuvnpeZCPZz2sMBRFgYQbpOBhyOH7cTN8aQ5-NJfKhGoLggElS5HzGswEVIrwcXaWLpcSKyJ68JFSClDG4T66RSALNygyxGwvTt%7ED8Hq2-H-8ADuPZiO3M6w8LydI36e%7E7p0KGPW4AApWM340QjzF8%7EXs4R1MVeN%7EN3Q5OdX44IlzCGzIO-UsbyGf7LtDNe1xbj8RFLKO%7E7wEqiGotsy8d70FqHdlk15TeIOyUQKMH4V8K2Sp3Yz5CoTelXsFTg22v4nKpbbsw32g-z06DxCtbmi4cPAsU4HVKvJ-KG7hOqQR3RdEkeixUl2ODsycqWEtSLjGp4bLR4g3K9QfJS7Q__&Key-Pair-Id=K6UGZS9ZTDSZM
160d0cbb38578f96aad28cfcf604f518
PDF Text
Text
Spreading the Word
Linguistic Access in COVID-19 Vaccination Communications
Leonor Fernández,¹² Jonathan Blair,² Marian Dezelan,² Tenzin Dechen,¹ Shari Gold-Gomez¹, Larry Markson¹,
Introduction Peter Shorett,² Sharon Wright,¹² Jennifer Stevens¹ ¹BIDMC ²BILH (Depts of Medicine, Strategy, Mar/Communications, Interpreter Services, Clinical Information
Ashley O'Donoghue,¹
Systems, Strategy, Infection Prevention, Center for Healthcare Delivery Sciences) CONTACT: Leonor Fernández, lfernan1@bidmc.harvard.eduCCONTACT: Leonor Fernandez lfernan1@bidmc.harvard.eduONTACT:
Results and Lessons
This project improved BILH system-level communications
language access by creating and resourcing a standardized
translation process for mass communications. Our
approach mitigated language and ethnicity-based
disparities, but some persisted.
Background In early 2021,
BILH was charged with delivering
COVID-19 Vaccination to its patients. Health equity
is paramount when delivering potentially life-saving
interventions. 7.5% of patients at BILH and over
15% at BIDMC have limited English.
Goal To decrease anticipated disparities in rates
of COVID-19 vaccination experienced by patients
with limited English proficiency. As part of a
broader vaccination equity strategy, we sought to
create an intentional language access strategy
that prioritizes prompt translation and strategic
dissemination of meaningful messages to patients
with limited English.
Conceptual Approach
• To “speak the language of patients,” we need
to use accessible words and appeal to
commonly held values.
• Professional translations can be improved by
input of bilingual, culturally concordant
clinicians, patients, and community dialogue.
Methods and Interventions
• We used Arcadia to integrate language data fields across hospitals and refined
language groupings to improve REAL (Race, Ethnicity, Ancestry and
Language) data.
• We identified the most prevalent patient languages at BILH after English. We
compared our list of “target” languages to census data and to other health
organizations.
• We tracked vaccinations by language throughout the Jan-June campaign.
• We established new processes for prompt translation of BILH patient..
communications, including emails to all patients, in 6 languages.
• BIDMC Interpreter Services recorded outgoing calls in the top 10 BILH
languages 24—48 hour turnaround
• BILH and BIDMC staff made live outreach calls in Spanish, Chinese and Cape
Verdean, led by BIDMC Bowdoin Health Center, BIDMC Chelsea, and BILH
Call Center.
• BILH Call center had no bilingual staff. We added temporary Spanish and
Chinese-speaking part-time staff, to supplement 3-way interpretation services.
• Further work is needed to improve language access
throughout care continuum, including call centers and
appointments.
• Analysis of REAL data revealed common knowledge
gaps that reduced our ability to identify patient language
reliably, e.g., Creole languages were frequently
misclassified.
• Granularity matters: populations with limited English are
heterogenous and face differing structural barriers to
care.
• Translations are more effective if the original English is
also written clearly at 7th grade literacy level.
• Digital inclusion strategies are key for linguistic
minorities who may lack digital access. SMS reaches
more diverse patients than email alone, but needs to be
complemented by phone, in person and communitybased outreach.
�
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.
Leonor Fernández (<a href="mailto:lfernan1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">lfernan1@bidmc.harvard.edu</a>)
Project Team
Leonor Fernández
Jonathan Blair
Marian Dezelan
Tenzin Dechen
Shari Gold-Gomez
Larry Markson
Ashley O'Donoghue
Peter Shorett
Sharon Wright
Jennifer Stevens
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.
Medicine
Marketing and Communications
Interpreter Services
Clinical Information Systems
Strategy
Infection Prevention
Center for Healthcare Delivery Sciences
Dublin Core
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Title
A name given to the resource
Spreading the Word: Linguistic Access in COVID-19 Vaccination Communications
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
Effectiveness
Equality
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/dd4cfad7180c989d8824f4d0d4224735.pdf?Expires=1712793600&Signature=XmI4YGpn8-L%7EMTz1HjbslQ6gSvu041YZu8uDy9hDw%7EHYNpuoYzFqPO61KZS729gcpxkV4d1ObSLH8yQPwfguaqSUvE3PHuF1CNHXhDaLt5gB9Vb0lacn8ZXhoAi80ouOL1HOBxlcUphdzVni87prJa%7EN43xewlshomyDplghi0QyNIX7lNqt2fIkAOraw-gimr5uMOMdQKNYZZmuy-4f46nJKSSVaurAACbsm3jisXGQ03dmlWJI0Yr83Z4CUYaiFD58%7EjzpRln9qHEnEVTSC7gt9e57xQkCQDPdS01eR54-pJOSn9SVx2Pc-qhodjNEMEZ-R5RiPO%7ELKGXo8f2pmg__&Key-Pair-Id=K6UGZS9ZTDSZM
5c12d6245489467456029a8403cb8060
PDF Text
Text
Research Administration Quick Response to Remote Work Improves Collaborations with Principal Investigators
Allisson Dugan, Beth Doiron, Jennifer Sabbagh
BIDMC
Introduction/Problem
With little lead time to prepare, Research Administration needed to move quickly to figure out how to
continue work collaborations without a loss in productivity.
Research Administration was following the telecommuting for disaster response guidelines that were
implemented by BIDMC, and most of our staff was not accustomed to working remotely. We needed to
do this with limited tools and training and still be able to provide the same level of service to the PIs that
was standard while we were all on site.
Prior to COVID a majority of our workforce was fully on site or occasionally working from home on an adhoc basis. When faced with the prospect of working remotely, the RA’s rose to the occasion and
transitioned to remote work quickly and smoothly.
The Interventions
Directors notified their teams to start remote work the following week;
–
–
Evaluated what equipment could be brought home
Reviewed what resources individuals had at home
RAs adapted to phone call and video meetings opposed to in person;
RAs and PIs embraced the flexibility of remote work and learned how to communicate effectively through
video meetings;
We continue to evaluate the long term prospect of being fully or hybrid remote to reduce physical space on
campus, improve work/life balance and reduce our rate of turnover
Results/Progress to Date
Aim/Goal
The goal was to move to remote work without negatively impacting our work product and our
commitment to serving our customers (PIs.) We did not have a set timeline to achieve this goal, it was
essentially as soon as possible.
The Team
Allisson Dugan, RAD, R&AA
Beth Doiron, RAD, R&AA
Jennifer Sabbagh, Sr. RAD, R&AA
Collaborating with all Research Administrators and Principal Investigators across BIDMC
The Pie charts are showing that the majority of RA’s feel like the pandemic has increased communication with PIs and had
a positive impact on their working relationships. The bar graphs show that zoom meetings are the preferred method of
meeting effectively with PIs and that the ability to work remotely has had a positive impact on our staff.
For more information, contact:
Allisson Dugan, Research Admin Director, adugan1@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.
Allisson Dugan (<a href="mailto:adugan1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">adugan1@bidmc.harvard.edu</a>)
Project Team
Allisson Dugan
Beth Doiron
Jennifer Sabbagh
Department
Any departments listed on the poster or identified in the spreadsheet.
Research Administration
Principal Investigators
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
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Title
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Research Administration Quick Response to Remote Work Improves Collaborations with Principal Investigators
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
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pdf
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5551ffcb171537e72bd9755b50008519.pdf?Expires=1712793600&Signature=nu6kGOiLQSIgD5M6-o0Nh%7E3iMj6TVwSHZOeqYa-9LnkVDO9N1AL86lLTCpMo8Cw963VCUMQH8QhdgYI%7EU6dnypus9Dh7vE2-gW3NN%7EqGNd2dvLLyLfqTOfJzRdNd%7ESUr2Zzo8kiTOF2PAvVIMHlPXFwMhyWxiyBUeI6H1duz8Lyu0Vbo4rEGOfYf0FqvqXpUti9ptqe7VuXKhKTBU8UywEO-KoHFkYjZw308n8-VWtIOY1tbPW31tvQJjwCBUh9AIzr0zXV3zAYGodNndnkndytHN8xOfgxRvtsQFSudXKVbrl85RladZApxlfShH%7EgEZomGNSwLjzuD49jjpf2XSQ__&Key-Pair-Id=K6UGZS9ZTDSZM
df4c26a0f4a2e81a54b01bc6f0f68801
PDF Text
Text
Transferring patients back to community hospitals during the COVID-19 pandemic
Lauren Doctoroff, MD, MBA; Tracy Lee, RN, DNP; Sandra Sanchez, RN; Alicia Clark, MD;
Afrin Farooq, MD; Molly Hayes, MD; Jordan Ellis
Introduction/Problem
The BIDMC is the flagship tertiary care center in the BILH network, and operates at or close to full
capacity during normal times. During the COVID-19 surge, it was imperative to keep beds open for high
acuity medical and surgical patients. We needed to develop a process to return patients to community
hospitals when they no longer need tertiary care.
Aim/Goal
The Interventions
Ø Market Research:
• Focus groups with patients, survey to physicians, meetings with hospital leadership
Ø Community Hospital Engagement:
• BIDMC hospital leadership met with community hospital leadership to set expectations for return
transfers
Ø Process Development:
• IT: Developed new reports to standardize identification of patients
• MD leadership engagement: Collaborated with medical directors to create standard process to identify
patients through regular distribution of community hospital patient list
• Standard language: Developed standard language for MDs to use when having conversations with
patients and families about return transfers
• Standard process: Created standard process for identification and patient agreement prior to sending
potential transfer to admissions facilitators to reduce rework
Results/Progress to Date
The project aim was to create a standardized process to identify and easily transfer patients back to
community hospitals. The goal was 5 successful community hospital transfers/week.
The Team
Ø Lauren Doctoroff, MD, MBA- Medical Director,
Center & Bed Placement
Case Management, Project Lead
Ø Afrin Farooq, MD – Hospitalist, BI Milton
Ø Tracy Lee, RN, DNP- Senior Nurse Director,
Ø Margaret Hayes, MD- Medical Director, MICU
Case Management
Ø Jordan Ellis- QI Project Manager
Ø Sandra Sanchez, RN- Nurse Director, Transfer
Center & Bed Placement
Ø Alicia Clark, MD- Medical Director, Transfer
Lessons Learned
Ø
Ø
Ø
Needed to engage community hospitals early
Patient identification early in hospitalization is most important factor
Community hospital capacity limited growth of program
The above graph shows the community hospital referrals to the transfer center versus the accepted
community hospital transfers. We consistently get 3-5 community referrals weekly as this work continues.
For more information, contact:
Lauren Doctoroff, MD
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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.
Lauren Doctoroff (<a href="mailto:ldoctoro@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ldoctoro@bidmc.harvard.edu</a>)
Project Team
Lauren Doctoroff
Tracy Lee
Sandra Sanchez
Alicia Clark
Afrin Farooq
Molly Hayes
Jordan Ellis
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID-Milton
Department
Any departments listed on the poster or identified in the spreadsheet.
Case Management
Transfer Center & Bed Placement
Medical Intensive Care Unit
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
Transferring Patients Back to Community Hospitals During the COVID-19 Pandemic
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
Effectiveness
Efficiency
Safety
Timeliness