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70e35aec7b5441c4d5a480e335ee48b0
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A Post-Acute Care Transition (PACT) Program: Targeting 30-Day Readmissions
Beth Israel Deaconess Medical Center, Boston MA
The Problem
The Results/Progress to Date
Avoidable 30-day readmissions represent unfavorable health outcomes for patients and
are now associated with significant financial penalties for hospitals.
• Our hospital’s readmission rate was too high.
• Care transitions post-hospitalization were fragmented and confusing for patients.
• Changes were needed to smooth care transitions for patients across all diagnoses in
order to improve outcomes and avoid costly readmissions.
We have achieved a significant reduction in 30-day all-cause readmissions over the
first 12-months of the three-year demonstration project.
Aim/Goal
To improve patient outcomes and prevent avoidable cost in the high-risk 30-day period
following acute care hospitalization.
The Interventions
• Program deploys a nurse and a pharmacist to visit newly admitted patients and to
provide 30 days of telephone support following discharge.
• 2011-12 pilot achieved a 20% reduction in readmission rate for the targeted
population and led to an expanded program with $4.9 million funding from the
Center for Medicare and Medicaid Innovation.
• Innovative staffing model employs 10 nurses and 5 pharmacists who are each paired
with one of six primary care practices, facilitating collaborative relationships with
primary providers.
• PACT clinicians visit patients from their assigned practices who have been
hospitalized and facilitate all aspects of post-discharge care according to patient needs:
ensuring medication compliance, facilitating in-home and outpatient support,
communicating with primary care team, helping to ensure patient gets to follow-up
appointments, and more.
Lessons Learned
• Intensive care management takes time but yields results.
• Inpatient nurses have been well suited to the PACT role, being familiar with
acute care needs of newly discharged patients.
• Aligning care transition staff with particular practices enhances communication
but creates variation in caseload for PACT staff.
• Having PACT team members sit in an open space facilitates cross-fertilization
of ideas and sharing of information on community resources.
• Patients at home will almost always respond they are “doing fine.” PACT nurses
have learned to unpack “fine” and assess how the patient is really doing.
Next Steps
•
•
•
•
Continue to refine systems throughout the demonstration period.
Enhance relationships with post-acute care facilities and home care organizations.
Refine metrics to measure effects of particular interventions.
Identify populations that benefit most from PACT services.
Team
Julius Yang MD
Lauren Doctoroff MD
Sarah Moravick MBA
Norma Wells RN
May Adra PharmD
PACT Nurses and Pharmacists
�
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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.
Norma Wells (<a href="mailto:nwells@bidmc.harvard.edu">nwells@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Julius Yang
Lauren Doctoroff
Sarah Moravick
Norma Wells
May Adra
PACT Nurses and Pharmacists
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Title
A name given to the resource
A Post-Acute Care Transition (PACT) Program: Targeting 30-Day Readmissions
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ebaeedf43d8d81d5f469a9e96f1107b.pdf?Expires=1712793600&Signature=t3aPJHRxADbjhkkSidkCAjtz3hEzfu2HhB33uR%7EiPcxJ5mtVEBe0GZ%7E7ay3YOtFjLuXVW24KFbp2OhFe%7E6P3NdPYTmxG0yKdCNnCV2D26GR88uDzK3Y6yaS1DvR3RznsEmaFEvpHCpQIPEUaDNKTDowEp-GrOoVGjSY3To8wTZBK5D3YJMIEQDVm%7ElxONVf5VtXH3IZoUjsHr363kCaj5m2Vzq6Sgm6u0C%7EQT-tyxqVrY6Vkj%7ES3SUxHU64NO%7EZyQbwu6p4qPazeGHe2oaf3KofR0EHobwwsocu8OagNv60XF8Pb8vGlzSrymh8dPoj2i7JkK6SD4kt6ALHYpzBLuw__&Key-Pair-Id=K6UGZS9ZTDSZM
5967d3a93da7129834614d6252f717e1
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Add‐On Team
A Faculty Hour Team
IV. Solution
I. Background
Unscheduled cases that unexpectedly require surgery and must be added on to the OR schedule represent both a high priority and a
dilemma to the OR care team. How should cases of varying levels of urgency and emergency be classified and handled while continuing
to provide optimal care to all surgical patients? How can the needs of urgent, complex surgical patients be met, particularly when
resources are constrained on nights and weekends? How can a communication system be instituted to serve all team members in a
timely and reliable way? This team will benchmark other institutions that have re‐designed perioperative flow and test best ways to
improve access, safety, and efficiency as well as clinician satisfaction regarding add‐on cases at BIDMC.
GOALS:
1. Develop and implement a priority‐based system to define the order of cases. Concerns include:
• When booked?
• Urgency?
2. Make resources evident and ensure that they are communicated early
3. Optimize matching of resources and expectations
4. Improve the communication system between the anesthesia floor manager, front desk, surgeon and resident
Project Team
Mary Austin
Seema Chowdhury, MD
Jane Cody
Jonathan Critchlow, MD
Alok Gupta, MD (Co‐Leader)
Stephanie Jones, MD
Pete Panzica, MD
Beth Person (Co‐Leader)
Verna Rettagliati
Edward Rodriguez, MD
Dottie Sarno
Ross Simon (Facilitator)
Jason Wakakuwa, MD (Co‐leader)
Sponsor: Richard Whyte, MD
II. Current Condition
III. Analysis
For More Information Contact
Alok Gupta, MD agupta4@bidmc.harvard.edu
Beth Person, bperson@bidmc.harvard.edu
Jason Wakakuwa, MD jwakakuw@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jason Wakakuwa (<a href="mailto:jwakakuw@bidmc.harvard.edu">jwakakuw@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Anesthesia
Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mary Austin
Alok Gupta
Verna Rettagliati
Jason Wakakuwa
Seema Chowdhury
Stephanie Jones
Edward Rodriguez
Jane Cody Pete Panzica
Dottie Sarno
Jonathan Critchlow
Beth Person
Ross Simon
Richard Whyte
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Title
A name given to the resource
Add-On Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e403b445d8f9689a876bb75d524e391d.pdf?Expires=1712793600&Signature=DSiRhkXdmi2BJqex2ACTd82oqjGmW4pF3eH5z7vnD8XRmcVgsFuGLACf2GX5SQddC8d85m9LHMCfpbPGjaZVilR1FHL9-RVoshHBJ3dRlVQml%7EjZsGu4TSSbbklSka-zg85b0eCUnSCxl0YuwZP12CvQgBP%7Es9SLHFTXz0ygkHZ-8yY0Rxi5vDxktO8sj1OMFzfLbSDIQC4HU4QSdgjFFeKqTW9jp-Rs6sxFD7OLhUpgW5h5G4e7Xkfe-icFmDLpS7g2JLarQdVDrmudAj-kw%7EvJKI-WCLnRWOsJGaMz59VGqWk1QeCIKWBeYhWIlsKNOBHJxRtRFNugn-d9FJEARQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ffd7c8a8b1cb6c32358140b53cfef35c
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Text
Advantages of Programming and Implementing an
Internally Developed NICU/Newborn Nursery cPOE
AIM
Beth Israel Deaconess Medical Center
Boston, Massachusetts
RESULTS: cPOE DEVELOPMENT
To develop a Computerized Provider Order Entry
(cPOE) program that mimics the order sets and
forms that were currently being used in the NICU
and Newborn Nurseries.
Original Paper PN Order Form
NICU Daily Orders Entry Screen
cPOE PN Order Form
SETTING
48 bed Level III NICU, Academic Medical Center
Approximately 5,000 deliveries per year
METHODS
IMPLEMENTATION
The team began meeting in June, 2008.
The neonatal formulary weight based dosages
were programmed into cPOE using the existing
renal dosing for adults.
Clinicians worked directly with our medical center
programmers to develop a user friendly cPOE
with good work flow.
The internally developed cPOE programming allowed customization
to include:
a scrolling view of all active orders
the ability for clinicians to make changes and enter new orders
while scrolling through active orders
a total fluid goal bar created by all parenteral and enteral orders
display of birth weight and weight from last 3 days
The cPOE went live in our NICU and Newborn
nurseries on November 29, 2011.
ASSESSMENT
To assess one measure of impact of the cPOE
implementation, we reviewed orders for
parenteral nutrition entry for 3-month periods
prior to and after cPOE launch. Parenteral
nutrition is the most complicated platform within
cPOE. Orders were reviewed for number
requiring revision after pharmacy review.
RESULTS: cPOE ASSESSMENT
Order Revisions Pre- and Post- cPOE
To assess staff satisfaction, a survey was sent to
NICU clinicians in September 2013.
TEAM
Chair: Susan Young CNS
LESSONS LEARNED
Survey of NICU Staff cPOE Users
• Following implementation of cPOE, more pharmacy interventions
were seen with PN orders than with paper order entry.
Babies on PN vs. PN orders with interventions
80.00%
• Developing a PN order for cPOE that could do calculations and
osmolarity checking proved to be a challenge. The paper form was
more time consuming, but communicated changes more clearly
than the cPOE PN order.
70.00%
60.00%
50.00%
Clinical Systems: Laura Ritter-Cox, Mary Biagiotti
40.00%
Dietitian: Claire Shoaie
% Babies on PN
30.00%
% PN orders with
interventions
10.00%
ry
br
ua
Fe
ar
y
nu
ec
e
D
Zinc
2
2
Selenium
Error Subtype
4
Fluids
2
5
• Keep paper orders updated with cPOE format in case there is a
computer downtime.
Potassium
2
L-cysteine
11
Total fluid goal
23
1
PTE
2
2
• Continue to update cPOE to maintain patient safety and reflect
clinical practice changes.
Protein adjustment
PN rate
8
0
• Add a feature to the cPOE PN order entry so that additives that are
held are highlighted rather than deleted.
Fat Emulsion
5
Enteral intake
10
15
n
CORRESPONDING AUTHOR:
Greg Dumas, RPh
gdumas@bidmc.harvard.edu
NEXT STEPS
1
Programmers: Kevin Afonso, Jeanne Hurley, Nan
Zullo
Respiratory Therapist: Nina Koyama
• It is important to retest all aspects of cPOE when it is launched to
insure that the functionality in Test is transferred to Live.
Overall Error Subtypes
Pathology: Gina McCormack
Pharmacy Interns: Jessica Baron, Lauren Escobar
Ja
m
m
ov
e
N
RNs: Radka Arnold, Janine Caruso, Jane
Smallcomb, Deirdre Wooley
Pharmacy Information Systems: Steve Maynard
be
r
er
ob
r
m
be
Se
pt
e
be
r
0.00%
NPs/PA: Aimee Madden, Mary Ann Ouellette,
Mary Quinn, Laura Tannenbaum
Pharmacists: May Adra, Holly Creveling, Greg
Dumas, Christine Huynh, Rena Lithotomos
• Additives held for clinical issues were crossed out on the paper
form making the change visible. With cPOE, the additive is deleted
from the printed form which resulted in ordering and
compounding errors.
20.00%
O
ct
MDs: Munish Gupta, Stephanie Hale, Camilia
Martin, DeWayne Pursley, Vincent Smith
• Internally developed cPOE programs allow clinicians to work
closely with programmers to reflect established clinical processes.
20
25
Dextrose
Calcium, Phoshate
Number of responding clinicians
110 clinicians responded to the survey and 81% felt satisfied with cPOE.
• Continue to evaluate cPOE to insure that it accommodates order
entry for infrequent clinical occurrences.
�
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.
Greg Dumas (<a href="mailto:gdumas@bidmc.harvard.edu">gdumas@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Clinical Systems
Nutrition Services
Neonatology
Newborn Nursery
Nursing
Pathology
Pharmacy
Information Systems
Respiratory Therapy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Susan Young
Laura Ritter-Cox
Mary Biagiotti
Claire Shoaie
Munish Gupta
Stephanie Hale
CamiliaMartin
DeWayne Pursley
Vincent Smith
Aimee Madden
Mary Ann Ouellette
Mary Quinn
Laura Tannenbaum
Radka Arnold
Janine Caruso
Jane Smallcomb
Deirdre Wooley
Gina McCormack
May Adra
Holly Creveling
Greg Dumas
Christine Huynh
Rena Lithotomos
Steve Maynard
Jessica Baron
Lauren Escobar
Kevin Afonso
Jeanne Hurley
Nan Zullo
Nina Koyama
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
Advantages of Programming and Implementing an Internally Developed NICU / Newborn Nursery cPOE
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e2bf631139624a9873da23e0632853a9.pdf?Expires=1712793600&Signature=AL-cNt0qZs-nlzCe2TSSKgQikLKtrxdqPYsCPSA-Sh0eI7rxGBKw-80k4izC3UcnlVnrNq1VJ6epJRNhxGt1Nqr2ZI5TUBdem9GyAJMMwhAW1i3f-E%7E4cp0P2KX9ZbP%7EWl23MiGu-t%7EHIkv57lpHmyELyExsygGPQOoym-xP2TCvuiSL6QrvHb1mcBTxsfvT1Vdb--Ed-H9yjZLS1gdYdaqclEoVjJKGq4it%7EY-qGu7J%7EYbg4OXfe07OI6I0bnS8u6Ol3Mn9HzNBoCBJZCjoYYAWzPRmb1vGdQCTBoBOsFXVta86nvH4H-0eqbQD22IpTGcfODTUs2b7MFUMKo3row__&Key-Pair-Id=K6UGZS9ZTDSZM
136cb5e4c1746321c55e11cddb65d5af
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Text
Answering the Call….(Bell)
The Problem
During the 2013 TJC visit the access to nurse call systems for patients in the hallways
of the emergency department was seen as vulnerability. A patient in a hall bed may
have direct line of sight of the nursing station however there must be a mechanism for
the patient to summon help without the use of their voice.
Aim/Goal
To identify and deploy a reliable system to allow patients to summon help without the
need to install a high cost wired system or to deploy a low tech solution such as
physical bells which in an emergency department could be lost or used as a weapon.
The Team
Daniel Nadworny, RN BSN – ED
Shelley Calder RN, MSN – ED
Bernita Krueger LICSW - ED
Jane Dufresne , RN, BSN- ED
Pam Dicapua – Clinical Engineering
ED Staff ( Patient information, nurses and techs)
The Results/Progress to Date
The Interventions
The ED leadership team met to discuss options for corrective action:
Discontinue Hallway beds
o Would have negative impacts to flow of the unit with 20-25 hallway
spaces used each day
o High workload to assure compliance
Place small bell at each location
o Low cost for installation but high risk of loss
o May be hard to hear or determine location
o Audit process would be difficult
Wireless systems
o Higher cost but leverages current IT solution in place
o Audit process could be automated
o Required staff education on new system
The ED team working with Clinical Engineering, IT and our vendor we able to deploy
an adaption of our RFID tags to work as a call system. This was paired with a
desktop system at the main desk to alert staff of a patient need.
Lessons Learned
•
•
•
Staff had larger learning curve for use than expected
No patient notification that the alarm was recognized
Online log in issues occurred throughout the process
Next Steps/What Should Happen Next
Aeroscout and mobileview shown as proof of concept but hard wired
nurse call system preferred
System could be used as back for a nurse call system
Address challenges that may have impeded successful achievement of
the improvement goals.
For more information, contact:
Daniel Nadworny, RN BSN dnadworn@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.
Daniel Nadwonry (<a href="mailto:dnadworn@bidmc.harvard.edu">dnadworn@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Emergency Department
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Daniel Nadworny
Shelley Calder
Bernita Krueger
Jane Dufresne
Pam Dicapua
ED Staff ( Patient information, nurses and techs)
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Title
A name given to the resource
Answering the Call...(Bell)
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/8248231dd6d1f9b09ab3360bf9688e10.pdf?Expires=1712793600&Signature=j-3eYFO5zSdscxrMYofJTPcdkAThQ-aN0BmTz44cau9xJz-iGlBD8Ji0-De2mKSg1U2Yct2cakSOy27ANN21MkcABEjVr9eqXlQ6VGr5DeNegqixEQaDUjN6gzEe2oTAe1tM0OoytUpUQa3WezEiaXJ6TIl1FXh45mUhwFYfpcEFUMS0G8ns%7E6ZWdM0dcugQ6nBQQF44h3Zg3aiUB%7EKgLHtSOf3zxJx4mCFTX6EGKAgu62GSzThRI489ytRCgSmScFdqU0cXiQWwA6-4dhTB7e%7EsmVfcygIXJp8VVhqzGwjFljm4B9vCZUgRwO047hMTP%7EcMR6e2L9C7ao5AvNzebg__&Key-Pair-Id=K6UGZS9ZTDSZM
b950c7287e882aa4ea58bb16aea20f3b
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Text
Anticoagulation for Patients with Known or Suspected Heparin
Induced Thrombocytopenia During Cardiac Surgery
The Problem
The Results/Progress to Date
Completion of literature review
Multi-disciplinary meeting between cardiac anesthesia and perfusion completed
Institutional standard for bivalirudin concentrations obtained
Preliminary protocols established as follows:
On-Pump Cases
1. Bolus of 1 mg/kg bivalirudin
2. Start infusion at 2.5 mg/kg/hr
3. 50 mg added to pump prime
4. Check ACT 5 minutes after bolus and every 30 minutes after
5. 0.1 to 0.5 mg/kg boluses as necessary
6. ACT target – 400 s vs. 450 s vs. 2.5 x baseline ACT
7. Shut off infusion 15 to 30 minutes before coming off
8. Infuse venous line blood to patient and fill circuit with saline
9. Once off, add 50 mg to pump, start infusion of 50 mg/hour, and recirculate
10. Once CPB definitely not needed, run pump contents through cell saver (cell
saver removes bivalirudin)
Surgical Issues
1. Flushing of grafts and testing of flows should be performed with saline or, if
blood with bivalirudin is used, should be flushed out with saline and bull-dogged
while there is pressure on syringe.
2. IMAs should be transected only just before grafting is performed to avoid stasis
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated, adverse drug
reaction that can lead to life threatening complications. It occurs when patients
develop antibodies to a complex of heparin and platelet factor 4 that has platelet
activating properties. This platelet activation can lead to devastating thromboembolic
complications. The avoidance of heparin exposure is critical during the time that
these antibodies persist. However, during cardiac surgery, the avoidance of heparin
is extremely problematic and risky. This stems from the fact that no other clinically
available anticoagulant can be so quickly and easily monitored at the point-of-care
and have its activity so quickly reversed. Our current protocol for anticoagulation in
cardiac surgical patients with known or suspected HIT calls for the use of heparin with
a potent anti-platelet medication known as alprostadil. Unfortunately, the safety of
this protocol has never been well established. Bivalirudin, is a direct thrombin
inhibitor with a relatively short half-life has been suggested as a possible alternative.
Aim/Goal
To develop a new heparin-free anticoagulation protocol in cardiac surgery for patients
with known or suspected HIT.
The Team
Lessons Learned
Anesthesia: Jacob Clark, MD; Adam B. Lerner, MD
Perfusion: Kyle Spear CCP, Christopher Dacey CCP, Ralph Deyo CCP, Lauren
Finkelstein CCP, Robert Marquis CCP
CT Surgery: Kamal Khabbaz, MD; David Liu, MD; Senthil Nathan, MD
CVI Nursing – Verna Rettagliati, Mary Francis Cedorchuk
The Interventions
Multi-disciplinary meetings reveal issues not even considered by individual
disciplines
Regular reevaluation of protocols for relatively infrequent circumstances is
difficult but important
Finding scientific support for developing protocols related to rare clinical
conditions can be an enormously unfulfilling exercise
➢
Reviewing current literature and other institutional protocols regarding
anticoagulation for HIT patients in cardiac surgery
➢
Soliciting input from anesthesiologists, surgeons, perfusionists, and
pharmacists at multidisciplinary meetings
➢
Review preliminary protocol at multidisciplinary meeting with entire cardiac
anesthesia and cardiac surgical teams
➢
➢
➢
➢
➢
Develop a preliminary protocol for review and modification
Modify protocol as necessary and finalize
➢
➢
➢
➢
➢
➢
On-going performance measurement and safety monitoring
Next Steps/What Should Happen Next
Finalize protocol via multidisciplinary meetings
Purchase necessary equipment (heparin free bypass circuitry)
Program infusion pumps with institutional standards
Educate residents, fellows, and staff through information sessions, internal
communications, and publication to the institution’s PPGD
Program infusion pumps
Educate anesthesia staff and residents as to new protocol
Publish protocol to PPGD and anesthesia intranet
Monitor effectiveness and safety of protocol
For more information, contact:
Jacob Clark, MD,Fellow Cardiothoracic
Anesthesia,jclark4@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
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Adam Lerner (<a href="mailto:alerner@bidmc.harvard.edu">alerner@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesiology
Perfusion
Cardiac Surger
Cardiovascular Institute Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jacob Clark
Adam B. Lerner
Kyle Spear
Christopher Dacey
Ralph Deyo
Lauren Finkelstein
Robert Marquis
Kamal Khabbaz
David Liu
Senthil Nathan
Verna Rettagliati
Mary Francis Cedorchuk
Dublin Core
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Title
A name given to the resource
Anticoagulation for Patients with Known or Suspected Heparin Induced Thrombocytopenia During Cardiac Surgery
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/a4a27692ef6effae12d54d8f73079cc0.pdf?Expires=1712793600&Signature=T%7EYTnT3%7E3FciIENbn9cwRgDfY6NrQcveLXFCxbOs0p5A6yO407H6VcqbfYTZPF4deQ7JzyHQrE7QQ1EHTrYaVZLbUFq2KwV-8q3BFdebh7row7usAGDRCP6FWB7IbrHevWhMh2pvjjpcAw8sKXBi8eH6Arx3mBwHGLPk%7ETvzv0%7EUOF4kFTXxmPaTlg27QIJIuzD8Zl0BpJnmnxTzVKGFdR9%7EmBg2vioxM1KG7lfhgK9kaJSY0ai6PAT%7EV0OOTzN3HlJOAhjvYs0fhNrJCOWZcM5bXR%7EsKBLTy899V6U9MdA91ukhm1HRrgFwDr7pYcSPyOP8b71bY8VBx5L0B2A%7EEg__&Key-Pair-Id=K6UGZS9ZTDSZM
0c880f8c8e480c8cb1c488fdacc9ce83
PDF Text
Text
Benzodiazepines and opiates for admitted patients
with cirrhosis: Can we do better?
The Problem
Patients with cirrhosis are at high risk for hepatic encephalopathy.
Acute exacerbations of hepatic encephalopathy are associated with high
mortality and can be triggered with medications, such as benzodiazepines or
opiates.
Despite this fact, patients with cirrhosis are commonly prescribed these
medications during their hospital admissions, with unclear consequences.
Progress to Date
70.0%
Ammonia <60 umol/L on admission
60.1%
60.0%
50.0%
Ammonia >60 umol/L on admission
39.3%
39.2%
40.0%
26.8%
30.0%
25.5%
16.2%
20.0%
Aim/Goal
Our team sought to investigate the prescribing habits of BIDMC physicians of
10.0%
0.0%
benzodiazepines and opioids to cirrhotic patients admitted to our hospital with an
ammonia level checked on admission.
We also looked at how being prescribed a benzodiazepine or opiate affected
length of stay or in-hospital mortality for these patients.
Our longer-term goal is to decrease the frequency with which cirrhotic patients
Rx'd Benzodiazepines
Yesenia Risech-Neyman, MD (Internal Medicine)
Vilas R. Patwardhan, MD (Gastroenterology)
Zhenghui G. Jiang, MD PhD (Gastroenterology)
Gail Piatkowski (Decision Support)
Elliot B. Tapper, MD (Gastroenterology, Internal Medicine)
Ammonia level is associated with changes in management: Analysis revealed
significantly lower prescribing rates for patients with admission ammonia of >60
umol/L for benzodiazepines, opiates or both.
We are putting our patients at risk: We found increased odds of longer than
median length of stay (5 days) for patients prescribed benzodiazepines (OR
2.31) or opiates (OR 3.88) Patients with an admission ammonia >60 umol/L
were also more likely to die during their admission after prescription of a
benzodiazepine (OR 3.31) or an opiate (OR 4.68)
Room for improvement: About 1 in 4 cirrhotic patients with ammonia level >60
umol/L were prescribed a benzodiazepine during their admission, and about 2 in
5 were prescribed an opiate. Many were prescribed both (see bar graph above)..
The Intervention
Defining the problem: We analyzed the admissions of 492 cirrhotic patients to any
service at BIDMC between April 25, 2007 and September 24, 2012 who had an
ammonia level checked on admission.
Prescribing rates were compared between patients with high (>60umol/L) and
low (<60umol/L) ammonia levels on admission for benzodiazepines, opiates,
non-benzodiazepine sleep aids and antipsychotics.
Examined length of stay and risk of dying during the admission after
adjusting for age, MELD, sodium, lactate, infection, acute kidney injury,
variceal bleeding, DNR/DNI status or palliative care consult.
Rx'd Both Opiates and
Benzodiazepines
Lessons Learned
are prescribed these medications when admitted to our hospital to decrease the
adverse outcomes identified in our investigation.
The Team
Rx'd Opiates
Next Steps
Education: Present to hepatology faculty, housestaff and nursing.
Prompts: Similar to the decision support alerts for our GRACE protocol patients,
we are in the process of creating a proposal for our Provider Order Entry system
to include new prompts to help inform or remind clinicians of the potential for
harm when prescribing opiates and benzodiazepines to patients with a diagnosis
of cirrhosis or hepatic encephalopathy
For more information, contact:
Yesenia Risech-Neyman, MD PGY-2 Internal Medicine
yrisech@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Yesenia Risech-Neyman (<a href="mailto:yrisech@bidmc.harvard.edu">yrisech@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Internal Medicine
Gastroenterology
Decision Support
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Yesenia Risech-Neyman
Vilas R. Patwardhan
Zhenghui G. Jiang
Gail Piatkowski
Elliot B. Tapper
Dublin Core
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Title
A name given to the resource
Benzodiazepines and Opiates for Admitted Patients with Cirrhosis: Can We Do Better?
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/31021d2f3cb0fd12d7118812318448e3.pdf?Expires=1712793600&Signature=YyUdCF15RHS7C2JmnOHIT%7EjZpLj0zkZZveAZ0Et3R19CUjvG4XK-k5GtrGIyiJjlfaU1fXEZOGl-JQ4nKWY7XTePZ4kTmfxUwdpEVjr%7E-XlYhHDWb%7EZN-CqLQHsx%7EzT4sHuce8M429fVV4SKIQkLIKzVkS744yNcshw6TiXCy5B-cLC5NBtoUmrdn%7E6sDkswDhW4Kx6x7JBcFWMCeyubdmRfGGFnRes15VrdMFIAmpD%7E3S7ecYhj%7EUIf4myrEV-E5aAOwyRMCtcBaxue43MeG1XPmCIqnfoPC7gk4pYdU9kyrNbaXWH0XPU8DHLUOdrsf81VjM9x6RMHpofiRCBkgA__&Key-Pair-Id=K6UGZS9ZTDSZM
436eadcd96460b9c75a6c3c593dc2331
PDF Text
Text
Best Practice: Thoraco-Abdominal Aneurysms
The Problem
The Results/Progress to Date
The operative treatment for Thoraco-abdominal aneurysm requires meticulous application
of best practices to decrease risk of complications such as myocardial infarction,
respiratory events, excessive blood loss, or visceral and spinal cord ischemia. This team
reviewed current evidence and designed a process to ensure consistent implementation of
state-of-the-art best practices.
The following Thoraco-abdominal CSF drainage protocol was established and is used
by multidiciplinary team members:
ICP
Drainage (per hour)
< 10
No Drainage
10-15
10cc
15-20
15cc
>20
Call HO
Call HO for:
New onset ICP > 15 mmHg that does not respond to
drainage
Change in neurological exam
Aim/Goal
The goal of this team was to identify best practices in the approach to elective thoracoabdominal aneurysm repairs and construct systems that ensured these practices were
consistently applied.
The Team
Feroze Mahmood, MBBS, Co-Leader (Anesthesia)
Marc L. Schermerhorn, MD, Co-Leader (Vascular Surgery)
John Whitlock, RN, MS, Co-leader (CVICU Clinical Nurse Specialist)
Matthew Alef, MD (Vascular Surgery Fellow)
Mary Cedorchuk, RN (Cardiac, Vascular & Endovascular ORs)
Mark Courtney, NP (CVICU)
Senthil Nathan, MD (Cardiac Surgery)
Shahzad (Shaz) Shaefi, MD (Anesthesia)
Kamal Khabbaz, MD, Advisor (Cardiac Surgery)
Marjorie (Margie) Serrano, RN, MS, Advisor (CVICU Nurse Manager)
Richard Whyte, MD, MBA, Advisor (Surgery)
John Tumolo, MBA, Facilitator (Surgery)
All documented protocols were used to design a Post‐Op Order Set in POE
to standardize practice for each Thoraco‐abdominal aneurysm:
Lessons Learned
The Interventions
The following interventions were identified thorough literature review and best practices of
high-volume centers across the country:
Consistent scheduling communication to appropriate departments two weeks
prior to surgery and use of distribution list
Multidiscipline joint “huddle” prior to case start
Consistent line and drain placement in the OR holding area
Implementation of intraoperative neuro-monitoring for all cases
Development of Cerebral Spinal Fluid (CSF) drainage protocol with “rescue”
protocol for patients with altered neurological exam
Development of standardized postoperative order set
Implementation of hands-on training program as part of annual ICU nursing
competencies
Commitment to daily multidisciplinary rounding
Next Steps/What Should Happen Next
It is unclear if these efforts have had a measureable impact on patient outcomes.
The following next steps will need to be implemented to measure a consistent,
coordinated approach to managing thoraco-abdominal repair patients:
Measure utilization of standardized order set
Measure compliance/appropriateness of CSF Drainage Protocol
Measure patient outcomes and complications: Review on
Education & Reinforcement: Service level review of protocols
Joint Rounds are difficult to coordinate with multiple services
Measuring goals with such a small cohort presents unique challenges; Ongoing
measureable goals were difficult to establish in evaluating success given low
numbers of cases done each year
Staff are able to articulate a perceived consistency in their approach to patient
management and a clearer understanding of what is expected of them
The body of evidence is relatively small for TAA management; the team learned
from shared experience of other major academic medical centers
For more information, contact:
John Whitlock, RN, MS, CVICU Clinical Nurse Specialist
jwhitlo@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.
John Whitlock (<a href="mailto:jwhitlo@bidmc.harvard.edu">jwhitlo@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
Anesthesia
Nursing
Intensive Care Unit
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Feroze Mahmood
Marc L. Schermerhorn
John Whitlock
Matthew Alef
Mary Cedorchuk
Mark Courtney
Senthil Nathan
Shahzad (Shaz) Shaefi
Kamal Khabbaz
Marjorie (Margie) Serrano
Richard Whyte
John Tumolo
Dublin Core
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Title
A name given to the resource
Best Practice: Thoraco-Abdominal Aneurysms
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5fc1533e4b00ef8cccc05e2e2290e59b.pdf?Expires=1712793600&Signature=cJvaYqxOir5JjeRFBIw7ddcoBagbzW-XHz2iBw7FQOoAYFIt21lJVlLtzm-lC3vePma6qAfRni9Abr2sa8CdxuEM9w23EcDGqmFrUfV91-hsdWniVBQnz36KA9kQmpInOY0OVy8Ut2nGXD5Ey8BOBKH4VbR0Hm512kTZpP9ltZW-ckitneel-eKBSRyO9khhJO7w54lpt5UPpN52Wc07d-idL%7E3mK4SpROmbQUvlsrNnIvvEt3%7E58cmXLkxtMv1uIBHVMlIQKM5O9-7tTWfU381SpGGig0s0mlBWbJY08oB3rD340ZmRCdaAyZPlEgtoSyUUdx5loOvP1i97Jbg%7EAA__&Key-Pair-Id=K6UGZS9ZTDSZM
cb6e0700faad7db7955c2c9b71c9620a
PDF Text
Text
BID-Plymouth Low Back Pain Clinical Pathway
The Problem
Due to a lack of adherence to low back pain best practice guideline, there is significant geographic
variation in quality and utilization of surgical, interventional procedures, imaging, opioids and
psychosocial intervention related to low back pain.
This variation leads to:
•
Significant rise in costs of evaluating and treating LBP - IOM dimension of quality: inefficient
care
•
Significant rise in costs associated with LBP impairment/disability - IOM dimension of quality:
ineffective care
•
Compliance concerns associated with the constraints of new payment models on hospital
admissions which are deemed inappropriate for admission - IOM dimension of quality:
appropriate care
In most communities, there is no established or quantatively defined standard for evaluation and
management of the psychosocial components of a low back pain patients presentation.
Aim/Goal
•
•
•
•
•
•
•
Define, develop and implement a comprehensive, patient centered and evidence based Low
Back Pain Clinical Pathway that is the standard of care for the BID – Plymouth community.
Encourage physician behavior to utilize this pathway
To effectively manage the psychosocial concern in our communities LBP patient population.
Achieve 95% compliance for BIDP-ED back pain patients completing STarTBack questionnaire
o
STarT Back tool is validated to assess a LBP patients psychosocial risk factors.
To increase the number for patients seen in spine center with >3 score on STarTBack
To reduce by 50% the number of return visits to BIDP ED for LBP.
To reduce hospital admissions for Medical back pain (MS DRG 552)
The Results/Progress to Date
Aug 27, 12-Oct 5, 13 N-793 – Seen in ED/Referrals Sent to BID-Plymouth Spine Center
>1000 Visits assessed in ED – StartBack Score >3-100% offered appointment within 48 hr
ED Questionnaire Completion Nov 7 -Dec 31 12 Compliance: 65% (96/148)
Jan 2 – Nov 12,13 Compliance: 93% (963/1033)
42% (340/793) seen in BID-Plymouth Spine Center
60% (204/340) Returned Pt Satisfaction Survey – 91%Rated Care (Excellent)
Note: Primary Negative Comment-will not refill opioid prescriptions
6% (21/340) of pts seen in BID-Plymouth Spine Center returned to ED for additional visits
26% (118/453) not seen on referral at BID-Plymouth Spine Center
Returned to ED for additional visits-Avg 2.6 visits/pt (118 pts with 313 visits)
BID-Pymouth Admissions
MS DRG 552 Medical Back Pain w/o MCC
2009-132 2010-125 2011-90 2012-59 2013-31
MS DRG 551 Medical Back Pain with MCC
2009-10 2010-12 2011-5 2012-5 2013-12
Spine Center (SC) Referrals: N-150
50% treated >1x SC 35% Physical Therapy 25% CT/MRI 22% Pain Management 18%Neurosurgery
The Team
Ian Paskowski, DC Medical Director, BIDP Spine Center
Christine Healey, RN, Office Manager BIDP Spine Center
Mark DeMatteo, MD, Chief, BIDP Emergency Services
Jessica Nichols, RN, Nursing Director, BIDP Emergency Department
Judy VanTilburg, RN,BSN,MHM,CPHQ, BIDP Senior Director of Quality and Safety
James A. Berghelli, RPh, MS, BIDP/JCACO Director of Clinical Integration
BID-Plymouth Clinical Pathway Team
The Interventions
•
Implemented hospital wide LBP Continuum of Care Clinical Pathway in 2011 with
training/education of all key stakeholders throughout the community.
•
Gathered data:
1. Within ED for administration of STarTBack questionnaire to those patients with
LBP
2. Patients seen at BIDP ED for LBP and percentage of return visits to ED for those
groups who did follow through with referral to Spine Center and those patients
who did not follow through with their referral to Spine Center
3. Data for patient satisfaction and appointment offered within 48 hours of ED visit.
4. # of admissions for past 3 years with diagnosis of MS DRG 551 and 552
•
Track changes in measures defined above.
Lessons Learned
•
When appropriate resources are established, physicians will employ patient centered,
evidence based care for low back pain patients.
•
Involving key stakeholders at the initiation of the project ensures ‘buy in’ and greater ease
during implementation and increasing physician behavior changes
•
Utilization of a Primary Spine Practitioner model facilitates quality care for patients and
enhances “Patient-Centered Care” for LBP patients within the BID – Plymouth system
Next Steps/What Should Happen Next
•
Continue to monitor the above data sets to ensure sustainability of the model and make
modifications if trending changes to ensure patient centeredness and quality.
•
Expand the BIDP LBP Continuum of Care Clinical Pathway to other facilities within the Atrius /
BID health care system
For more information, contact:
James A. Berghelli, R.Ph.,MS
Director of Clinical Integration/JBerghelli@BIDPlymouth.org)
�
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.
Ian Paskowski (<a href="mailto:ipaskowski@jordanhospital.org">ipaskowski@jordanhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Spine Care
Emergency Department
Quality and Safety
Clinical Integration
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Plymouth
Project Team
Ian Paskowski
Christine Healey
Mark DeMatteo
Jessica Nichols
Judy VanTilburg
James A. Berghelli
BID-Plymouth Clinical Pathway Team
Dublin Core
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Title
A name given to the resource
BID - Plymouth Low Back Pain Clinical Pathway
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/1d6b01c9acd5f558ad2ea710638dc380.pdf?Expires=1712793600&Signature=Pc0EI4acxDei6-IkY6mG9c4ZFxRyYldlREJI3mowZGMrsjtbcYlGsoyRtjT1MmILbZJF48JyBIfce1xvVNu-GyPt1MTcb3nIaJIYkezdcsW2rLuB-REEYeVvZVtJVVbebIRnNhs-GydAMitqsqoTw19YcXfRbowko8qFnA7ERP5KAIjwdx9MmQd9V4PqDophQVughFgdTzu3Yze3RcQgBqrmDjlZO0YnceoR3hsHsBWDcLpDUtEDvquW94AXBiqHwnUVQ5NP-KwjafNMU4JkSwpcpcb3RLhpd4keiR3kelTQB2RxBTu2V7o4JY8tHiJgW8iKMkh1P2LEF4RbD4B1Yg__&Key-Pair-Id=K6UGZS9ZTDSZM
49ed95cbe9fd2e6c7e2c71b594d44a7b
PDF Text
Text
BIDMC CSIs: Creating A Culture of Delirium
Assessment and Treatment
The Problem
The Results/Progress to Date
Delirium is a sign of acute brain dysfunction affecting 60% - 80% of intubated
patients. Delirium is associated with increased ICU length of stay,increased ventilator
days, a three-fold increase in mortatliy, and long-term neurophysiological deficits.
Furthermore, delirium is associated with an annual cost of $4 to $16 billion annually.
Desptie this delirium remains unrecognized by more than 65% of nurses and
physicians. Initially interventions to improve outcomes related to delirium in the ICU
at our institution focused on identifiying and implementing a well-validated screening
tool. At the start of this project comliance with perfomring routine delirium
assessments each shift was sustained at >88%; however, the accuracy of
assessments in high risk patients remained < 50%.
The purpose of our project was to impove the accuracy of delirium assessments.
Aim/Goal
Achieve correct implementation of CAM-ICU in ≥ 90% of assessments by
September of 2013
Achieve ≥ 90% inter-rater reliability in CAM-ICU assessments by September
2013
Facilitate standardized daily interdisciplinary discussion of RASS, CAM-ICU, and
sedation management for all ICU patients.
Lessons Learned
Effective and sustainable change requires involvement, commitment, and
leadership from staff at all levels “from the bedside to the boardroom” (IOM,
2011). Ongoing support from administration, critical care leadership and frontline
staff has been invaluable
The Team
Collaboration with our nursing peers was fundamental to project success.
Justin DiLibero, RN, MSN, CCRN, CCNS, CSI
Janice Moreira, RN, BSN, CSI
Annalyn Ninobla, RN, BSN, CSI
Allison Woods, RN, BSN, CSI
Sharon O’Donoghue, RN, MS, CS
Time dedicated to planning, in addition to formal education and guidance from
The Interventions
Engaged frontline staff to elicit input, obtain buy-in and develop a culture of
delirium assessment and treatment
Identified key opportunities for improvement in delirium assessment from
baseline audits and staff feedback
Developed and used case study scenarios to facilitate group discussions
Provided real time auditing and feedback to support staff, improve
assessment accuracy, and achieve inter-rater reliability
Facilitated meaningful discussions around delirium assessments and sedation
management
Aligning goals and ensuring relevant concerns of staff were addressed was our
top priority
the CSI Academy on project implementation, allowed us to avoid many negative
roadblocks
Next Steps/What Should Happen Next
The primary goal for “next steps” is to standardize interdisciplinary
communication for delirium management across all BIDMC ICU’s
We plan to utilize the ABCDE model in addition to the THINK mnemonic –(Toxic
situations; Hypoxemia; Infection; Non-pharmacological factors; K-electrolyte
disturbances) to guide individualized management for critically ill patients
Ongoing measurement of the clinical and financial impact of our project may
allow us to scale-up our project to include the surgical ICU’s
We hope to maintain momentum for the project by celebrating the success of our
staff and sharing our results with the medical community
For more information, contact:
Justin DiLibero, RN, MSN, CCRN, CCNS – CNS SICU/TSICU
Jdiliber@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.
Justin DiLibero (<a href="mailto:jdiliber@bidmc.harvard.edu">jdiliber@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Justin DiLibero
Janice Moreira
Annalyn Ninobla
Allison Woods
Sharon O’Donoghue
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
BIDMC CSIs: Creating a Culture of Delirium Assessment and Treatment
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2158ea8d9d929b207ef34dd3c9ef6895.pdf?Expires=1712793600&Signature=pwrdLYtC0-UKRw%7EWXclHzOkjOqqoJOE1z71haMvEg79zhzp3eNtA8g2TGwGDTe6-e3UFJ4JzHsIoPzIMA54WivMV60OuZDaf-1pDnv11-hiH9lbC%7EQ9VRQIDSEU8JDCuvIyeUPCSBV%7E4FRb7kCKzLfCSG0GzXsZzfGuskVJngA1C%7Er6pKQrlUVLJFtbY9jFmA8IkL9m5%7EglH-nzSeruapJr6yUHPlQg7xT2Ulx3LTr8IATiK%7ELx9Cxp4egOfL3A8dcbZObtz%7EzIhJW1ebNcpGFLInZcrcPkQyMf69dVcW-PQL4dDk90Uxn6edd3bVZp4JhkLz1lrBtZTD1875viu2A__&Key-Pair-Id=K6UGZS9ZTDSZM
5af39e2e9e1e0149b0a0e9800631bbfc
PDF Text
Text
Building a Peer Support Program at BIDMC
The Problem
In the course of day-to-day care of patients our clinicians are put in challenging,
stressful, and often upsetting situations. The death of a patient, a difficult code, an
adverse event which may be viewed as a routine part of the job can leave clinicians
feeling like the “Second Victims.” Clinicians often do not have the support they need
to be able to cope.
The problem was recognized through observation throughout the medical
center, and an analysis by Health Care Quality in which it was noted that a
significant number of clinicians were not getting the support they needed and
were suffering because of it.
A Faculty Hour team validated that there was a need for additional peer
support at BIDMC. The team reviewed the literature and met with national
leaders in this area prior to launching this program
The Communication, Apology, and Resolution (CARe) program at BIDMC also
found the issue to be important to providers while training them to
communicate empathetically with patients after adverse events.
The Results/Progress to Date
Aim/Goal
Our goal was to have active trained Peer Supporters in each of the pilot areas by the
end of 2013. These Peer Supporters will reach out to colleagues who were part of an
upsetting event, and will be available for those that reached out to them.
The first phase of the project launched a Peer Support Program in the ORs,
Labor and Delivery, the Emergency Department, and the ICUs.
We have trained 40 Peer Supporters in the pilot areas and cumulatively 35 reported
supports have been given as of Feb 2014.
The Team
Melinda Van Niel, HCQ; Pat Folcarelli, HCQ; Steve Pratt, Anesthesia; Judi
Bieber, Human Resources; Pamela Peck, Psychiatry; Leslie Ajl, Nursing; Jane
Foley, Nursing; Phyllis West, Nursing; Kristen Russell, Nursing; Joanne Devine,
Nursing; Mary McDonough, Social Work; Mary Fay, HCQ.
The Interventions
A survey was launched, sent via department chiefs/managers, asking all
clinical staff members to send the name of a peer they would turn to when
they had a difficult situation at work.
We then collected those nominated the most frequently by their Peers, asked
if they would be willing to fill the role of the Peer Supporter.
Supporters were professionally trained and attending bi-monthly debriefing
sessions. They are known to their departments and are listed on the portal.
Lessons Learned
Training is the most helpful when it is integrated with BIDMC’s strategy for the
program, and not completely external to the organization. The Peer Supporters were
nervous about being named as “official “peer supporters. It was important to
emphasize to the Peer Supporters that they were selected for this role by their peers
because they are already doing much of the supporting naturally.
Next Steps
Spread the program by implementing it in the Med/Surg Units, adding
non-clinical staff, and using a BIDMC training in the spring.
Continue to collect data on the number of reach outs, and will consider
collecting data on the type of situation the reach out was for (still
completely de-identified).
For more information, contact:
Melinda Van Niel, M.B.A., Project Manager,
Health Care Quality and Patient Safety
�
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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.
Melinda Van Niel (<a href="mailto:mvanniel@bidmc.harvard.edu">mvanniel@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Melinda Van Niel
Pat Folcarelli
Steve Pratt
Judi Bieber
Pamela Peck
Leslie Ajl
Jane Foley
Phyllis West
Kristen Russell
Joanne Devine,
Mary McDonough
Mary Fay
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Title
A name given to the resource
Building a Peer Support Program at BIDMC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/61a621482a0aad9782f47d3bac5821d3.pdf?Expires=1712793600&Signature=dVHg3RqLGCXmTUvnC%7EBYFFBbCaHwJNMzl09borJAq0-8SFgNMnUd3eUb14Q3%7ErBBKAKTooaY6R9pIUUzlesOVGcsbRc1ggGmasR4IwttR6vHG402rGjjuf2LtcyacKmkyLJMXro60XBFEHtZR8vZjDHnsJK71s4aKC6IAbkWG-slWWm2kYRkSep57PyR3oODrXEX5lQpPxpWtJlnthIfO0PXFxt8Bv71N2wi1zohZ7YPVUUGswhWN6HWDSQg%7Ee1a%7EKaAfU1FHMDrirgz6oFZPo6ZfpYeABMherRgX8Td9EfUxOmj2iA2qlyANdAs6o4U18ec0GKvbV7rVmAFjcl-jg__&Key-Pair-Id=K6UGZS9ZTDSZM
31d23e98c391dc7a10ad8746b74a80e3
PDF Text
Text
Cardiac Surgery Unit Advanced Life Support
The Problem
The Results/Progress to Date
Cardiac Surgery patients have unique risks and opportunities related to standard
cardiopulmonary resuscitation. The risks include life-threatening damage, such as
right ventricular tear and bypass graft dehiscence, which can be caused by external
compressions. Conversely, internal cardiac massage can be performed relatively
easily in a post-sternotomy patient and the literature suggests improved outcomes
using this technique. One published study reports 48% survival rate in patients that
were re-opened <10 minutes versus 12% survival in those that took >10 minutes in a
review of 79 re-openings (Mackay JH, et al. (EJCTS 2002).
Additionally, the U.S, has historically lacked a standardized approach to training
CVICU staff how to perform in open-chest emergencies. This has left staff with a
general lack of confidence in their ability to participate was a clear gap in education.
The percentage of respondents that reported a high or very high level of
confidence participating in open chest arrests improved from 13% to 66%
The overall percentage of respondents that felt at least average confidence
participating in open chest arrests improved from 53% to 93%
2/5 patients that required open chest resuscitation since training began were
extubated the next day and did not experience an appreciable change in
hospital LOS
Aim/Goal
The goal of this project was to apply the tools and training described by Joel Dunning,
MD, et al and published in the European Journal of Cardio-thoracic Surgery (2009) in
an effort to improve staff confidence in participating in open chest arrests.
The Team
A small group of CVICU staff nurses attended training and served as
champions/educators to their peers
Margie Serrano, RN, MS; Nurse Manager, CVICU
John Whitlock, RN, MS; Clinical Nurse Specialist, CVICU
Barbara Regan, RN; Unit Based Educator, CVICU
Carol Kilday, RN; Staff Nurse, CVICU
Jamie Weinstock, RN, BSN; Staff Nurse, CVICU
Michelle Doherty, RN, BSN; Staff Nurse, CVICU
Angela Hindery, RN, BSN; Staff Nurse, CVICU
Kamal Khabbaz, MD; Chief of Cardiothoracic Surgery
Mark, Courtney, PA-C; Director of Cardiothoracic Surgery
The Interventions
Training classes that consisted of 8 hours of combined didactic and handson practice and included multiple disciplines
Mock open chest arrests performed twice monthly in CVICU
Redesign of open chest carts
o Non-essential equipment placed on separate cart
o Items placed in logical sequence top to bottom of cart
o Carts labeled clearly
o Standardized checklist created
o Pertinent emergency phone numbers and paperwork were placed
on top of cart to be readily available
Lessons Learned
Applying a validated method to training significantly enhances probability of
success and reduces time spent on “learning curve.”
A systematic approach to emergency procedure training significantly
improves staff confidence performing in open chest arrests
Next Steps/What Should Happen Next
Continued multidisciplinary mock open chest arrests in the CVICU
Continued surveillance of outcomes experienced by patients requiring open
chest resuscitation
For more information, contact:
Margie Serrano, RN, MS/John Whitlock RN, MS
jwhitlo@bidmc.harvard.edu
�
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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.
John Whitlock (<a href="mailto:jwhitlo@bidmc.harvard.edu">jwhitlo@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
CVICU
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Margie Serrano
John Whitlock
Barbara Regan
Carol Kilday
Jamie Weinstock
Michelle Doherty
Angela Hindery
Kamal Khabbaz
Mark, Courtney
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Title
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Cardiac Surgery Unit Advanced Life Support
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/af81c91b4431fc12bff44260eb76f0f2.pdf?Expires=1712793600&Signature=CEp26IcrOvlMDlhWZMKXqcPfsu3l3SDxkfJFrFeoJ8QoY8QeURkGf5Wfb-CxvOciruzGLVOoDwATCrdlIdsYehqIhTzYpTX4q-FWQ54CW0b2YkIKZz3sstkoVVmSZ%7EQP9WsLg6Tl7cC5sJfEeVPnroX%7Etz61KvlhiQatZqvHwclTyjZqMML0q3nIQ60HsKuAEw%7EtLadBC%7EyWaggBzcHc1kD0SYf3sswsYr0ybKO4xOLCZFUVtis9aulo9tpNoMrpw7UpKD1GU15kTZrIvYjeBLnFjIylAhiPDKhgqI8YHiYzNiGAazKEd020%7E3OC%7EeFJ1Zbf92jLhjBSVmwKlMDRqw__&Key-Pair-Id=K6UGZS9ZTDSZM
7fc6cbf87209467ff539f7a65e88143c
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Text
Beth Israel Deaconess Hospital-Milton
CAUTI: Sustaining the Reduction and Elimination of Preventable Patient Harm
The Results/Progress to Date
The Problem
Catheter-associated urinary tract infection (CAUTI) is the most common hospital
associated infection (HAI), accounting for more than 1 million cases each year in
US hospitals and nursing homes (Behnaz, 2012). The significant number of
infections, associated costs, potential for patient harm and dissemination of
resistant bacteria in hospitals make it important to find ways to decrease their
incidence.
Catheter Associated Urinary Tract Infection Rates 2009 - 2014
G
O
L
In 2009, BID-M’s Infection Prevention surveillance process identified an increase
in the number of urinary tract infections acquired during inpatient
hospitalization and associated with the use of urinary catheters.
Aim/Goal
Eliminate the incidence of Catheter Associated Urinary Tract Infection (HAI
attributable) by implementing evidence-based criteria for catheter use and
implementing processes to reduce device days and faciliate prompt removal
once indicated.
The Team
Lessons Learned
Nursing
Medical Staff
Clinical Education
Infection Prevention
The Interventions (Select Actions Taken)
Implementation and adherence to IHI endorsed CAUTI practice bundle
Purchase and utilization of a bladder scanner device as a means to determine
the need for catheterization prior to insertion
Extensive education and competency development for involved clinicians
Daily renewal of all inpatient catheter orders, including justification for
continuation of use
Post-operative urinary catheter order set as a means to ensure prompt postoperative removal (CMS SCIP Measure #9). Hospital has maintained 100%
compliance with this measure for > 2 years.
Outcome validates the efficacy and benefit of implementing evidence-based
practices
Used as a sentinel success to support the implementation of and buy-in from
clinicians in regards to other evidence-based practice guidelines
Focusing on this important safety measure positively impacted other externally
reported metrics i.e., CMS/JC measures, Hospital Acquired Conditions (HACs)
Reduction of non-reimbursable costs associated with Hospital Associated CAUTI’s
Next Steps/What Should Happen Next
FY 2014 Goal for Infection Prevention and the Hospital’s Antibiotic Stewardship
Committee:
o Eliminate the non-evidence based use of antibiotics for patients presenting with
asymptomatic bacteruria (ASB) as a means to mitigate/reduce antibiotic
resistance
Explore the development and implementation of nurse-driven protocols associated
with urinary catheter utilization
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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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.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Medicine
Infection Prevention
Healthcare Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Nursing
Medical Staff
Clinical Education
Infection Prevention
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CAUTI Sustaining the Reduction and Elimination of Preventable Patient Harm
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/dbf92eb051f3ebee96e9f553ad1d1e9d.pdf?Expires=1712793600&Signature=VueitAQk2YKGWufiLdQ3au4dDr9Ma4jw1tTXH65yT7gT14StvPM5R5cB2Gzm%7EH1qMAFvSYxTAmZnt4aYB2Rb23sDsGMlazsO1KKl53o2pD1NgemtNEavSMxnISBEy5kpvGgRLK1kLdEHCYwGnZAOaw9hH%7EjD%7EXmh2afD3n1Ri8XRIv-VxGb9%7Eehhg5LNlYDfyqDrhT2ygSuV6t60eRApPrCMh7k6WWjWq75pj4o5uxJAGNzr8ogYfccTXV53t-351H%7E-bkqyRSvjGSvEJMQ4KgnQshWm1V9ghrRhEu6WjqBtReomPabq0333o7tQjCOL8UDDrB7O1rPhARrMftdEtQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ece260a02b1bc26cd45bbfd835ac06f3
PDF Text
Text
CO2 Insufflation: Ensuring Safety in the Advanced Endoscopy Patient
The Problem
This displays the high ETCO2
observed during CO2
insufflation.
CO2 insufflation has been introduced into the advanced endoscopy unit. During
procedures such as endoscopy, ERCP and colonoscopy this type of insufflation has
been shown to lead to enhanced patient recovery, but its use has been associated
with rare cases of CO2 narcosis.
Aim/Goal
Our overall goal was to assess the impact of CO2 insufflation on ventilation and
expired CO2 and understand the anesthetic implications of CO2 insufflation in
our patient population/case mix. Specific goals:
Educate GI Anesthesiology Team about CO2 insufflation and its potential
impact on patient ventilation.
Assess the impact of CO2 on the patient’s blood CO2 level and determine
whether current respiratory monitors (ETCO2) are valid during CO2
insufflation.
Trial a noninvasive monitor that measures transcutaneous CO2.
2. Transcutaneous Monitoring: Easy to use during cases
This displays transcutaneous
CO2 during insufflation.
The Team
Anesthesiology: K Zaleski MD ,S. Barnett MD, and the GI Anesthesia Division: R.
Cohen MD, R. Steinbrook MD, E, Sundar MD, MA Vann MD, R Glidden MD, R
Kverga MD, D. Feinstein MD, F. Shapiro DO,
Advanced Endoscopy Gastroenterology: R. Chuttani MD, D. Pleskow MD, M.
Sawhney MD MS, and T Berzin MD MS.
Lessons Learned
The Interventions
Changes in technique and equipment that are directed at improving one aspect of a
patient’s care can have unintended consequences. Our example shows that although
the administration of CO2 improves the GI outcome, it may have negative effects during
the administration of anesthesia.
E-mail Notification to Anesthesiology providers regarding introduction of
CO2 with reminder notices posted by each Anesthesia machine.
Discussion of initial observations and concerns at Faculty Hour.
Provision of ABG syringes and lab slips to confirm PaCO2 value in the
setting of high ETCO2 values.
Trial of transcutaneous PaCO2 monitor to confirm accuracy of ETCO2
monitoring in upper GI cases using CO2 insufflation.
When new techniques are introduced it is very important that all disciplines are educated
and informed about the change in practice and possible consequences.
The Results/Progress to Date
1. Early observation of elevated EtCO2 and PaCO2 during MAC Anesthesia
Next Steps/What Should Happen Next
with CO2 insufflation.
Case
Scope
Time
Start
ETCO2
End
ETCO2
ERCP, stent pull
12 min
42
68
67
ERCP, pre-cut
38 min
40
83
End
PaCO2
Publish clear guidelines for patients who should receive CO2 for insufflation and
when to change from CO2 to air during a procedure.
Include a statement on CO2 insufflation as part of the time out prior to procedures.
Regular monitoring or spot checks of patient’s carbon dioxide levels during CO2
insufflation and collect data on any adverse events.
Perform cost benefit analysis of additional monitoring with a transcutaneous CO2
monitoring.
96
For more information, contact:
Katie Zaleski, MD, BIDMC, Department of Anesthesia, Critical
Care, and Pain Medicine, kzaleski@bidmc.harvard.edu
�
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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.
Katie Zaleski (<a href="mailto:sbarnett@bidmc.harvard.edu">sbarnett@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Gastroenterology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
K. Zaleski<br />S. Barnett<br />R. Cohen<br />R. Steinbrook<br />E. Sundar<br />M.A. Vann<br />R. Glidden<br />R. Kverga<br />D. Feinstein<br />F. Shapiro<br />R. Chuttani <br />D. Pleskow<br />M. Sawhney<br />T. Berzin
Dublin Core
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Title
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CO2 Insufflation: Ensuring Safety in the Advanced Endoscopy Patient
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f6a4e30f6a7b92ef0917c088fc9b2653.pdf?Expires=1712793600&Signature=tUqnDyNxqZYLz5zNC1PlSV9bbTA8BlPhSNL0RNnwiF4OOTx7qb-bYPlQrYk1tx2WOQSg-%7E5-aMOGV248Cr3Q9jKxXGC8J6srsGyn00BBqTOj5xeCBd8hkMjhrX9-CLMBAd3U6mMwVfnxkJ7S3kWGW0jiy4NdRyAitID7M9J0L9cFE0PWWqesHl7A4XBm5OPeN5SyoZ1iWciU6c%7EnV3QrYVG3abktfVzYLavYBWuqJBWcG4kGWEeOl-4DBUMYGBlE-4pDXDiQ7y0WscIsOAjdRSJbcGALrQgC%7ENcTn2LC9M4E5FCHn%7EQyut4pHf4jX-cq8h-x-uIFx0LDBjsa3Zn2Lw__&Key-Pair-Id=K6UGZS9ZTDSZM
929ed635f8d1c9d6e8035551accb2b7d
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Text
Completeness of CT Examination QA
The Problem
The Results/Progress to Date
CT examinations have many components that are merged into a single file in PACS
for radiologic interpretation. Feedback from the radiology QA system, as well as on
the spot communications from radiologists indicated there were cases with missing
information, incomplete examinations or studies not performed as requested per
protocol.
Oct‐12
Jan‐13
Jun‐13
Feb‐14
Aim/Goal
Our Goal was to create a sustainable QA program that would identify trends that
could be used to increase compliance in examination presentation and to provide
education in exam protocol selection.
samples
48
53
51
81
Cases with Cases with
Ave # of
no
some missing missing
omissions
criteria
criteria
26
22
1.75
40
13
1
51
0
0
61
20
1.4
The Team
Carol Wilcox (Advanced Imaging Lab Technologist)
Pam Roberge (Weekend CT Supervisor)
Anthony Gattonini (WeekDay evening Supervisor)
Tim Parritt (CT Manager)
.
Data collection began in FY13. 46% of exams reviewed were missing some of
the components listed below. Immediate feedback was given to staff, as each
case reviewed was shared with the technologist, so we could provide positive
feedback on cases completed correctly and identify areas for improvement in
the remainder. 8 months later we had 100% compliance for criteria being
reviewed.
The Interventions
We performed random screening of routine CT exams on the overnight shift,
screening for 9 specific components that we would expect to see in a complete CT
examination.
Scout Cross
Reference
Smart Prep
Graph
Exam done
per
protocol
Lessons Learned
Giving timely feedback to technologist about missing CT examination
components reduced incomplete cases from 46% to 0% over an 8 months
period. However, sustaining the program proved difficult. The work is manual
and it is time intensive to evaluate 9 components for each individual
examination. In the absence of the QA program, the percentage of complete CT
examination decreased with 25% being incomplete in February 2014.
Next Steps/What Should Happen Next
Document
uploaded
Smart Prep
Images
CT QA
Exam
Review
Communica
tion tool
complete
ROI as per
protocol
Questionna
ire
completed
Contrast
per
protocol
Continue Program in the Evening shift
Early stages of Implementing on the Day shift
Review the 9 criteria (are all still relevant?)
Focus on what directly affects image quality and
Evaluate compliance with new regulations
For more information, contact:
Tim Parritt, CT Manager
tparritt@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tim Parritt (<a href="mailto:tparritt@bidmc.harvard.edu">tparritt@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Carol Wilcox
Pam Roberge
Anthony Gattonini
Tim Parritt
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Title
A name given to the resource
Completeness of CT Examination QA
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/24ece5aabb06ef4befbdc7bfd8f5ec4d.pdf?Expires=1712793600&Signature=Ll7ESsy5WMRbS0hQKA2HefNhZkPfWo2Pztl86lNS78Rr9VZPBZhZemO6DoxEFg3Bl-kXqqNVJ%7Ek1%7EY-CyzqtrLRJssatO8-aYrsBGBPixNyW-G8shFariD0gjtpvAe50rs9GDJHkAqY0C6nfReJpJg4dErt2OuQH9BIBCOvZKDt1Wov7oJrC7AO8qvu25s8AUYaRe19alLCe17A5Z2BFs4mHwtGTboibJx5Vm7SgEqwrh3tVrmkTtziv0I0Dt6gaQutHbCMv6lom94SRWRlfiq5yiUIQTYdpqhq4M78YKqSWgqOldxDZCpz8WS54fXuRxL81-bgZLsgyGHkfzoUL3Q__&Key-Pair-Id=K6UGZS9ZTDSZM
b7671fd50c2d16c332dfc31fdd909bf5
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Text
Coordinated Care in Massive Obstetric Hemorrhage
The Problem
The Results
A 32 year-old female presented to Labor & Delivery at 31 weeks gestational age with
known placenta percreta for Cesarean/hysterectomy. Her obstetrical team recognized
the potential for massive hemorrhage and began planning
months in advance.
After approximately 12 hours (8 hours in the operating room, 4 hours in interventional
radiology) the patient was transferred to the Finard ICU intubated in stable condition
on a low dose vasopressor infusion. A balanced transfusion ratio of 6:6:6:1 (pRBCs,
FFP, platelets and cryoprecipitate) had been designated in advance and was
reflected in every cooler received from the blood bank. Only three calls to the blood
bank for general updates were required the entire case. Estimated blood loss was
greater than 60 liters.
Placenta percreta is associated with a high morbidity and
mortality, and many aspects of the Institute of Medicine
Dimensions of Quality Care were required – Effectiveness,
Efficiency, Timeliness, Safety, and perhaps most importantly,
Patient Centeredness. Preparation for this case was
markedly different from a normal delivery.
Goals
Our goals were 1) deliver a viable, healthy infant and 2) maintain end-organ perfusion
to minimize morbidity to the mother in the face of massive hemorrhage.
The Team
Multidisciplinary, collaborative preoperative planning group
Anesthesiology team
Blood Bank team
Gynecology/Oncology team
Interventional Radiology team
Neonatology team
Obstetrics and L&D nursing team
Urology team
Additional colleagues called to the
operating room to assist
Acute Care Surgery team
East OR staff/team
Perfusion (cell saver) team
Vascular Surgery team
The Interventions
The anesthesia team was divided into roles - one person was assigned to each of the
three intravenous catheters, one person charted and sent labs every 30 minutes, one
checked and distributed blood products and one communicated with the OB team,
administered miscellaneous medications (calcium, antibiotics, muscle relaxant,
narcotics, anti-fibrinolytics). Coordinating everything was one senior anesthesiologist
who was designated team leader. A dedicated OB nurse made continuous trips to the
blood bank with coolers.
Transfusion totals included 73 units of pRBC's, 72 units of FFP, 66 units of platelets,
12 units of cryoprecipitate, ten liters of crystalloid and a liter of cell saver.
Obstetrics and anesthesia maintain preparedness for cases of this magnitude with
simulation as well as a maintaining an obstetric hemorrhage protocol.
Labs upon arrival in the ICU showed a pH of 7.53, a normal ionized Ca++ (nadir was
0.26), lactate was 3 mmol/L (peak = 8.3), Hct was 25% (nadir was 21%). Coagulation
profile demonstrated an INR of 1.3 (peak = 1.5), fibrinogen of 203 and platelets of
79,000 (nadir 62 K).
Mother was extubated on POD #5 and transferred to the floor on POD #8. Her
newborn son was transferred to the NICU for care related to his prematurity.
Lessons Learned
Preparation for these patients demands coordination among multiple disciplines well
in advance of delivery. Interventional radiology was involved pre-operatively but
general surgery and perfusion (for cell saver)
were not; given the important role they ended
up playing it would have been optimal to
include them in surgical planning.
Assigning specific roles to each anesthesia
provider in the operating room was essential
to maintaining order in the controlled chaos of
having multiple surgical teams in the
operating room and the near-constant
checking, documenting and administration of
over 150 blood products.
The unconventional 6:6:6:1 ratio of pRBCs,
FFP, platelets and cryoprecipitate
transfusions resulted in minimal coagulopathy
both intra-operatively and post-operatively.
Next Steps/What Should Happen Next
A post-operative debriefing with nearly all involved parties led to several suggestions
for future similar cases including a more standardized pre-procedural checklist,
involvement of several departments earlier, and a more in-depth discussion of
whether these cases should be done on Labor & Delivery or downstairs in the main
operating room.
For more information, contact:
John McNeil, M.D., jsmcneil@bidmc.harvard.edu
Yunping Li, M.D., yli1@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
John McNeil (<a href="mailto:jsmcneil@bidmc.harvard.edu">jsmcneil@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Multiple
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Anesthesiology team <br />Acute Care Surgery team<br />Blood Bank team <br />East OR staff/team <br />Gynecology/Oncology team <br />Perfusion (cell saver) team <br />Interventional Radiology team<br />Vascular Surgery team <br />Neonatology team <br />Obstetrics <br />L&D nursing team <br />Urology team
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Title
A name given to the resource
Coordinated Care in Massive Obstetric Hemorrhage
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/63147cda31d7b540e85ed622ad64c507.pdf?Expires=1712793600&Signature=dpd1YMAq6CBOYSSB1BG479S7MwS5rHpY8ES4bN6gqKivO0FTXPZwxyOgUMAmWzWZ4qbukEUYryEppzDCyHPDWdU1ZOND-0avodZI4BED2QvJWrG332qciIxxMfLUwPBb55BT2YR2lbZclHPrh3K7AZhONzbq7-vTcc2CikPKEEQwxqPMqTUj4bguxyyfDq5TQxZNvi-Rd7gchz7ZBg6nmEOzJ9zmCYhIynMtZTvt2nZUfMdsqVya6eUZVYEczIyj3oHm0pRY2WznrNpFt8YNaWMMSquB%7E7kpUPd-Q6tEYc%7EFzTmNxD5yGw%7EAder8kTiITwUo2rybdfKVBd3325mDMQ__&Key-Pair-Id=K6UGZS9ZTDSZM
484bb1f04ee7934749d4d129b398d79f
PDF Text
Text
Data Driven Education for Front Line Staff
The Problem
The Results/Progress to Date
We wanted to have meaningful use of data in frontline care. We continually use
Quality and Safety audit data to identify compliance with process as well as gaps in
nursing staff knowledge and want to effectively use these results to target our
education toward identified problem areas.
Metrics that were removed began with 30‐45% compliance rate and with
education improved to >99% and this was sustained over multiple quarters
.
120
Meaningful use has been defined as” using electronic health records to improve
quality, safety, efficiency. “(Health IT. gov.)
100
Aim/Goal
80
To provide real-time education and feedback derived from the monthly audits to
correct substandard practice, thus supporting efforts to prevent harm and improve
patient outcomes.
60
40
To monitor meaningful metrics and return compliance summaries that align to internal
priorities, external reporting requirements and pay-for – performance initiatives.
20
The Team
0
Kim Sulmonte,
Jaime Levash,
Barb Donovan,
Linda Denekamp,
Susan DeSanto Madeya,
Susan Kitchens
White Boards
Clean shared
equ
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr
45.9
99
99
99
30.6
99
99
99
The Interventions
The team’ wanted to focus our audits on current new roll outs:
We solicited input from staff and colleagues about the need to change the
Lessons Learned
metric to assess new rollouts
Added “yes with correction” to allow for real time staff training to reinforce
correct practice
On-going performance measurement and monitoring to assess effectiveness
of education.
We simplified the audit tool by removing those metrics we determined were above
benchmark for the prior year and added the new IHI fall bundle and IV observations.
Next Steps/What Should Happen Next
The Team will continue to:
Monitor monthly audits for need to focus on metric for education
Base our nursing practice decisions on real time audit information
identify improvement opportunities through data
It directs us to focus our resources where the need is the greatest.
Example: Changed metrics to assess new IHI fall bundle and new IV tubing
and Curos caps compliance.
For more information, contact:
Kim Sulmonte Associate Chief Nurse BIDMC Quality and Safety
ksulmont@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kimberly Sulmonte (<a href="mailto:ksulmont@bidmc.harvard.edu">ksulmont@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kim Sulmonte
Jaime Levash
Barb Donovan
Linda Denekamp
Susan DeSanto Madeya
Susan Kitchens
Dublin Core
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Title
A name given to the resource
Data Driven Education for Front Line Staff
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/74aa8f4039f5bcb2d69e3cfeba71adea.pdf?Expires=1712793600&Signature=oXxmThz9nLj6rvLHuOHPos6lU0p9zY-%7E98tZ2tnC62ZJ92DiXD2Yr62lMa2hBzD77JmAFeTgZHQoT3H2FvLdq8AYO4bWY7clAnPVOiyA%7EeZA6DKwxMb8yOK9kCPCoFYAx-7qSztujMQ9967JBKRFTMfkftbYD5cseDKtA9wSWuf%7EkJkZrcBIXFtAPrm5IOowu6DgD5CnVG1UmWzc1WepbtgbxwnGFlF6IQc%7E7eXq2hYuUc0scvwz3F3AMebxxEqJNNWhHsqS9cUZSucKYo%7EqLCj7Zi9-zQ1o6pl1epM10duWtjqt1iyomb9iR6cVzoGiv3TSICuCqJrChchMuFHq6g__&Key-Pair-Id=K6UGZS9ZTDSZM
5f7398771ec0a33341cc02b2613ede5c
PDF Text
Text
Data Mining with MIMIC‐II in BIDMC ICUs
Joseph Paonessa MD, Thomas Brennan PhD, Mengling Feng PhD, Roger Mark MD PhD, Leo Anthony Celi MD, MS, MPH
Beth Israel Deaconess Medical Center – Harvard Medical School
MIT Laboratory of Computational Physiology
Problem
Progress
The failure to store and analyze the vast amount of
data generated on a daily basis is a key hurdle in
advancing the practice of critical care medicine. The
intensive care unit (ICU) provides a cogent example of
a data rich clinical domain in which an insufficient
portion of the data generated has been employed for
guiding practice by, for example, supporting the
creation of clinical decision support tools, identifying
significant patterns in population data, and employing
feedback on system outputs for the formulation of
systematic process improvements.
Predictive Modeling, Prognostication, and Outcomes
The MIMIC database has allowed our group to develop predictive models with actionable
outputs that potentially lead to measurable improvements in process and/or outcome. Such
models could support appropriate early triage regarding level of care and monitoring, as well as
the allotment of costly resources such as specialist‐requiring interventions and/or technologies.
For example, these tools could assist emergency departments if limitations in ICU resources lead
to regionalization of critical care.
Aims
Unraveling Complexity and Variability
MIMIC that include detailed clinical information has provided researchers an opportunity to
accumulate safety and efficacy evidence, discover patient subpopulations that experience
important variances in efficacy or unanticipated delayed adverse effects, and uncover
interactions between and among simultaneous treatments as drugs become used in wider, more
diverse patient populations than those possible during premarket approval clinical studies.
To build a learning system around an open‐access ICU
database where practice informs research, and
research informs practice. Clinicians at the frontline of
care should be at the core of this dynamic learning
system, fully supported by engineers to collaborate on
the daily translation of questions into strategies for
database interrogation, modeling and analysis.
The Teams
Teams of clinicians (nurses, doctors, pharmacists) and
scientists
(database
engineers,
modelers,
epidemiologists) have formed around the Multi‐
parameter Intelligent Monitoring in Intensive Care
(MIMIC) database. The database was established in
October 2003 from a partnership that combines the
resources of a powerful interdisciplinary team from
academia (Massachusetts Institute of Technology),
industry (Philips Medical Systems and Philips
Research North America) and clinical medicine (Beth
Israel Deaconess Medical Center). The public‐access
database now holds over 60,000 ICU stays in the
BIDMC ICUs.
The inter‐disciplinary teams have been translating
day‐to‐day questions typically asked during rounds
that often have no clear answers in the current
medical literature into study designs and then
perform the modeling and the analysis and publish
their findings.
Intervention
The learning system described above has been
operating since 2010. The scientists attend ICU
rounds, observe the processes surrounding data
capture and interact with the rest of the clinical team.
The clinicians on the other hand come to MIT and
learn the tenets of clinical data analysis. This culture
of collaboration is crucial in democratizing research
and lowering the barrier for frontline clinicians who
are most familiar with the information gaps in
practice to participate in knowledge generation, as
well as for those not traditionally associated with
evidence creation, including patients themselves.
In January 2014, the MIT‐BIDMC Critical Data Marathon and Conference was held. The basic
premise of the data marathon was to bring together providers and data experts to answer
clinically‐relevant questions over the course of a weekend. While a truly novel discovery or a
fully functioning solution is a rare outcome, these events enable crowdsourcing of valuable,
varied points‐of‐view and new personal connections that will form the basis for longer‐term
collaborations. More than 80 participants formed 10 teams, including one in London, United
Kingdom. The best projects were presented during the Critical Data Conference that followed.
The conference was attended by more than 200 participants, and watched by another 400 via a
live stream. The talks and discussions revolved around two themes: how to operationalize the
vision of a data‐driven learning system and how to safeguard big data in healthcare from
contributing further to the swaths of unreliable research that plague medicine. The
presentations have been made available online and have been viewed by more than 700
unique visitors (http://criticaldata.mit.edu/events/conference/program.html).
Next steps
While the current MIMIC database is limited to one academic hospital in the United States, plans
are already in motion to extend the data to other hospitals, including institutions outside the
U.S. As the database expands quantitatively and qualitatively across diverse care environments,
the power and significance of any individual analysis will only increase over time. Furthermore,
such analyses can be easily repeated, modified, and strategically improved based on iterative
interpretation of prior findings.
Our vision is for the development of a care system consisting of “clinical informatics without
walls”, in which the creation of evidence and clinical decision support tools is initiated, updated,
honed, and enhanced by crowd sourcing. In this collaborative medical culture, knowledge
generation would become routine and fully integrated into the clinical workflow. This system
would employ individual data to benefit the care of populations and population data to benefit
the care of individuals.
Acknowledgements
NIBIB Grant 2R01‐001659
�
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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.
Joseph Paonessa (<a href="mailto:jpaoness@bidmc.harvard.edu">jpaoness@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Internal Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Joseph Paonessa<br />Thomas Brennan<br />Mengling Feng<br />Roger Mark<br />Leo Anthony Celi
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Title
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Data Mining with MIMIC-II in BIDMC ICUs
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/1931299a57500523a60c593f56f467a9.pdf?Expires=1712793600&Signature=Sh5vMiVsjq-PDLujlfpOjJycvFfnrMD9c6dWuSHAZGuRYfZW7WfMeIhcutdxjK5-RPzRkdTk4l74u5jUCwhYUMFV0myXNsgmsLZoRT-PSZRMT-ytpWAlJJAsMDg6DooczBuVBlpLdopOP%7E8LYGUVOkbal1fy%7EP8hstLBWTk3mrk99f84X-aDycNrdFuQLGCaX2dGrVlq%7E%7EBhyfW-ageetRHD9JUg3idoqFYyglXtqTFsihRczZ4mTQM%7EIi7hOq5zMgSz6ZZoen2v38lxFs5rms273XRdByygN8MkLWUm74lsM818RJF3zqtXblzIWNJkcPHdoCp3uKbCDZWJpCkqqA__&Key-Pair-Id=K6UGZS9ZTDSZM
771ba1bc56e41a4e32ae53e133539ef7
PDF Text
Text
Decreasing CAUTI Rates to Zero by Decreasing Device Days in CCC
The Problem
Above average Foley catheter Device Days in our CCC
When we engaged in the MHA CAUTI Cohort and received National comparative data, we realized that our
device day rates were unacceptable. In order to best accomplish decreasing CAUTI, we needed to evaluate
device days and the practices of placing and removing Foley catheters in the CCC. The initial evaluation
highlighted the need to raise awareness and accountability for placing and removing Foley catheters. Our aim
was to decrease device days for our patients and hopefully, CAUTI rates in CCC. We set a goal to be more
efficient with removing Foley catheters, which in turn would improve safety and quality of care in CCC.
The Results/Progress to Date
CAUTI Rate in CCC
Device Days CCC
per 1,000 device days
per month
300
7
240
6
250
232
200
CAUTI Rate CCC
150
Linear (CAUTI Rate CCC)
100
Our overall CAUTI rate fell from a high of 6.74 to 0 and has sustained at 0 for 10 months as of 12/31/13. .
When we began the project, our goal was to decrease device days/utilization rates by 50% and achieve and
maintain a zero CAUTI rate for 6 months or more. The entire project was planned and implemented from
November 2012 through December 2013.
181
202
4
3
Aim/Goal
228
5
167
170
162
143
142
122
133
128
Device
Days CCC
2
50
1
0
0
12‐Nov 12‐Dec 13‐Jan Feb‐13 13‐Mar 13‐Apr 13‐May 13‐Jun 13‐Jul 13‐Aug 13‐Sep 13‐Oct 13‐Nov 13‐Dec
The Team
Lessons Learned:
Kathleen M. Mercurio, RN Infection Preventionist
Lisa Bergendahl, RN BSN , Director, CCC
IP+C Department
CCC Staff
Backing up the entire process to recognize that our ED was placing far too many catheters encouraged
education and increased awareness of the criteria for placing Foley catheters.
Once we reduced the number of unnecessary catheters overall, we then learned that the CCC did not have
the tools with which to succeed. For instance, they only stocked one size of condom catheters and had
limited commodes.
The Interventions
Gathered and shared current data and best practices around removing Foley catheters in a timely fashion
Developed criteria for placing Foley catheters using evidence based research
Educated staff in CCC and ED on the criteria established for placing and removing Foley catheters
Shared data monthly and as needed with CCC staff
Review of CCC patients/devices by IP+C daily
Implemented daily rounding with core focus on devices and evaluation of the necessity of those devices
Engaged in one‐on‐one staff conversations when IP+C felt a Foley catheter should be removed per record
review
• As an alternative to indwelling catheters, offered a full stock of condom catheters, wicking under pads and
commodes
• Held staff accountable for driving down device days and CAUTI rates in CCC once they had the tools to
succeed.
•
•
•
•
•
•
•
Next Steps/What Should Happen Next
• Monthly updates shared throughout the hospital
• Sustain the current zero CAUTI rate throughout 2014
• Share criteria for placing, then removing Foley catheters within 48 hours of insertion with all nursing
units
• Implement GU consulting protocol for Foley catheters on all units that remain in place > 48 hours for
evaluation by Urologist
• Continue to ensure that all nursing and medical staff have the tools they need to succeed
• Celebrate successes and implement a plan for improvement when challenges or “slips” occur
For more information, contact:
Kathleen Mercurio, RN LNC LCP
Infection Preventionist
BID/Plymouth Hospital
kmercurio@jordanhospital.org
�
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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.
Kathleen Mercurio (<a href="mailto:kmercurio@jordanhospital.org">kmercurio@jordanhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Infection Prevention and Control
Critical Care Center
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Plymouth
Project Team
Kathleen M. Mercurio<br />Lisa Bergendahl<br />Infection Prevention and Control <br />CCC Staff
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Title
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Decreasing CAUTI Rates to Zero by Decreasing Device Days in CCC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3a6928f604249f4faa84e780c68aac98.pdf?Expires=1712793600&Signature=HNIn%7EeEHOTtVbXuf7P55PlWEwq2EXKjRpUAhs84NDvve04P8%7EFTvdm%7Evmzd3uy5ENdnH5iuZBY7DTSClgoN90A93e2JflOFV4h3fsZFfvfJSNqWGa6CvB5pE84Yk9ix0ZJRx26GwS5Y8EsdEqCHxTTd6f1Y9ZA9I3Yrf4KD7%7Ess%7EV-fialKlPuERjxjPqumgmArVENLT1P2t3GZbCB9JVXnZV2sx4lvW1Wt2Kw2Ne-WKnd5GrOV33x2kyboRVAzl30kmZwmVQz0hW38ptz2-NBjyBy46iVpEpD4ATOe1ST4qHI4IRUwqIL4mrqmCtMlKxyQJCYDDILhVfA8sUtQSng__&Key-Pair-Id=K6UGZS9ZTDSZM
625eec750027a80e790bed1d40fc443c
PDF Text
Text
Design Orientation to Engage New Faculty and Accelerate High Performance
Discovery Site: External Site Key Learnings
Defined 1‐2 Week Training Program including partnering with a designated trainer
Recognition for high performance
Staff is motivated and encouraged to develop job skills
Consultation with Workforce Development: Joanne Pokaski, Director
In‐person training & designated resource
An online resource guide or binder for quick reference
Aim/Goal
The Results/Progress to Date
Develop a comprehensive multidisciplinary perioperative orientation program for new
faculty and staff in Anesthesia, Surgery, and Perioperative Services.
Perform a needs assessment
Solicit current clinician perspectives and explore potential resources such as peer
mentoring, simulation, and a web‐based resources
Explore orientation practices at other institutions
Assess program quality by instituting 360 feedback
Most Useful Orientation Items: Incorporate in Onboarding Checklist
The Problem
Clinician engagement and retention are crucial to carrying out the mission of providing world
class, high quality, and coordinated care. Structured orientation programs for new faculty
are lacking in many departments, notably Anesthesia and Surgery. Inadequate orientation
during onboarding and lack of interdisciplinary training can result in high job dissatisfaction,
iindividual and system stress impacting patient care, retention challenges impacting MD and
RN shortages, and costly recruitment.
The Team
Anesthesia
Ruma R. Bose, MD
Brian P. Ferla, MD
Surgery
Selena E. Heman‐Ackah, MD, MBA (ENT)
Sahar Kohanim, MD (Ophthalmology)
John Tumolo, MBA, MPH
Nursing & Periops
Maureen Houstle, RN
Sheila Hunter, RN
Angela Kelly, RN
Charlotte Guglielmi, RN
The Interventions
Needs Assessment Survey Results: 104 Faculty & Periops staff respondents
Anesthesia & Surgery have revised departmental orientation processes to include
onboarding checklists with useful orientation items, resources for new Faculty, and
transparency in process
Surgery has implemented a 360 Review of Faculty
Lessons Learned
Key Takeaways Regarding Needs Assessment:
Orientation is NOT standardized across Departments and Divisions
Checklist for orientation should include key items
o A list of resources, names, numbers, maps, administrative contacts
o Clear definition of orientation, expectations, process & timeframe
o Orientation to IS systems
o Mentor/Preceptor(s)/designated resource for orientation
o Easy accessibility to Departmental Policies and Procedures, Guidelines
Multidisciplinary learning and strategy enabled identification of existing resources
and practices and how tools might be deployed to a wider audience
Perioperative Services maintains a well‐organized and thorough orientation
process reinforced by designated RN Educators
Scale: Creating an interdepartmental onboarding process electronic resources
requires significant resources and time to design and implement
Next Steps/What Should Happen Next
Use Departmental resources to create an Interdepartmental Orientation Process &
Checklist
Deploy Departmental and Interdepartmental Mentorship Program
Create of Online Resource Guide integrated into the Portal
Explore team building exercises across departments to improve communication
that includes both experienced staff and those employees new within the last year
For more information, contact:
Ruma Bose, MD, Anesthesia
rbose@bidmc.harvard.edu
Selena Heman-Ackah, MD, Surgery
sackah@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.
Ruma Bose (<a href="mailto:rbose@bidmc.harvard.edu">rbose@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Ruma R. Bose<br />Selena E. Heman-Ackah<br />Maureen Houstle<br />Brian P. Ferla<br />Sahar Kohanim<br />Sheila Hunter<br />John Tumolo<br />Angela Kelly<br />Charlotte Guglielmi
Dublin Core
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Title
A name given to the resource
Design Orientation to Engage New Faculty and Accelerate High Performance
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ad0f0043f62b9ef821079d487170fb0.pdf?Expires=1712793600&Signature=j5JFCsxnxDo7j%7EFkHabzIvX0PdVcHaANsUjB7H5U21wsi02zYFJcqwQF9jRnKCqcU7I8LH37UUtJW4TyI59XSDua2VqDvewgw3VR7p4NQSDJkrrX94q%7E%7EDPD6DpQGmvv-F3nDJUgerBgsbEpOmqtaehYA9xCgpSFMopHok0bL5-nJdRPQ-5lFdVYJBEqXd-3NvSGqUi89p9e73BLCSfqkCFn9xw6I1EI0Op2%7EsvOseT0R0KSCOypFdRPdM4vS729hDVNgePRS%7EPBRV6g-sQSR7KeFx-jsJJLJNBITAV8WLZ66cWPwW8z1ulYILEawyhKSC-%7En%7EozaAWi9JPifHlfPg__&Key-Pair-Id=K6UGZS9ZTDSZM
32a4720cf3d496abf633b16f0f9d2fa3
PDF Text
Text
Developing a Dynamic Postoperative Neurosurgical Triage System
The Problem
The Results/Progress to Date
An
increase
in
neurosurgical
and
high-‐risk
spine
volume
has
strained
the
resources
of
our
neurological
intensive
care
unit.
This
has
resulted
in
unplanned
admissions
to
other
critical
care
locations,
including
the
postoperative
anesthesia
care
unit
(designated
as
“neurosurgical
boarders”).
Data
supports
improved
outcome
when
such
patients
receive
the
specialized
care
provided
in
a
neurological
ICU.
Ø Collected
AIMS
Data
1/1/13-‐12/31/13
Ø Track
postop
destination
of
neurosurgical
patients
(in
progress)
Ø Correlate
data
since
implementation
(ongoing)
Aim/Goal
NEUROVASCULAR+
Ø Reduce
the
number
of
neurosurgical
boarders
by
designing
a
dynamic
system
to
effectively
triage
patients
between
levels
of
care
(Hospital
floor,
Step
down
Unit,
Neurosurgical
Intensive
Care
Unit)
FUNCTIONAL+
STEREOTACTIC+
SHUNTS/DRAINS+
TUMOR/CRANI+NOS+
EMERGENCY+
The Team
Dustin
Boone,
MD,
Anesthesiia
Brian
Ferla,
MD,
Anesthesia
Ron
Alterman,
MD,
Neurosurgery
Nicole
Catatao,
NP,
Neurosurgery
Suzanne
Joyner,
RN,
ICU
Patricia
Sorge,
RN,
ICU
N=#645#
Lessons Learned
Ø Resource
allocation
can
be
used
effectively
and
safely
to
triage
patients
who
undergo
neurosurgical
and
high-‐risk
spine
procedures.
The Interventions
Ø
Ø
Ø
Ø
Create
criteria
to
assist
with
triage
Daily
multidisciplinary
communication
Daily
pre-‐round
in
Neuro
ICU
to
identify
patients
who
can
be
discharged
Identify
patients
from
OR
who
would
need
admission
to
postoperative
Neuro
ICU
Next Steps/What Should Happen Next
Ø Expand
the
number
of
step-‐down
beds
Ø Continue
to
track
postoperative
critical
care
utilization
For more information, contact:
D. Boone, MD, BIDMC, Department of Anesthesia, Critical Care,
and Pain Medicine, mboone@bidmc.harvard.edu
�
Dublin Core
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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.
Dustin Boone (<a href="mailto:mboone@bidmc.harvard.edu">mboone@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Neurosurgery
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Dustin Boone<br />Brian Ferla<br />Ron Alterman<br />Nicole Catatao<br />Suzanne Joyner<br />Patricia Sorge
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
Developing a Dynamic Postoperative Neurosurgical Triage System
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency