1
20
358
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3e5c68ecd9057853b7833000d572b910.pdf?Expires=1712793600&Signature=AuRvElrGCs-WD8EOVmxd9B2lnYIhg1-HkGDrcvmu%7ETjBfUiqj6j9EyRPHQXWVThWXtKFIXoaMi%7EXrcSVPgxxrGscp3ZMjWFaQGb8T-FNPTrhN-D3wwGgwAsUqA2ETPMnzlTiYLOa-S3ClU6a257LS5qWiyeMfnZXOTRNIhkc4LpD0ezI%7E5ILDJqQFgqFTC76aKIv3KabC4Wr%7EwzJoSt22ymRfucbsdBJyAAUxle9MMDdEPLnCl7ecYvXO02Gh68I0yduxufELkJFvRUFUSJk9xrLvRjHFfncN1zanCaIrw02-1ivR9fUH4ZG3xNZaKZiz5hil7WzBf08b4HEVpz2HQ__&Key-Pair-Id=K6UGZS9ZTDSZM
b090ba29bfef97a2ac7b5dcce2071a9f
PDF Text
Text
Inpatient Rehab Services’ Response to COVID-19 Pandemic
Brigitte Greenstein, OT, OTD
Margaret Walkup, PT, DPT
Beth Israel Deaconess Medical Center
Introduction
With the onset of the COVID-19
pandemic, the rehabilitation services
team had to adapt to the changes in
patient caseload, visitor policy, and
infectious disease guidelines. This
poster aims to describe the process
changes and outcomes that the rehab
department implemented during the
pandemic.
The motivations for our process
changes included:
- Minimizing the risk of transmission to
ourselves, families, coworkers, patients
- Maintaining a high standard of patient
care
- Maintaining a supportive atmosphere
to reduce burn out amongst our
colleagues
- Learning about COVID-19, how it
spreads, and the long term effects on
function and cognition
- Patient preference for discharge home
over discharge to rehab given the higher
COVID-19 infection risk
Process Changes
Minimizing risk of transmission:
- Implementation of staggered start times
- Creation of a virtual huddle board
- Day neutral staffing split into two teams
- Identification of COVID OT/PT
- Purchase of portable stair for in-room use
- Creation of patient fact sheets about energy conservation,
staying active while in the hospital, and PICS
- Minimized 1:1 time with patients by calling into their rooms to
schedule visits and obtain social history
- Bundling tasks to reduce need for other care providers to enter room
Clinical resources:
- Team leaders summarized up to date literature about COVID-19 and implications
for rehab
- Clinical guidelines were developed to assist with decision making regarding timing
of OT/PT interventions
- Weekly case discussions to debrief and educate
- Redeployed per diem and outpatient staff
- Safe Patient Handling team’s role in proning team
- Disaster documentation
Discharge planning:
- Use of technology to facilitate family trainings during periods of limited visitation
- Assisted in identifying candidates for transfer to NEBH and Boston Hope to
facilitate discharge and throughput
- Increased the frequency of OT/PT visits to promote d/c home rather than rehab
when able
Staff comradery:
- Created homeward bound board as a visual representation of patients that rehab
services helped discharge home
- Created a pool of therapists to rotate in COVID units
- Runner shifts to support nursing staff
- Wellness rounds, including group yoga
Outcomes
- Continued use of virtual huddle board
- Development of COVID-19 Rehab
Intranet that includes fact sheets and up
to date clinical information
- Ongoing use of the portable stair
- Streamlined documentation
Conclusion
Rehab Services was able to adapt to
patient specific needs during the
COVID-19 pandemic, while maintaining
quality care, that continue to be utilized
to this day.
In the event of another pandemic,
Rehab Services now has structures in
place to improve communication with
patients, families, and staff, while
keeping transmission risk low.
Acknowledgements
We would like to thank all of our rehab
colleagues who worked tirelessly
throughout the pandemic to provide
quality patient care.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
<p>Brigette Greenstein (<a href="mailto:bgreenst@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">bgreenst@bidmc.harvard.edu</a>)<br />Margaret Walkup (<a href="mailto:mwalkup@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mwalkup@bidmc.harvard.edu</a>)</p>
Project Team
Brigette Greenstein
Margaret Walkup
Katelyn Campbell
Brian Mcdonnell
Shannon Stillwell
Department
Any departments listed on the poster or identified in the spreadsheet.
Rehabilitation Services
Occupational Therapy
Physical Therapy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Inpatient Rehab Services' Response to COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/eb0a7b3713190eafd9d8db47cfafe959.pdf?Expires=1712793600&Signature=rDngNIbbwXxoxSb9jB7zllcd3alylFI3DV3Sp1o3QcjOwABKN9%7E8-9Ov8Q9nAm8GJr9uoY-mzvj9hJcM-lgnvk0S0mpGM5oJv11wUyndnL7BRZSI4r%7EiFaSLDuACrb-R-Zzg-781uLrZTb8fEUQxWW7p13Y0ogyTDXVT3WXWC5AOXAwairiGjg12Uf3Y1khzVcegG%7E4BgSPcDZRFw2FnHL5YSDghfcTwpGN8JcmgK0V1O-us2WRVLaNtRwqAyUHasNTjXM2U1xC17Y9%7EFjYS0x6k1fvgdX2oRLCgWNFH6dKwf8AWexxUg9xLIM1OFC6nHfVYpsXsPBmDxCPRaL4l%7EA__&Key-Pair-Id=K6UGZS9ZTDSZM
028b6079f2a3e5d07aff6598c309b11c
PDF Text
Text
Potentially Inappropriate Use of Opioid Infusions at End of Life
Jonathan Yeh MD, Sul Gi Chae PharmD, Peter Kennedy NP, Harry Han MD, Cindy Lien MD,
Mary Buss MD MPH, Kathleen Lee MD
Section of Palliative Care, Division of General Medicine
Problem
Table 1: Patient Demographics
- Patients at end-of-life (EOL) commonly develop
symptoms like pain and dyspnea.
- Intravenous-as-needed (IV PRN) opioid boluses
at effective doses provide rapid symptom relief
(onset 15-30 min) and faster dose titration.
Continuous opioid infusions (“drips”) require 6-8
hours to reach steady state.
- Overreliance on drips instead of IV boluses
can lead to poor symptom control and
increased side effects
- Aim: retrospectively review opioid bolus/drip
practices in patients who died at BIDMC on an
opioid drip in the last 24 hours of life.
Approach
193 pts who died at BIDMC with CMO (comfort
measures) status and on a drip in last 24 hrs of
life between Oct 2020-March 2021
Identified potentially inappropriate use of
drip, defined as any of the following:
• Started drip in opioid-naive patient (<50 oral
morphine equivalents (OME) in 24 hours
preceding drip initiation)
• Increased drip rate >3 times in 24-hour period
• Started or increased drip without using IV
PRN bolus at least 3 times and at least every
2 hours
Abstracted admission data, opioid use patterns
(total doses, frequency), written evidence of
patients, caregivers, and staff distress in notes
Examples of Distress
Table 2: Hospital Utilization and EOL Processes
Age at death (mean)
Gender
Male
Female
Race/Ethnicity
White
Black
Hispanic/Latino
Asian or Other
Unknown
Insurance Status
Medicare
Medicaid
Private Insurance
Uninsured/Self-Pay
Other
COVID-related deaths
Cancer-related deaths
Location of Death
ICU
Floor
Campus
East
West
Service at Death
Cardiology/CV Surgery
Medicine
(Attending Service)
Medicine
(Housestaff Service)
Medical ICU
Neurology/Neurosurgery
Oncology/BMT
Surgery/Surgery ICU
Trauma/Trauma ICU
All
(n=193)
69 ± 14
Appropriate Inappropriate
p-value*
(n=109)
(n=84)
68 ± 15
70 ± 13
0.35
126 (65%)
67 (35%)
73 (67%)
36 (33%)
53 (63%)
31 (37%)
0.31
104 (54%)
22 (12%)
18 (9%)
14 (7%)
35 (18%)
60 (55%)
14 (13%)
13 (12%)
9 (8%)
13 (12%)
44 (52%)
8 (10%)
5 (6%)
5 (6%)
22 (26%)
0.09
102 (53%)
27 (14%)
50 (25%)
7 (4%)
7 (4%)
40 (21%)
58 (30%)
62 (56%)
16 (15%)
23 (21%)
4 (4%)
4 (4%)
29 (27%)
36 (33%)
40 (47%)
11 (13%)
27 (32%)
3 (4%)
3 (4%)
11 (13%)
22 (26%)
131 (68%)
62 (32%)
70 (64%)
39 (36%)
61 (73%)
23 (27%)
51 (26%)
142 (74%)
33 (30%)
76 (70%)
18 (21%)
66 (79%)
15
9
6
16
10
6
13
5
8
83
19
14
19
14
47
10
11
10
7
36
9
3
9
7
Continuous variables: mean ± standard deviation,
Categorical variables: raw numbers with percentage distribution in each column.
Abbreviations: BMT, bone marrow transplant; COVID, coronavirus-related infectious
disease; EOL, end-of-life; ICU, intensive care unit; LOS, length-of-stay; OME, oral
morphine equivalents; PC, palliative care
Hospital LOS (days)
PC consulted for EOL
management
Days from Admission to PC
Consult
Hours from CMO to Death
Floor transfers during EOL care
Enrolled in hospice
Hospice LOS (days)
All
(n=193)
13 ± 14
Appropriate Inappropriate
(n=109)
(n=84)
14 ± 15
11 ± 12
p-value*
0.15
40 (21%)
32 (29%)
8 (10%)
<.001
11 ± 13
12 ± 15
9±9
0.53
21 ± 41
21 (11%)
29 (15%)
3±2
23 ± 36
10 (9%)
20 (18%)
3±2
18 ± 46
11 (13%)
9 (11%)
2±2
0.42
0.75
0.14
0.43
Table 3: Opioid Use and Frequency of Distress
All
(n=193)
0.54
0.02
0.30
0.22
0.17
0.62
Opioid infusions used in EOL
care@
Fentanyl
93 (48%)
Hydromorphone
66 (34%)
Morphine
45 (23%)
Total OME (24 hours prior to
419 ± 672
infusion)
Total OME (first 24 hours of
517 ± 675
infusion)
Total OME (24 hours prior to
648 ± 731
death)
Potentially Inappropriate
Criteria Met
None
109 (56%)
Any
84 (44%)
Patient was opioid-naïve prior
60 (31%)
to infusion
Infusion rate increased >3
16 (8%)
times in a 24-hour period
Infusion started or increased
43 (22%)
without sufficient PRN usage
Distress Noted in Medical
Record&
None
166 (86%)
Any
27 (14%)
Patient
22 (11%)
Caregiver
4 (2%)
Staff
10 (5%)
Appropriate Inappropriate
(n=109)
(n=84)
p-value*
56 (51%)
41 (38%)
18 (17%)
37 (44%)
25 (30%)
27 (32%)
0.31
0.25
0.01
667 ± 784
100 ± 249
<.001
643 ± 769
354 ± 486
0.003
796 ± 807
458 ± 568
0.001
109 (100%)
-
84 (100%)
-
-
60 (71%)
-
-
16 (19%)
-
-
43 (51%)
-
1. Patient: “Appears to be in extremis,” “Rate
increased, pt exhibiting discomfort, rate
increased again.” “Drip uptitrated because pt
gasping, gurgling.” “Pt upset, c/o restraints.”
2. Caregiver: “[Family] wanted RN to decrease
gtt… for her vitals to be taken and to speak
with the doctor in regards to CMO.”
3. Staff: “Medications given w/ minimal effect.
Resident asked to assess.” “Pt retracting...
Morphine gtt titrated from 5 to 15 mg/hr, MD
aware".
Limitations and Next Steps
• Single center, retrospective chart review
identifying associations, not causal relationships
• Chart review for opioid use and distress may
not be accurate, may underestimate true
prevalence of distress
• Process map and cause/effect analysis to
identify factors contributing to this practice.
• Develop multimodal interventions with
interdisciplinary stakeholders (i.e. clinician
education, POE order set revisions, triggered
Palliative Care consultation)
Conclusions
105 (96%)
4 (4%)
2 (2%)
1 (1%)
2 (2%)
61 (73%)
23 (27%)
20 (24%)
3 (4%)
8 (10%)
<.001
<.001
0.20
0.02
*P-value compares Inappropriate to Appropriate groups, by chi-square test for categorical variables and t-test for continuous variables. P-values <0.05 (highlighted)
were statistically significant.
@Some patients received more than one type of opioid infusion for EOL symptom management
&More than one source of distress could be present for one patient
Potentially inappropriate opioid infusions
are…
1. …common at BIDMC. 44% of EOL
infusions met pre-defined criteria for
“potentially inappropriate use.”
2. …associated with more charted evidence
of patient and staff distress,
3. …less likely when Palliative Care assists
with EOL symptom management.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jonathan Yeh (<a href="mailto:jyeh3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jyeh3@bidmc.harvard.edu</a>)
Project Team
Jonathan Yeh
Sul Gi Chae
Peter Kennedy
Harry Han
Cindy Lien
Mary Buss
Kathleen Lee
Department
Any departments listed on the poster or identified in the spreadsheet.
Palliative Care
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Potentially Inappropriate Use of Opioid Infusions at End of Life
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/9cade9f5bfe0cb9f6780971a605e5d00.pdf?Expires=1712793600&Signature=B6rXqw6RU%7E9WcuebyzZYT0pHHiHFR5SwsVBpiuvAD0Rf3CeDl86LfqAk5O5CtVwXZjsiqivrp9T%7EjB17com60MXS3vHoba3xir%7EogdO3sPOYQMtlBz%7E1PLKS7WER7wF7T93i6ExCX-coz%7EYSmpEfJT6oN-Puocv7JQuKqBvJyJ6OKvjhwoHb61ESa8ivckmhauNLamnJMDBpSUyXLE7Niwb6QCUqqscOb-4ij7eRQTEN-T1h-7fMbeX34xefbs9KG1f6gJMXhXJdg1EJYNH7g8ai-GhO8ApcC9lPRO93bgXmj-79FxraB6OO3c1iYT-hj1Uu7qW5B8gl7hUyn9FKhw__&Key-Pair-Id=K6UGZS9ZTDSZM
fb6ce74aade0da53c16e9fc2257df6df
PDF Text
Text
Measuring Economic Gains for Telehealth for Primary Care Patients, Providers, & Hospitals
Catherine M. Ternes, Senior Project Manager, BIDMC-Healthcare Associates
Introduction/Problem
The Interventions
Out of necessity, HCA went from 0% to 90% telehealth in one weekend in March 2020. Now that we are
emerging from the pandemic, there are critical learnings for our practice and the broader
BIDMC/HFMP/BILH system we should heed moving forward.
Estimates of the annual economic loss of in person care for patients, providers, and the hospital were
calculated using a combination of primary, secondary, and tertiary sources. The data were pulled from the
real-life experiences of the patients and providers of HCA between 2019-2021, and validated using
external scientific articles and reporting on the impact of telehealth on primary care, before and after the
COVID-19 pandemic.
Telehealth represents the greatest opportunity for radical redesign in health care since electronic health
records. Primary care is particularly well-positioned to benefit from widespread telehealth utilization due
to diversity in cases and increasing focus on chronic care management, behavioral health, which can be
done remotely However, there are two primary weaknesses in BIDMC/HCA’s current approach to
telehealth: 1) Insufficient investment has led to inefficiencies which make telehealth more time-consuming
for providers than in person care and 2) A gap in proactive outreach, education, and customization means
the most vulnerable patients, who are also most likely to benefit from telehealth and whose lack of care
continuity and/or access to primary care contribute significantly to inefficiencies in the system, are at risk
of underutilizing it or not using it at all.
Aim/Goal
The aim of this research was two-fold: First, we wanted to better understand the realities of telehealth at
HCA during the COVID-19 pandemic. We wanted to get some quantitative data and qualitative analysis
around how the system was performing and what some of the barriers were for patients and providers.
The second goal of the research was to begin to develop a basic method for estimating the financial cost
of not having telehealth for patients, providers, and the hospital.
Results/Progress to Date
Process map of in
person care experience
showing MassHealth
patients (10% of HCA)
spend an additional 261
minutes (4.4h), more
than double the time
spent by nonMassHealth patients
(90% of HCA), who
spend 130 minutes
(2.1h)
The Team
Catherine M. Ternes, Principal Investigator, General Medicine, BIDMC-Healthcare Associates
Marc L. Cohen, MD, Senior Sponsor, General Medicine, BIDMC-Healthcare Associates
Kayla Tremblay, MBA, PMP, Senior Sponsor, General Medicine, BIDMC-Healthcare Associates
Ravi Shankar Chaturvedi, MIB, MBA, PhD, Advisor, Tufts University, Fletcher School of Law & Diplomacy
Process map of virtual care experience
showing all HCA patients spend an
additional 10m for a 20m telehealth
appointment
For more information, contact:
Catherine M. Ternes, Senior Project Manager, cternes@bidmc.harvard.edu
�Measuring Economic Gains for Telehealth for Primary Care Patients, Providers, & Hospitals
Catherine M. Ternes, Senior Project Manager, BIDMC-Healthcare Associates
More Results/Progress to Date
HCA providers spend an additional 22m for a 20m in person visit compared to 28m for a 20m telehealth visit. With
investment in telehealth technology and support staff integration, providers could reduce time spent to just 20m.
Analysis of five common post-COVID scenarios regarding availability of in person vs. virtual care
and associated economic impact on patients, providers, hospital, and state economy.
Lessons Learned
-
Financial impact is an important metric to capture but one which is not as readily available as other
measures
Process maps are powerful visualizations and conversation starters
There are subsequent opportunities for research (publication) and improvement (Linde, CRICO grant)
Private companies, from startups to major institutions, are pivoting towards virtual primary care.
BILH/BIDMC needs to decide whether to collaborate or compete.
Recommendations
-
Calculation of savings to patients, providers, hospital, and state economy by going from 0%
telehealth (pre-COVID environment) to 25% telehealth (Most likely post-COVID environment).
Formally embed telehealth as a pillar of care
Pursue collaborations with public and private partners
Invest further to reduce provider inefficiencies
Better telehealth experience will enable us to not only operate more efficiently but also offer a way to
care for more of the most vulnerable patients.
For more information, contact:
Catherine M. Ternes, Senior Project Manager, cternes@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Catherine M. Ternes (<a href="mailto:cternes@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cternes@bidmc.harvard.edu</a>)
Project Team
Catherine M. Ternes,
Marc L. Cohen
Kayla Tremblay
Ravi Shankar Chaturvedi
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Healthcare Associates
Tufts University, Fletcher School of Law & Diplomacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Measuring Economic Gains for Telehealth for Primary Care Patients, Providers, & Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5883bcb04f1dcd626ff8b9172e55989f.pdf?Expires=1712793600&Signature=jS0BLvDiOrwUewEtSvSi-JSzqmpowE-DIApB6VXGhpESXjv8ATV9vrn4TdkM%7EHUr4IzCY-C3SZfKfFRhiY66ZQ6SdqscejEhhWJMncylzf9%7EJAJ9kq8jheaTH4WDwBomRHHOfm2s3jFMDupSscjvsw9D0MgPn4P5FlzFGVpoO5AxdeGS0LR3VZCUcD6efSGyLSM4qOFkFTzyR7WohPeoiwPDd2xmx98RIDQP6kWuFjddPEHkCG101RYfwjIY7LZmC9jX-pixQdaFOUc7TQelYUNFMsNHyJDA%7EM2G4Y3JcCM3ryKPrX64QfGkCXpIXzV7I7rS3j3WevdnxktiMiZn6Q__&Key-Pair-Id=K6UGZS9ZTDSZM
2a5d2341b474e6d90f263bcb78f8c782
PDF Text
Text
Addressing the Gap in NAFLD Screening
Nathan Sairam, MD1; Eddy Leung, MD1; Hirsh Trivedi, MD2, Jonathan Li, MD3; Michelle Lai, MD2
Department of Medicine1, Liver Center2, Health Care Associates3
Beth Israel Deaconess Medical Center
Introduction / Problem
Methods
● Non alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease that causes steatosis of the
liver in the absence of alcohol consumption.
● 50% of cases of advanced fibrosis from NAFLD are not discovered until they present with
decompensated cirrhosis, which has an 85% 5 year mortality without transplant.
● The incidence of NAFLD is projected to increase significantly by 2030 and will cause increased
incidence of NASH cirrhosis, HCC, and associated complications.
● NAFLD currently leads to $103 billion dollar in medical expenses annually.
● Diabetics have very high rates of NAFLD, with some studies showing 71% of diabetics having NAFLD.
● 23.1% of diabetic patients have F3-F4 fibrosis, which would warrant HCC and variceal screening.
● The American Diabetes Association currently recommends screening patients with diabetes for NAFLD
with yearly LFTs.
● 50% of diabetics with NAFLD and 56% of diabetics with NASH actually have normal LFTs.
● Fibroscan screening has the potential to identify patients with F3/F4 fibrosis with higher sensitivity
allowing for more early identification of HCC and varices.
● Using Arcadia, we generated a list of 101 diabetic patients seen at HCA clinic by three of our study
members.
● All patients were manually chart reviewed to determine whether or not they were getting yearly LFT
screening. Any patients with a 2 year or greater gap with no LFTs starting from the time of their
diabetes diagnosis was considered to not be getting yearly LFTs.
● All patients were chart reviewed to determine if they ever had persistently abnormal LFTs on at least 2
consecutive checks at any point in time.
● We reviewed prior imaging to determine if patients ever had incidental findings of steatosis of the liver.
Results
37% of patients with
diabetes were not being
screened yearly with LFTs
Aim / Goal
● Identify patients with F3/F4 fibrosis prior to presentation with decompensated cirrhosis and enroll
these patients into HCC and variceal screening pathways.
● Retrospectively review a cohort of patients with diabetes in the primary care setting to determine how
well we are currently adhering to the ADA’s current guideline of yearly LFT screening.
● Determine how often fibroscans are ordered for patients with abnormal LFTs or steatosis on imaging.
● Determine feasibility of direct to fibroscam screening strategy.
59% of patients with
diabetes had past or present
abnormal LFTs or imaging
showing steatosis but had
never received fibroscan
Conclusions / Next Steps
At HCA clinic, there is poor adherence to the current ADA guideline recommendation for yearly LFTs to
screen for NAFLD among diabetic patients. Furthermore, the majority of diabetic patients have had
abnormal LFTs or incidental steatosis of the liver on imaging at some point in their care but have not been
ordered for fibroscan to follow this up. Offering one-time fibroscan may therefore be a superior screening
strategy. We developed a call outreach effort to offer fibroscan to these patients. The outreach effort and
our results are described on the following slide.
For more information, contact:
Nathan Sairam (nsairam@bidmc.harvard.edu)
�Patient Perceptions about NAFLD and its Screening
Eddy Leung, MD1; Nathan Sairam, MD1; Hirsh Trivedi, MD2, Jonathan Li, MD3; Michelle Lai, MD2
Department of Medicine1, Liver Center2, Health Care Associates3
Beth Israel Deaconess Medical Center
Aim/Goal
Results continued
• Ascertain patient-related barriers to NAFLD screening by gauaging knowledge and interest in NAFLD
screening in patients by outreach calls
• Implement a direct-to-fibroscan approach to NAFLD screening for those patients who agree to be
screened with this approach
Methods
79%
A subset of patients were identified
through Arcadia and sorted with
exclusion criteria. The remaining
patients were contacted with outreach
calls using a standardized script
Number of Responses
Results
Number of Responses
What Patients had to say:
● “My liver numbers (liver function tests) are excellent. What else would
justify doing it (fibroscan)?”
● “Do my [diabetes specialists] know about this? None of them mentioned
anything about fatty liver disease.”
● “I have an appointment with my primary care doctor tomorrow. I want to
talk to [them] about it instead.”
● Patient was afraid the call meant she had fatty liver disease because nobody
had mentioned it to her before.
● Patient stated she was nervous about the [fibroscan] results because she
knows diabetes is bad and it “puts you at risk for everything.”
Conclusions
• Knowledge and awareness about NAFLD are low among patients with T2DM. For many, it had not
been discussed by their primary care doctors or specialists.
• Most patients intuitively believe that fatty liver disease is serious and warrants screening.
• Patient hesitancy regarding NAFLD screening may be improved by discussions initiated by the primary
care doctor as part of healthcare maintenance.
• Outreach calls using a standardized script may be an effective method in improving rates of NAFLD
screening in patients with T2DM.
Next Steps
1-10 scale where 1 is not serious at all and 10 is among the most serious
medical conditions
• Follow up on fibroscan completions rates in three months from the time they were ordered to
determine adherence
• Follow the results of fibroscans ordered. This may inform whether a direct-to-fibroscan approach
identifies advanced fibrosis in those who otherwise would not have been screened according to
guidelines that recommend liver function testing.
For more information, contact:
Eddy Leung (eleung3@bidmc.harvard.edu)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Nathan Sairam (<a href="mailto:nsairam@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">nsairam@bidmc.harvard.edu</a>)<br />Eddy Leung (<a href="mailto:eleung3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">eleung3@bidmc.harvard.edu</a>)
Project Team
Nathan Sairam
Eddy Leung
Hirsh Trivedi
Jonathan Li
Michelle Lai
Department
Any departments listed on the poster or identified in the spreadsheet.
Department of Medicine
Liver Center
Health Care Associates
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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
Addressing the Gap in NAFLD Screening
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/151880e0917fd1e491b7aab5c7917f54.pdf?Expires=1712793600&Signature=WKZtUGZ7wU4qUpq4pJPO3pm6HQHpitUwOj8DdzYJR3EUu0pTBxME2jIw7flMyg4CoI9GRUfvXZPQRBxRVhBGJMmnl56bn9IP5LtOHcmjhnkTLk9Nj7lOtJOH4gIVvNXSVoXjLv88XlJyWl-DfjPGMsKaFFlHVRQ-tgQ5WkWhNCvWjXaklhhD-4eGKpFXuC0wHazX9glJqw0KsFsRalZQ5iwxtC%7EoYnkiDNSA4gwhohldPujCju1Y8eHGOX%7ENjcRVn9EZZvTb5OklxcW0i2DsLEQf%7EJ1QYMJSnL%7E3cg7JQFmEAUW9gMh-0ACbCzYFXC4TxStJRH6KFQmsFw-4SlrYBg__&Key-Pair-Id=K6UGZS9ZTDSZM
3b1d4200ecd2a6b5ddd6f0b3c05425fc
PDF Text
Text
Social Work Response to COVID
Mary McDonough, LICSW
Social Work Department, Clinical Manager of Med/Surg, ED and Transplant
Beth Israel Deaconess Medical Center
Introduction/Problem
How did inpatient social work team respond to needs presented by pandemic beginning March 2020
Initial concerns regarding safety, ability to meet needs of patients, families and staff.
The Interventions
Staffing
Work on units
Support to pts and families
Staff support
A whole new focus in our work in collaborating with teams to facilitate end of life visitation, working with
on line meetings, discussions of end of life decision making via ipads.
Readjusting to new world of resource needs, transportation, shelter limits, dialysis unit limitation, court
closures.
Providing support to staff, informal and formal support modalities, in person vs remote,
groups/individuals, bringing in resources.
Aim/Goal
Results/Progress to Date
Immediate response
What worked
Pulling team together immediately, 3/13 met w/ whole team in person, didn’t have
tools yet for zoom, etc.
Decision made to work 50/50 onsite/remote
To respond to needs of patients, families, and staff during differing stages of COVID pandemic
To adjust staffing to meet needs of patients, families, and staff.
The Team
Medical Surgical Social Work Team
Safety concerns
Remote vs onsite work
Working in teams to provide response to inpatient units
Requirement daily “pod” check ins to make sure that patient needs addressed
What didn’t work
Unclear message to patient care units,
Interpreted as we “went home” altho more than half the staff and both leaders were
here on site 100%
Eventually developed on site requirement, but created more flexible schedules with 10 hour days to allow for some
social distancing and address staff exhaustion. Still evaluating effectiveness
Collaboration throughout the medical center, often standing with spiritual care colleagues.
For more information, contact:
�Social Work Response to COVID
Mary McDonough, LICSW
Social Work Department, Clinical Manager of Med/Surg, ED and Transplant
Beth Israel Deaconess Medical Center
More Results/Progress to Date
STAFF SUPPORT
WORK ON UNITS
Quickly became almost all COVID patients
ICU’s expanded beds to RB6, RB7
Primary role in end of life care
Strengths:
Formal and informal leadership within social work group
MICU/SICU Social Worker and RB 7 Social Worker became
interchangeable
Challenges:
Some staff unprepared for end of life work
Staff were not sufficiently cross trained to work in other units
Responding to the needs of the responders
Formal and informal support
Inpatient support groups, led by social workers (inpatient and outpatient) and chaplaincy
Inconsistent participation but some very powerful moments and times on patient care units
Mostly effective with/from social workers well known to units
Outpatient staff want to be helpful but hard to do by Zoom and hard to predict time that worked
Informal support most often what worked, staying late after a hard shift, debriefs after a hard death
Lots of tears, few hugs
Lessons Learned
SUPPORT TO PATIENTS AND FAMILIES
Became proficient in zoom, facetime, and other technologies
Coordinated arrival of IPADS on patient care units
Coordinated end of life visitation in collaboration with medical, nursing leadership, hospitality staff, public safety, and Spiritual Care
Prepared families for visits, escorted families from lobbies
Strengths:
Great collaboration to meet needs of families, everyone just picked up
whatever they needed to get it done
Challenges:
Guidelines kept changing, weekly meetings addressed outpatient and clinic
visits, cafeteria visits but not very clear about managing inpatient visits
Weekend staffing, late evening staffing
Social Work drop in time
Working in crisis mode, not best decision making
Changing guidelines really hard to keep up with
More cross training needed, internal shadowing
Need to evaluate effectiveness of changed schedules
Turn over of staff, pulled manager away from staff to cover for almost a year,
Next Steps
Reevaluate pros and cons of 4 day work weeks
Survivor mentality, grown in closeness, 9 new hires since beginning of pandemic, 30% turnover of
staff, redeveloping identity of group
For more information, contact:
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mary McDonough (<a href="mailto:mmcdonou@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mmcdonou@bidmc.harvard.edu</a>)
Project Team
Medical-Surgical Social Work Team
Department
Any departments listed on the poster or identified in the spreadsheet.
Social Work
Spirtual Care
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
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
Social Work Response to COVID
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c4f0bc4d64d50bfe1cac4a489f009d51.pdf?Expires=1712793600&Signature=wQgB5ThpesdwuivyLXX97kcAtVRLct6vCQeg26N0iDqAE6PpRdCqhb20032703J19B718khzhaFtqMWXNoW%7E3AwRDN%7EDErZS%7El1jrxx56fGtEJ4ATIfcLwX4QoJhKOCWVzvT9JLXWi6TNb18OCSlDnFgPFg-zkraXXFHLZ1gmCs7O-59yFGIpcTCnylZZFMDn33nRe1E%7EZE4AmQWVHUvZYJZKw9kqTrWfSkxgbBWrxGmTMWNTKIPTeHbGOTqszjMrFWv%7Ec60Vcn7fl3v5T0VAM-WuqTLvd7OHRjRG0f%7Er5qhLD-Px65egYYwdLtjuL486u5aQ5ZT804Yyx2hFTZv1Q__&Key-Pair-Id=K6UGZS9ZTDSZM
39123ce8be1dcde1e9d4e56e1a29de79
PDF Text
Text
Alicanto Consult as a clinical tool for virtual tumor boards, asynchronous dialogues and referrals across the BILH Cancer Care Network
Andrew C. Lyu, MD1; Jessica A. Zerillo, MD2,4 ;David J. Einstein, MD2; Robin Joyce, MD3; Melis Celmen, MHA4, Brian Russell, MD1;
Katherine Bloom5; Yuri Quintana, PhD5
1Department
Introduction/Problem
of Medicine, BIDMC, 2Division of Medical Oncology, BIDMC, 3Division of Hematology and Hematologic Malignancies, BIDMC, 4BID Cancer Center, 5Division of Clinical Informatics, BIDMC
Implementation and Design
With the COVID-19 pandemic and limited in-person
attendance at meetings, the Division of
Hematology/Medical Oncology saw a need to develop
and implement a clinical platform that would allow for
tumor boards to be conducted virtually. Such a platform
required the ability to easily upload, safely store,
organize and access clinical data by collaborators
across the BILH network.
At the same time, with the growth of the BILH care
network, patients have access to a wide variety of care
options, ranging from convenient community locations
with high-quality care to more specialized quaternary
care centers. Within Hematology/Medical Oncology,
patients are able to receive care close to home in their
communities and have the ability to be referred for
specialized care including clinical trials at BIDMC. To
provide the best, personalized patient-centered care,
patients are often referred from one BILH site to another.
Keeping track of patient referrals across a wide variety
of EMR systems has been a challenge with the growth
of the network.
Features and Advantages of Alicanto Consult:
Ø Allows users from all BILH sites (regardless of home EMR) to easily submit
and review clinical cases via an online interface
Ø Ability to upload, securely store, organize and access clinical data via an
online web interface or iOS application
Ø Workstation notifications via browser while logged into Consult system
Ø In-house team development team allows for customization and system
modifications to be made rapidly depending on clinical need
Ø
Ø
Ø
Aim/Goal
To develop and implement an online platform to allow
for virtual tumor boards, efficient, asynchronous clinical
discussions and electronic referrals across the BILH
cancer care network
Alicanto (https://www.alicantocloud.com) - an online platform with
tools to support group collaboration, such as web conferencing, document
sharing, and asynchronous discussion forums
Developed by Dr. Yuri Quintana and his team at the BIDMC Division of Clinical
Informatics
Alicanto BIDMC - launched in December 2019, initially to support collaborative
work across BILH within Hematology; can be accessed online at
https://www.alicantobidmc.org/ or with a mobile application.
https://apps.apple.com/al/app/alicanto-mobile/id1481350682
Ø
Ø
Alicanto Consult – part of Alicanto BIDMC; developed and preliminarily
implemented in March 2020 to support virtual tumor boards and “Difficult Cases
in Oncology COVID19 Forum”
In order to support referrals across the BILH Cancer Care Network, a pilot
program was launched in January 2021 between BIDMC and BI Plymouth
within the hematologic malignancies and genitourinary oncology disease
subgroups
Above: Alicanto Consult
Web interface
Right: Alicanto iOS mobile
application
For more information, contact:
Andrew Lyu, MD, Hospitalist, Division of Medical Oncology; alyu@bidmc.harvard.edu
�Alicanto Consult as a clinical tool for virtual tumor boards, asynchronous dialogues and referrals across the BILH Cancer Care Network
Andrew C. Lyu, MD1; Jessica A. Zerillo, MD2,4 ;David J. Einstein, MD2; Robin Joyce, MD3; Melis Celmen, MHA4, Brian Russell, MD1;
Katherine Bloom5; Yuri Quintana, PhD5
1Department
of Medicine, BIDMC, 2Division of Medical Oncology, BIDMC, 3Division of Hematology and Hematologic Malignancies, BIDMC, 4BID Cancer Center, 5Division of Clinical Informatics, BIDMC
Results/Progress to Date
Ø
(March 2020 – October 2021)
30
Ø
Total of 612 cases submitted by 62
unique users between January 2020 –
October 2021
Total of 198 users from:
–
–
25
–
20
•
•
•
•
•
•
•
•
15
10
5
<1/9/20
AJH
Atrius Health
Number
6
2
Oct
Sep
Aug
Jul
Jun
May
Apr
2020
BILH network referrals
(March 2020 – October 2021)
(March 2020 – October 2021)
14
12
10
8
6
4
2
0
Number of Submissions
4-week Rolling Average
Source: Google maps
2021
(%)
1.0%
0.3%
0.2%
1, 0%
3, 1%
17, 3%
11, 2%
13, 2%
2, 0%
GU
7, 1%
Gyn
1
BIDMC Cancer
Center
BID-Milton
558
1
0.2%
Sarcoma
BID-Needham
24
3.9%
Neuro-Oncology
BID-Plymouth
2
0.3%
LHMC
8
1.3%
MAH
10
1.6%
Key Points
Ø
Ø
13; 2%
GI
35, 6%
Beverly Hospital
91.2%
Alicanto Consult
Submissions by Type
Alicanto Consult
Submissions by Disease Group
Submissions by Location
Location
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
(blank)
0
Jan
–
BIDMC Medical Oncology
BIDMC Hematology and Hematologic
Malignancies
BILH Cancer Care network:
BID-Plymouth
BID-Needham
BID-Milton
AJH
MAH
Lahey Hospital & Medical Center
Beverly Hospital
Atrius Health
BIDMC Divisions of Radiation Oncology,
Radiology, Pathology, Surgical Oncology,
Urologic Surgery, Gynecology and more
GU Tumor Board Submissions
19
-M
ar
-2
0
19
-A
pr
-2
0
19
-M
ay
-2
0
19
- Ju
n20
19
- Ju
l-2
0
19
-A
ug
-2
0
19
-S
ep
-2
0
19
-O
ct
-2
0
19
-N
ov
-2
0
19
-D
ec
-2
0
19
- Ja
n21
19
-F
eb
-2
1
19
-M
ar
-2
1
19
-A
pr
-2
1
19
-M
ay
-2
1
19
- Ju
n21
19
- Ju
l-2
1
19
-A
ug
-2
1
19
-S
ep
-2
1
Number of new Alicanto Consult users per month
72; 12%
Tumor Board
Submissions
Ø
Thoracic
58, 9%
Breast
465, 76%
Melanoma
Hematologic
Malignancies
Other
BILH Oncology Forum for
Difficult Cases COVID 19
submissions
Next Steps
Ø
Ø
527; 86%
Referrals across BILH
sites
Alicanto Consult has allowed clinicians from across the BILH Cancer Care Network to easily submit clinical
cases for multidisciplinary review in an online, collaborative environment without the need for in-person
meetings during the COVID-19 pandemic
Through this collaboration, knowledge can be shared and brought to the patient, wherever that patient is being
cared for. When appropriate, this collaboration then encourages referrals of patients across BILH sites of care
to ensure that patients are receiving the highest quality of care, as close to home as possible
Alicanto Consult allows for efficient clinical communication, expedient clinical care, and the potential to
centralize and organize referrals from across the BILH network
Platform roll-out to additional disease subgroups interested in utilizing Alicanto
Consult for virtual tumor boards
Enrollment of additional BILH clinical care sites and disease groups to simplify
network referrals with the hope of minimizing administrative redundancies and
ultimately improving the overall clinical experience for patients across the BILH
Cancer Center network.
For more information, contact:
Andrew Lyu, MD, Hospitalist, Division of Medical Oncology; alyu@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Andrew Lyu (<a href="mailto:alyu@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">alyu@bidmc.harvard.edu</a>)
Project Team
Andrew C. Lyu
Jessica A. Zerillo
David J. Einstein
Robin Joyce
Melis Celmen
Brian Russell
Katherine Bloom
Yuri Quintana
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Department of Medicine
Division of Medical Oncology
Division of Hematology and Hematologic Malignancies
BIDMC Cancer Center
Division of Clinical Informatics
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Alicanto Consult as a Clinical Tool for Virtual Tumor Boards, Asynchronous Dialogues and Referrals Across the BILH Cancer Care Network
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0fa49a0f310dd7b99d6ec818782fe93a.pdf?Expires=1712793600&Signature=WFTn7lLWnU6UulevzCkLwmCIq9tMDMecvaz1P2H1lCJnzi6EIm9LYEiayAsu1cC29cdg33a%7Ei6cJ-Oe%7EpFGIk0u14bOdGJMVchAqFq%7EaiH8ot-FPVKRh4f1lSPMyDsZeenE2LDW%7E3052mUOoSV%7EuhdXCEN0lWIWkU0NcIW1-mLr3%7ErZi-MNVl4uONEPxFXBUCNdiBxSmrGSoL60o-LqlhcPONABsqOoV29-qKJ-grYBdNI6Y1XmG1NZqeLGkrYBW9mNmCfYNSRoIJspWMNflu3dHfnEA9iqKwcu3CY4OX3yIDMQ3xE%7EtpaYejagoHewULzxUrBkWBftlU0YRJhS4Cg__&Key-Pair-Id=K6UGZS9ZTDSZM
28590d37b3dc0491bd013e2039a85384
PDF Text
Text
COVID-19 Monoclonal Antibody Therapy Implementation
By Mary LaSalvia, MD, Jaime Levash, Paula Stering, PA-C and Daniel Taupin, MD
Beth Israel Deaconess Medical Center
On November 13, 2020 the Massachusetts Department of Public Health (DPH) released a questionnaire to
determine which facilities had the capacity to treat COVID-19 positive patients in an outpatient setting.
BIDMC began preparing for an anticipated allocation of bamlivinimab (BAM) treatment. However, it was
decided implementing this treatment at BIDMC would not be feasible with uncertain drug allocation and the
challenge of bringing in COVID-19 positive patients into an ambulatory site. At the end of April, the group
moved forward with launching our ambulatory monoclonal Ab therapy clinic starting with casirivimab &
imdevimab which is under Emergency Use Authorization (EUA) by Food and Drug Administration (FDA).
Aim/Goal
The goal was to understand the rapidly-changing EUA and secure access to clinical space and resources in
order provide treatment to patients with COVID-19 who are at high risk for complications.
The Team
Jared Dore
Holly Creveling, PharmD
Kyle Franko
Howard Gold, MD
Michelle Knox, RN
Nicolas Kriketos
Mary LaSaliva, MD
Jaime Levash
Christopher McCoy, PharmD
Debra Melia, RN
Sara Montanari
Theresa Normile, RN
Margaret Stephan, RPh
Paula Stering, PA-C
Daniel Taupin, MD
Ellen Volpe
Julius Yang, MD
The Interventions
Worked with facilities to determine clinic location and ordering of equipment and supplies
Outlined a process for how the clinic would flow: referrals, documentation, scheduling, directions, and
communication with teams surrounding clinic
Outlined safety protocols in case of infusion reaction
Recruited and trained staff
Created a dashboard for team to review patients
Work with the drug shortage task force to develop a prioritization scheme
Worked with Lahey to open a second clinic to serve BILH patients
# Patients Treated
Introduction/Problem
80
70
60
50
40
30
20
10
0
Results/Progress to Date
Number of patients treated
172 patients (as of 10/27/21)
July '21
Aug '21
Sept '21
Oct '21
Lessons Learned
The multidisciplinary team learned to be flexible and pivot quickly when changes occurred with the EUA
and DPH allocation processes.
The importance of clear communication to providers explaining the steps to communicate with their
patient, order the medication, and provide necessary documentation.
The benefit and challenges of working across the network to provide equitable access to high-risk patients
across the city and state
Next Steps
Continue to expand treatment options; specifically for post-exposure prophylaxis for patients with severe
immunosuppression.
Finalize a shared electronic tracking system between Lahey and BIDMC.
COVID-19 positive test results will include information on monoclonal antibody therapy
For more information, contact:
Jaime Levash, Senior Project Manager Health Care Quality
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jaime Levash j<a href="mailto:%20">levash@bidmc.harvard.edu</a>
Project Team
Jared Dore
Holly Creveling
Kyle Franko
Howard Gold
Michelle Knox
Nicolas Kriketos
Mary LaSaliva
Jaime Levash
Christopher McCoy
Debra Melia
Sara Montanari
Theresa Normile
Margaret Stephan
Paula Stering
Daniel Taupin
Ellen Volpe
Julius Yang
Margaret Stephan
Kathryn Stephenson
Kim Sulmonte
Daniel Taupin
Cheryle Totte
Julius Yang
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Monoclonal Antibody Therapy Implementation
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5cddf11d65df7bd8a0122d52ac48e7db.pdf?Expires=1712793600&Signature=RXKNqJa2ztI03ENJSeNaMZUjSTKiJoualVS4KuPLddkR6JdUAZ80C7K7ipdic4VvrKWoowSky5L4B49jIOV8Cul%7EZDFaTqAcCAvJdqgtIDzX3Miw0ur9nXLvIF81FmhzvYTy543d2GeiaEsdhDOWwsoOehvi-FYJ6ouvEZ-AMfpOZgLuGltreRV7XeQiXekkqB1lJ4gYQwege1rm3d938xZJNS5uXv40UIS4wqB0B14noLX3OvOI2Yd0Hts7scmFkoyq1zO1fnkmta1Ztb7wKNCroSUreWJv-FSu3Yy4bdF%7EyQ4Ksqrnq8vMl7JxZIDEMsBPoCTQciLqQdnxfaWiTw__&Key-Pair-Id=K6UGZS9ZTDSZM
5f348c840976e5bc84f853f4a8c94461
PDF Text
Text
Adapting Interpreter Services to a Hybrid Model during COVID
Shari Gold-Gomez, Jordan Ellis, Interpreter Services Supervisor Team, and the entire Interpreter Services department
Introduction/Problem
In January 2020, Interpreter Services moved from a long-time paging system to a just-intime interpreter request software.
Two months later, in March 2020, Interpreter Services used this just-launched system to
enable appointment dispatching to approximately 50 interpreters, representing over 15
languages. We quickly increased to over 30 languages representing 100 interpreters,
including staff, per diem and non staff.
This quick transition to a hybrid model within 48 hours allowed BIDMC to maintain
communication and service delivery to LEP patient population.
Aim/Goal
The goal of this work was to provide seamless service delivery to the LEP patient population
in virtual, ambulatory, and inpatient settings during the COVID-19 pandemic.
The Team
Ø
Ø
Ø
Ø
Ø
Shari Gold-Gomez, Director, Interpreter Services
Jordan Ellis, Project Manager, Improvement & Innovation
Stephanie Baumeister, Operations Manager, Interpreter Services
Supervisors: Ana Torres, Janice P Chung, Ernestina Damoura Moreira, Rina Levin
The entire Interpreter Services department
The Interventions
Ø We first piloted remote interpretation with large
language teams in the weeks leading up to
March 13, 2020. We then had a proof of concept
that it was possible to provide interpreter
Ø
services remotely.
Ø We then changed protocols and began taking
hospital-issued devices home to be prepared for
remote work prior to March 13,2020.
Ø After the March 13th announcement that clinics
were closing, Interpreter Services changed their
configuration to base a minimal number of staff
on site with the balance of interpreters at home
ready to work remotely via the dispatching
software. The outcome was successful to adapt
the dispatching software to allow interpreters to
safely work from home while maintaining an onsite presence for complex patient interactions.
Donated clinical iPads were configured for ease
of use with Starleaf and interpreters on selected
inpatients floors for video interpreting.
Year
2019 (scheduled
interpreters)
2021 (hybrid model,
dispatching software)
Average Response Time
(Minutes)
15 minutes
5 minutes
Results
40,000 more encounters since FY18 with the
This project allowed a hybrid model to both
same staffing.
allow a key on site presence of interpreter,
with the balance of 100 interpreters to work
remotely: providing video and telephone
interpreting which had never been done
before by BIDMC interpreters.
This current models allows Interpreter
Services to serve 18% more encounters for
LEP patients and providers with the
efficiencies gained by not traveling and waiting
in a just-in-time model compared with FY 18
levels. This equates to supporting more than
For more information, contact:
Shari Gold-Gomez
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Shari Gold-Gomez (<a href="mailto:sgomez@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">sgomez@bidmc.harvard.edu</a>)
Project Team
Shari Gold-Gomez
Jordan Ellis
Stephanie Baumeister
Ernestina Damoura Moreira
Ana Torres
Janice P. Chung
Rina levin
Interpreter Services Department
Department
Any departments listed on the poster or identified in the spreadsheet.
Interpreter Services Department
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Adapting Interpreter Services to a Hybrid Model during COVID
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2933ab53c63567380ca632fe78ec98d7.pdf?Expires=1712793600&Signature=lZv%7EP-ixmzqvMfI%7EVU34pNkiX%7EOrsuqOOUNeQnYQmHQQNTkNM0EmO%7EwLQ7SOx-WTnPSiS2Ny55foKjB5LMEpYl9-VkewpAKH-okjxZZNoAUqC7Ba7R9DlK0br7nH8Vn8ZI1n28et6uJ-sEOrOjwlQVrkcFWpXuwMj%7EP0RS%7E89mnZH7fg7SUTBfztCwHNRgdJBG7EGDat7sfpNTq9wQgxd7I78YM0gdh0a6LKvcN8gUW4wns-DmRefkEtDcuMIWBLqnqwHBZ5xbzDXQtIVnU7bCyJqR%7Eg-eqUMYGerh0ckBt85YNm%7E9LA1ib8ErHFkFZK7Lc92ZmUbbXg7dlXMnvGCA__&Key-Pair-Id=K6UGZS9ZTDSZM
45ef80f097b8059c0c2de939ba683ca6
PDF Text
Text
Multidisciplinary approach to increasing vaccination rates of
patients starting immunosuppressive therapies
Ruby Gibson, MD, Min Ji Her, PharmD, Monica Mahoney, PharmD, Diana Kim, BS, Paula Stering, PA, Simi
Padival, MD, Martina Porter, MD, Daniel Taupin, MD
Introduction
•
Patients on immunosuppressive medications are
at a higher risk for infection. Dermatology
frequently
prescribes
immunosuppressive
medications and found a need to ensure patients
are appropriately screened and have up-to-date
vaccinations.
Objective
•
Increase the vaccination rates and appropriate
infectious disease screening of patients starting
immunosuppressive medication through the PreImmunosuppressive Clinic.
Methods
•
•
•
•
Through a multidisciplinary approach, a PreImmunosuppression Clinic was created. The clinic
is through infectious disease (ID)
and is
specifically dedicated to patients starting
immunosuppressive medications. We created
consensus immunization and screening guidelines
prior to starting immunosuppression.
We educated dermatology and infectious disease
physicians, pharmacy staff, and administration on
the workflow process (Figure 1).
A retrospective chart review was conducted from
June –September 2021 for dermatologic patients
starting immunosuppressive medications. We
reviewed referrals, successful follow-ups in the
Pre-Immunosuppression Clinic, and
vaccines/labs ordered by ID.
This chart review was approved by our internal Committee for Clinical
Investigations (CCI)/IRB
Dermatology visitplan includes
starting
immunosuppressive
medication
Infectious disease
(ID) administration
schedules
appointment
Dermatology orders
screening labs.
Prior authorization
process begins (if
needed)
Dermatology
pharmacist informs
patient about PreImmunosuppression
Clinic.
PreImmunosuppression
Clinic appointment
with ID
ID pharmacist
updates
vaccination
history
Results
Dermatology
places referral
ID orders
vaccines or
screening labs
as needed
ID Note
forwarded to
referring
dermatologist
•
Of the patients referred to the PreImmunosuppression Clinic, 63% went to the clinic.
•
100% of the patients seen in the clinic were due
for at least one vaccination per our consensus
guidelines. All patients seen in the clinic received
at least one vaccine dose.
•
Several patients received additional screening
labs after going to the Pre-Immunosuppression
Clinic depending on individual risk factors.
Common labs ordered included HIV antibodies,
Hepatitis A antibodies, Hepatitis B viral loads,
purified protein derivative (PPD)/ repeat Interferon
gamma release assay (IGRAs).
•
Several patients had already started their
immunosuppressive medication before seeing ID.
Figure 1. The referral process workflow for patient evaluation at the Pre-Immunosuppression Clinic
Immunosuppressive n
medications
Results
n
Patients starting
immunosuppression
64
Patients referred to ID
32 (50%)
Patients went to PreImmunosuppression Clinic
20 (63%)
Patients that received
vaccinations
20(100%)
Average age of patients who
went to ID
44.2
Average number of days that ID
visit occurred after referral
placed
12.75
Adalimumab
Risankizumab
Methotrexate
Ustekinumab
Mycophenolate
Secukinumab
Cyclosporine
Upadacitinib
26
12
7
6
6
5
1
1
Vaccines
received/planned
PCV13/PPSV23
Shingrix
Hepatitis B
Hepatitis A
Tdap
HPV
MMR
COVID-19 booster
Influenza
n
17
9
5
5
4
2
1
1
1
Discussion
•
The Pre-Immunosuppression Clinic has the
potential to increase vaccination rates.
•
There were additional recommendations and
screening/monitoring labs ordered for patients
based on risk factors or results from initial
screening labs ordered by referring dermatologist
•
Patients were seen in the PreImmunosuppression Clinic soon after the referral
was placed. Referral process and attending the
clinic did not delay the initiation of
immunosuppressive treatment.
•
Future directions include informing and involving
other specialties
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Ruby Gibson <a href="mailto:%20">rgibson1@bidmc.harvard.edu</a>
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Ruby Gibson
Min Ji Her
Monica Mahoney
Diana Kim
Paula Stering
Simi Padival
Martina Porter
Daniel Taupin
Department
Any departments listed on the poster or identified in the spreadsheet.
Dermatology
Infectious Disease
Pharmacy
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Multidisciplinary Approach to Increasing Vaccination Rates of Patients Starting Immunosuppressive Therapies
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/be08bceec45581574c7d7102519e3248.pdf?Expires=1712793600&Signature=wNYCj-qENhKo7h%7EmzueUc2rO1tgT-wPXGxxvvTZlyidDtKWDL8Qjq8x3NtYLaQ2LwygP%7EjeSwoq4CT9rOXhfaS4%7ErEmRf7PqeBoFB2OE4XRJBWjZk8MFST5z9FJPr5xc44ve7F1e79XNaJ8hOO1x59wJnhrWL0rv0mYpnT%7ES%7Ew7h8wRo-wZOnj2syP9kG0JJhVmNLTYBgfM%7EDOwUNsqmp6z7Ili-l4rOgI0ZkPV3GVPvFiUUNxB%7E3OATtw-YuZ1rUCGpEU3XaJn2lzXuKoD-ZpTM3FAFYqL1NJRFX1ixy7q3vksn3QmBgTlCk3%7EfgYFZYN%7E-QBxI%7EScvxBOEud273w__&Key-Pair-Id=K6UGZS9ZTDSZM
a4d2755a6e9cc76cb49b14246775e5f7
PDF Text
Text
Creating a Shared Model: Patient/Family Advisor Input into Crisis Standards of Care
David Sontag1,2, Lauge Sokol-Hessner2, Barbara Sarnoff Lee2, Melissa Doyle2, Laura Dickman2 – Affiliations: 1. BILH, 2. BIDMC
Introduction/Problem
•
•
•
As the first COVID-19 surge in early 2020 threatened to overwhelm health care
system resources, the prospect of potentially needing to implement Crisis
Standards of Care (CSOC) loomed over Hospital Incident Command (HICS)
teams.
CSOC provides a process for allocation of scarce resources (i.e., when demand
for certain resources is greater than the supply of those resources) that is fair and
equitable, and meets the values of the communities impacted by the CSOC.
Accordingly, leaders at BIDMC quickly recognized the critical importance of
engaging patients and families from across the Beth Israel Lahey Health (BILH)
network to explore how they would understand and respond to CSOC, and how
best to communicate about such changes.
Aim/Goal
Convene Patient/Family Advisors (PFAs) from BILH institutions to:
• Solicit their feedback about the Massachusetts Department of Public Health
(DPH) and proposed BILH CSOC guidelines, which were developed based on
DPH guidelines.
• Gather their suggestions about how best to communicate about CSOC should
they ever need to be implemented.
The Team
David Sontag, BILH Managing General Counsel, BIDMC Ethics Advisory Committee
Co-Chair
Lauge Sokol-Hessner, MD, Med/Surg Physician Leader for BIDMC HICS, Senior
Medical Director of Patient Safety, Department of Health Care Quality, BIDMC
Barbara Sarnoff Lee, LICSW, Senior Director of Social Work and Patient & Family
Engagement, BIDMC
Melissa Doyle, LICSW, Patient & Family Engagement, BIDMC
Patient/Family Engagement Leaders from across BILH
Patient/Family Advisors from across BILH
The Interventions
BIDMC Patient/Family Engagement (PFE) & BIDMC/BILH CSOC Leaders quickly identified the most optimal PFA
engagement strategy and functioned as a centralized planning team supporting other BILH PFE leaders in recruiting
their PFAs by providing background and sample scripts to increase buy-in to the project.
Ultimately, PFAs from all BILH entities were invited to attend a two-part series:
1. Large group presentation defining & outlining DPH guidelines & publicly available CSOC communication strategies
2. Smaller group bidirectional listening sessions where PFAs offered feedback, posed questions, and made suggestions
In advance of the listening sessions, PFAs were asked to reflect on the following questions and were encouraged to
bring their own:
1. The stated goal of the crisis standards of care is “to maximize benefit to populations of patients, often expressed as doing the
greatest good for the greatest number,” which it does by giving priority for critical care resources to patients who are most likely to
survive with treatment to hospital discharge and in the near term after discharge (i.e., beyond five years). Does this seem like a fair
approach?
2. Imagine if your loved one was admitted with COVID and didn’t need a ventilator at the time of admission, but might need one in 1-2
days. How would you suggest we describe to patients and families what CSOC are, and what it might mean for them?
3. Now imagine that your loved one who was admitted with COVID gets sicker and warrants being placed on a ventilator, but
unfortunately the Decision Team is unable to allocate them a ventilator because there are too few ventilators, and your loved one’s
Priority Score is too high relative to the other patients who need ventilators. How should we communicate such decisions to
patients and their families?
Results/Progress to Date
• >100 BILH Patient Family Advisors (PFAs) and staff joined the initial presentation; ~45 PFAs and the
staff authors engaged in the 4 subsequent listening sessions.
• Participants were primarily white women. All sessions were conducted in English. The lack of racial,
ethnic, sex, and language diversity was reflective of current PFAC membership, but it was/is not
reflective of BILH’s general patient population.
• PFAs acknowledged that allocation of resources is a difficult topic and offered opinions around
fairness, communication needs, advantages & disadvantages of the allocation framework, and the
emotional impact of CSOC. See next slide for more details.
Laura Dickman, BIDMC Patient-Family Engagement Program Leader, ldickman@bidmc.harvard.edu
�Creating a Shared Model: Patient/Family Advisor Input into Crisis Standards of Care
Page 2 of 2
More Results/Progress to Date
Continued…
Dominant themes from PFAs
Fairness: PFAs considered alternative allocation frameworks, but in general, agreed
that the proposed framework (focused on maximizing lives and life-years saved) was
acceptable, so long as it did not disproportionately affect marginalized and
vulnerable populations. PFAs noted the importance of considering spiritual needs.
Communication: PFAs identified two major areas of communication needs:
1. General communication about CSOC
• When CSOC are imminent, this must be communicated to the general public.
Different communities may benefit from different media strategies. Key points:
what CSOC entails, why CSOC may be needed, what the public can do to help
avoid CSOC, and how CSOC guidelines were developed.
• If CSOC are implemented, additional communication, especially for
patients/families entering hospitals, will be necessary. Key points: CSOC are
coordinated with other regional health systems and all hospitals follow the same
guidelines. The amount and detail of information conveyed should be titrated to
meet a range of patient-family information preferences.
2. Communication with patients/families when the patient would not be
receiving a scarce resource based on the CSOC allocation guidelines
• Focus on communication skills; pre-emptively provide health care professionals
the training and tools they need to most effectively and empathically
communicate with patients/families (e.g. Vital Talk framework for talking about
CSOC), recognizing the value of multi-disciplinary groups that can provide both
medical information and emotional support.
• Communicate early and often, in culturally sensitive ways, about (A) the people and processes that
make allocation decisions, emphasizing that allocation decision teams take into account each
patient’s unique situation and are separate from treating teams, (B) that despite any unfavorable
allocation decisions, all other available medical care will still be offered whenever appropriate, and
(C) any additional resources.
Need for More Advance Care Planning: PFAs appreciated that allocations should be consistent with
the patients’ values and preferences (to the extent possible), and recognized the need to better
engage in advance care planning conversations with primary care providers and family members,
prior to any suffering any serious illness.
Lessons Learned
It is critical to engage patients/families early when working on time-sensitive challenges that may significantly
impact their health and care experience
To encourage a diversity of perspectives, take a system-wide approach, and continually work to find ways to
better engage underrepresented and unrepresented populations
When the topic is complex and emotionally charged, first make time to explain the topic, then allow time for
absorption, then elicit feedback
*Reflections from CSOC Leaders*
Next Steps
•
•
Should CSOC ever be imminent or actually implemented, consider iterative testing and
revision of communication materials and tools with patient/family advisors
Consider proactively using a similar collaborative model between health system and patientfamily engagement leaders to address other challenging/sensitive topics that arise
Laura Dickman, BIDMC PFE Program Leader, ldickman@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Laura Dickman (<a href="mailto:ldickman@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ldickman@bidmc.harvard.edu</a>)
Project Team
David Sontag
Lauge Sokol-Hessner
Barbara Sarnoff Lee
Melissa Doyle
Laura Dickman
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Ethics Advisory Committee
Health Care Quality and Safety
Social Work
Patient and Family Engagement
Patient and Family Advisors
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
Creating a Shared Model: Patient/Family Advisor Input into Crisis Standards of Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Equality
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3b571792e33c013b32b2a8632a38e803.pdf?Expires=1712793600&Signature=NeW5NDAu1KrhBTWcQlGxpjfdToQA188o9uUX5oTBCXBZq%7EhaCbptw8kZgtj6cBpEFwpCTkOkaqq-8n653eLNOtZ47a%7EiTcrOWvIfyOI4nqzbld3iPPSmPtKcVXAxmAK3gRhG2m20lb6kpFAmj8Av9xmtP72HPOalr5xkvrRdKHBSzWd90%7EjjN37fXrHdZKZHhvQV4qTcuxy8ZivKbHXxIREqNximqz5Ub7OLd4MxoI6wc2mRDWuUrHpl1gqzl350L8iGkyEDIWdOEmsCTve3Bnu6atqgqXubOQQyilVPgZyLGUPCrTe8tSYGbLmDtj65TeJOs5oDfwFo6juTlveaIA__&Key-Pair-Id=K6UGZS9ZTDSZM
761f0283ac5895cf73d7ff63bfbfdc21
PDF Text
Text
Nurse Care Management for Pregnant & Postpartum Patients with Substance Use Disorder
Andrea Crompton, RN, Leanna Sudhof, MD, Bolanle Bukoye, MPH, Susan Remy, LICSW, Denise Studley, NP,
Aisling Lydeard, NP, Blair Wylie, MD, MPH, Toni Golen, MD, Meredith Colella, MD, Chloe Zera, MD, MPH
Beth Israel Deaconess Medical Center, Boston, MA
Introduction/Problem
Results/Progress
to
Date
Substance use in pregnancy is increasing in the United States. Meeting the needs of patients with
substance use disorders (SUD) in pregnancy and the postpartum period requires a collaborative,
multidisciplinary, patient-centered approach. As part of the national Alliance for Innovation on Maternal
Health (AIM) quality improvement collaborative, we created a multidisciplinary implementation taskforce
including obstetricians, social workers, nursing and improvement experts. Results of the current state
analysis indicated fragmentation of care as a barrier to optimal care delivery. The team proposed an
intervention focused on increased care coordination for patients.
Aim/Goal
The Nurse Care Management (NCM) role was implemented to address the absence of coordinated
effective care for birthing people. The role is developed to provide systematic, coordinated, and
personalized care for patients with SUD during pregnancy and the postpartum year. Our goal was to
have at least 60% of pregnant patients with SUD to have initiated multi-disciplinary care prior to delivery.
The
Interventions
The OB NCM provides individualized care via 5 primary methods:
Ø Multidisciplinary team coordination across neonatal intensive care unit, social work, anesthesia,
obstetrics, addiction psychiatry
Ø Identification of logistical and psychosocial needs and connection with appropriate resources
Ø Multi-modal recovery coaching & group meetings (phone, email, text, zoom, in-person
accompaniment to clinical appointments, in-person support during delivery hospitalization)
Ø Hand-off to PCP at ~12 weeks post-partum
Ø Individual psychosocial and breastfeeding support through 1 year postpartum
Intervention
Highlight:
Peer
Support
Stronger Together: Parents Supporting Parents is a weekly zoom meeting that connects pregnant and
postpartum birthing people with SUD. The NCM is present to answer questions and facilitate topics. In
the future, we will incorporate a facilitator with lived experience and survey attendees for their input.
Lessons
Learned
1. We were able to demonstrate feasibility of implementing the multi-disciplinary meeting goal for >60%
of our patients with SUD. Moving forward, we will increase this goal to 80%.
2. Patient needs vary and evolve throughout the prenatal and postpartum period.
3. The earlier a patient is referred to the NCM, the longer they can benefit from multi-disciplinary care.
4. Listening to patients with SUD is crucial to forming a trusting relationship. The lived experiences,
goals, and priorities of each birthing person should be respected.
Next
Steps
The future direction for this role includes the following:
Ø Expansion of screening and referral to treatment across the OB/Gyn Department, thereby capturing all
patients who can benefit from this support rather than only those who are referred by their MD
Ø Integration and centering of patient experiences, voices and feedback for improvement
Ø Streamline data collection via RedCap forms
Ø Identify ways NCM support can be modeled for care in other high-risk pregnancy groups
For more information, contact:
For more information, please contact Andrea Crompton, RN - OB Nurse Care Manager - acrompto@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Andrea Crompton (<a href="mailto:acrompto@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">acrompto@bidmc.harvard.edu</a>)
Project Team
Andrea Crompton
Leanna Sudhof
Bolanle Bukoye
Susan Remy
Denise Studley
Aisling Lydeard
Blair Wylie
Toni Golen
Meredith Colella
Chloe Zera
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
OB/Gyn
Nursing
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
Nurse Care Management for Pregnant & Postpartum Patients with Substance Use Disorder
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b71c639542bb946f59b8741304225c88.pdf?Expires=1712793600&Signature=pMDlb8Kr6v2gV2cNR%7Eweb7spEn%7EkYoHR9h9EsYWvolLV5KitwkXbwDNcrljhdt%7Epu-O4in9VII6YiKO-xU-OzpLn-00XOtwrPlaezaWKePWzFjVbXpdG%7EFM1DZ2XTD6uzML1Ur1T5gH3%7EbT63ZEp-EXj3Uq18wNzfC4YkpZPV3yQHr21ZmcC9KwaLeY1uz6QlNALfLAfGU8hOjrWznkk5QEISNfKLxeVIMasZ0cg5SCDjb5NLYEnZMtDIirjv29%7ETA8V6wNTu4btV6W4AzI%7ELV4az-YCv%7ECJOj5YT7uKHAY%7EeU9zbn2aI3jLcZ1QSBvP9aNNgD4mOu8vubSBwFxGrg__&Key-Pair-Id=K6UGZS9ZTDSZM
df3c0dcc63140c25b1d0abd6a4b44720
PDF Text
Text
Sienna Li1, Claire Rushin1, Abraham Z. Cheloff1, MS, Bruce Tiu1, Piroz Bahar2, Annie Miall2, Alexander Chen2, Oluwatobi Ariyo2, Betty Ben Dor3, Debby Chang1, Sammer Marzouk2,
2
2
4
2
1,5
1,5
1,5
1,5
1,6
Kavya Shah , Sarah Shirley , Iris Zeng , Andrew Zhang , Gina R. Kruse , MD, Jonathan Li , MD, Howard Libman , MD, Katherine C. Wrenn , MD, Marya Cohen , MD, MPH
Amy R. Weinstein1,5, MD, MPH
1) Harvard Medical School, Boston, MA; 2) Harvard College, Cambridge, MA; 3) Harvard School of Dental Medicine, Boston, MA; 4)MGH Institute of Health Professions, Boston, MA; 5) Beth Israel Deaconess Medical
Center, Boston, MA; 6) Massachusetts General Hospital, Boston, MA
BACKGROUND AND NEEDS
EVALUATION
WORKFLOW
• The impact of the COVID-19 pandemic on primary care practices has
been profound, transforming technologies, workflows, and physicianpatient relationships.
• As such, providers have had even less time to care for patients’ chronic
conditions. In needs assessment interviews, primary care physicians
(PCPs) generally expressed the need for additional time with patients to
explain medication regimens and available resources as well as greater
support regarding patient motivation and mental health issues.
• Patients with diabetes are at greater risk of COVID-19-related morbidity
and mortality and may delay care for non-urgent health issues due to the
fear of in-person interactions or face other pandemic-related barriers.
• If these growing pandemic-exacerbated social disparities are not identified
and addressed in the setting of chronic disease care, patient outcomes will
suffer.
• Baseline characteristics did not differ significantly between patients
who enrolled and did not enroll in our program
• Patients faced multiple care gaps and social challenges at baseline that
could be addressed by the program
• Patients enrolled in the programs had varying levels of engagement
with their medical teams and of follow-up appropriate for their diabetes
in the past year
• Despite facing multiple SDOH challenges, patients endorsed high
motivation (median 7.5/10 ± 2.2) and confidence (median 7/10 ± 2.1) in
managing their diabetes during their SDOH screening calls.
*Of 64 patients who enrolled, 52 have been successfully analyzed by our staff. All calculations in Evaluation for "enrolled"
patients are based on these 52 records.
OBJECTIVES
• Adapt an existing student-faculty collaborative practice model to a
telehealth platform for diabetes management
• Assess the impact of the intervention on diabetes outcomes
• Measure the effect of screening for and addressing social determinants
of health (SDOH) on patients with poorly-controlled diabetes
SETTING AND PARTICIPANTS
• Healthcare Associates (HCA) is the primary care practice at Beth Israel
Deaconess Medical Center (BIDMC) is a tertiary care center in Boston,
Massachusetts and a teaching hospital of Harvard Medical School
(HMS)
• SDOH screening and recruitment calls were made by medical, nurse
practitioner, physician assistant, and undergraduate student volunteers
• 52 patients were enrolled and participated in structured diabetes
management visits carried out via telehealth at the student-faculty clinic
with care provided by medical and nurse practitioner students
supervised by a certified diabetes care educator/nurse practitioner and
attending physicians
• Additional visits with dietitian students and their faculty were available
to patients
DISCUSSION
*
EVALUATION
Age
(median)
Enrolled
Female
Gender
64
(IQR=5970.5)
HTN
HCL
CVD
Sees an
Endocrin
ologist
50%
23 White
31.75
14 Black (IQR=26.
5 Hispanic 7-35.525)
81%
83%
19%
19%
31.25
10 White
11 Black (IQR=29.
1 Hispanic 2-35.5)
79%
79%
21%
21%
0.8
0.7
0.8
0.9
Did not
enroll
64
(IQR=5668)
39%
p-value
0.5
0.4
Race
BMI
(median)
0.5
0.5
Table (left): Baseline
characteristics for patients who were
screened who did and did not enroll
in our study.
Graph (left): Enrolled patients with
selected clinical characteristics who
completed at least one visit (n=47)
Graph (right): Percent of enrolled &
non-enrolled patients endorsing each
SDOH challenge
Social Determinants of Health Challenges
100%
100%
90%
90%
80%
80%
70%
70%
60%
50%
40%
60%
66%
60%
55%
**
84%
58%
NEXT STEPS
• Study the program's impact on clinical outcomes, SDOH needs, and
patient and provider satisfaction.
• Implement our telehealth model to address medical and socioeconomic
burdens faced by patients with other chronic conditions.
HTN: Hypertension; HCL: Hyperlipidemia; CVD: Cardiovascular Disease
Clinical Characteristics at Baseline
• Integrating SDOH screening into a telehealth diabetes program is a
feasible and efficient way to assist patients with uncontrolled diabetes
with both medical and social needs.
• Despite reporting high levels of motivation and confidence in managing
their diabetes, many patients reported needing help with and were not up
to date with diabetes management.
• Patients reported difficulty maintaining a healthy diet, affording healthy
food and medications, and exercising.
• Our data highlight how SDOH may modulate patients' ability to manage
diabetes in a practical setting.
80%
***
65%
ACKNOWLEGMENTS
65%
50%
47%
36%
40%
30%
30%
20%
20%
10%
10%
0%
0%
LDL levels Patients on a
Urine
Patients on an Aspirin daily
checked in
statin
microalbumin ACE inhibitor
last year
checked in
last year
27%
23%
15%
27%
19%
24%
16%
Challenge Inadequate Difficulty Challenge Challenge Challenge
maintaining
diet
exercising affording affording affording
a healthy education
medication healthy housing and
diet
food
utitilties
Enrolled
Not Enrolled
*:p<0.05
**:p<0.01
***:p0.001
• The authors would like to thank the Beth Israel Deaconess Medical
Center's Center for Healthcare Delivery which provided funding for the
completion of this work.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
<p>Abraham Cheloff (<a href="mailto:acheloff@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">acheloff@bidmc.harvard.edu</a>)<br />Amy Weinstein (<a href="mailto:aweinste@bidmc.harvard.edu">aweinste@bidmc.harvard.edu</a>)</p>
Project Team
Sienna Li
Claire Rushin
Abraham Z. Cheloff
Bruce Tiu
Piroz Bahar
Annie Miall
Alexander Chen
Oluwatobi Ariyo
Betty Ben Dor
Debby Chang
Sammer Marzouk
Kavya Shah
Sarah Shirley
Iris Zeng
Andrew Zhang
Gina R. Kruse
Jonathan Li
Howard Libman
Katherine C. Wrenn
Marya Cohen
Amy R. Weinstein
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Associates
Harvard Medical School
Harvard College
Harvard School of Dental Medicine
Beth Israel Deaconess Medical Center
MGH Institute of Health Professions
Massachusetts General Hospital
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
An Interprofessional Student-Faculty Collaborative Telehealth Program to Address Poorly Controlled Diabetes and Social Determinants of Health Exacerbated by COVID-19
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ad36879767228372da943e4331eccc5.pdf?Expires=1712793600&Signature=DJYWHgsgyCutIgMpLq7LmOsOP0JjF4jKBbvZ65raCPV07SsfWXK6K9CweXJXoa-IC2%7EPsfiR5%7EbxSWngn6xevOt2u-dBZK8YugN5rON-oqsT6Je6CMcjxeyudvBje3ZFzdHzvFPDOs-LydgRmiWWy8GF-9S3femNZZgBuDShys-NsPOj4K7itEMcO8kRZmQeiHL2dGS84oLmrM9F-hH5MRUbzxoDgn%7EDGtbZrV0GS1nvC5wegWuoINt6d6SyWFlAHw%7E8cZwrUxecnXrs2V6xo46rcOX5izyKVxBONkb1CT4JU58DE3Lq%7EV5wiHmzoyta7NuEzn4IOWqrPRkuhWwHaQ__&Key-Pair-Id=K6UGZS9ZTDSZM
b55842d930b9ddb5251c5f4f3441f8de
PDF Text
Text
Implementation of Disorders of Consciousness (DoC) Pilot Program
Shannon Carlson PT, DPT, NCS, Jill LaRoche OT, MS,
Sarah MacKenzieS, CCC-SLP, CBIS
Introduction/Problem
When reviewing cases of patients with severe traumatic brain injuries, the following patterns were
observed:
● Goals of Care conversations were occurring early in severe traumatic brain injury cases
● Prognosis was nearly universally described as grim, but no data presented to support prognosis
○ Feedback from patients/families was that this was one of the worst parts of their ICU admission
● Rehab staff had lack of competency and limited training regarding performance of Coma Recovery
Scale - revised (CRS-R) impacting reliability
● Lack of knowledge of CRS-R on medical teams
New Practice Guidelines / Recommendations for DoC care were released in August 2018
● “Clinicians should use standardized neurobehavioral assessment measures that have been shown
to be valid and reliable (such as those recommended by the ACRM) to improve diagnostic
accuracy for the purpose intended”
● “To reduce diagnostic error in individuals with prolonged DoC after brain injury, serial standardized
neurobehavioral assessments should be performed with the interval of reassessment determined
by individual clinical circumstances”
● “When discussing prognosis with caregivers of patients with a DoC during the first 28 days post
injury, clinicians must avoid statements that suggest these patients have a universally poor
prognosis.”
Aim/Goal
To improve interdisciplinary care for patients with severe traumatic brain injuries and ensure care is
consistent with most up to date practice guidelines by performing earlier and more frequent CRS-R
administrations for prognostication purposes and predicting recovery trajectory for use during goals of
care conversations.
The Team
Jaimee Cathers, NP
Shannon Carlson, DPT, NCS
Jill Laroche, OT, MS
Sarah MacKenzie, MS, CCC-SLP, CBIS
Dr. Alexandra Stillman, MD
Dr. Martina Stippler, MD
The Intervention Plan
● Identified key stakeholders within the neurology, neurosurgery, and rehab departments
● Collaborated to create a protocol to identify patients, perform the exam, and document
in OMR with use of standardized prognostic statements based on the most current
literature
● Educated key stakeholders in both formal and information settings to maximize buy-in
Progress to Date
Created a Protocol to Standardize Care
● Appropriate patient criteria identified for pilot program:
○ Acute severe traumatic brain injuries
○ GCS of </=8
○ Significantly impaired arousal
● Prognostic statements created from most recent literature in collaboration with TBI-specializing
neurologist
● Workflow process map established for consistent performance of CRS-R 2x/weekly at differing
times of day based on practice guidelines
● OMR macros created for consistent documentation with input from all stakeholders
● Physiatry now consistently consulted for patients on DoC census
● TBI pathway updated to include DoC consults to PT, OT, and SLP earlier in stay
● Evidence based prognostic statements to include in notes to assist in prognostication during
GoC discussions
● Created macro for documentation to aid in consistency and ease of reference
Education:
● Created training protocol for more streamlined performance and training of inpatient rehabilitation
staff
● Facilitated journal clubs, presentations with neurosurgery, rehabilitation services, trauma
services
● Incorporated patient and family feedback to improve ongoing care
For more information, contact:
Shannon Carlson : scarlso4@bidmc.harvard.edu
�Implementation of Disorders of Consciousness (Doc) Pilot Program
More Results
Results and Progress Indicators
● Earlier initiation of PT/OT/SLP consults for patients with DoC
● Improved communication and teamwork between disciplines and care providers
● Improved appropriateness of discharge environment, including education to case
managers regarding specific DoC programs in the nearby rehabs
● In alliance with practice guidelines, established consistent interval assessment of
CRS-R throughout inpatient stay (across 18 patients <=3 years)
● Standardized time from admission to first CRS-R administration (<=72 hours)
● Improved reliability and use of data to guide GOC discussions about
prognostication and recovery
Lessons Learned
● There is a need for interdisciplinary collaboration for a successful quality improvement
project
● A distinct value exists among differing areas of expertise and clinical application
● Ongoing barriers addressed to efficiently and effectively capture all appropriate patients
● Consistent therapy and care team leads to better medical management of patients with
DoC
● Consistent and easily accessible documentation results in increased reliable measures for
prognostication purposes
● To maintain good communication and adequate education across the care team a
considerable amount of time and resources are required
● It is possible to effectively carry out a DoC program in acute care
Next Steps
●
●
●
●
Continue to work collaboratively with neurosurgery to identify all appropriate patients
who fit inclusion criteria within 72 hours of admission
Continue to seek out opportunities to provide interdisciplinary education
Expand work group within rehabilitation department to include more therapists
○ Completion of observations and training modules
Expand into other diagnostic groups supported by the literature (i.e., anoxic brain
injury, stroke)
○ Provide education to primary teams (e.g., general neurology, stroke neurology,
cardiology)
References:
●
●
●
Katz, D. I., Polyak, M., Coughlan, D., Nichols, M., & Roche, A.. (2009). Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-2 year follow-up.
Progress in Brain Research, 177, 73-88. https://doi.org/10.1016/S0079-6123(09)17707-5
Lucca, L.F., et. al. (2019). Outcome prediction in disorders of consciousness: the role of the coma recovery scale revised. BMC Neurology, 19, 68. https://doi.org/10.1186/s12883-019-1293-7
Whyte, J., et. al. (2013). Functional Outcomes in Traumatic Disorders of Consciousness: 5-Year Outcomes From the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Archives of Physical
Medicine and Rehabilitation, 94, 1855-60.
For more information, contact:
Shannon Carlson : scarlso4@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Shannon Carlson <a href="mailto:%20">scarlso4@bidmc.harvard.edu</a>
Project Team
Jaimee Cathers
Shannon Carlson
Jill Laroche
Sarah MacKenzie
Alexandra Stillman
Martina Stippler
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Physical Therapy
Neurology
Neurosurgery
Dublin Core
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
Implementation of Disorders of Consciousness (DoC) Pilot Program
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0963f11bdf19d73fb632d0850140f779.pdf?Expires=1712793600&Signature=udHRK2W4rmYnZ5zdil3GnG251eY7MTlnFKNkM1unZ66vzAr32P005Hu8ecdKMUS0Kjk6M4V0aEIVRNnVCQLYFPGR-uE6uDHYoBrExu2p5t9vVDX664it5DOI4ySVXnJpnI9jrQkl3yLYh4ycP5Q3jvq%7E4LWZ-wcDU-ipI7IF5xFhyOjqbsCfGi7iDEabdMI1RBNRsuNRwvlJwNJnmCK-L3DO79KWU3nRGAKsNGloxA3OQCscr2VXXVevEmsMwDcfhgV1bltldNUZecJxFO0xjHm1AR0mPhPU1Rr2vrpogEf5LxEgSw6WQP7NPCCh3NfX3JEm9jSPhGDLkV6ot1-xRg__&Key-Pair-Id=K6UGZS9ZTDSZM
7b8d68ef90fb640bbb03c121ec5c5366
PDF Text
Text
Conducting clinical trials from home: The implementation of a remote work model in CARE
Krystal Capers, MPH , Valerie Banner-Goodspeed, MPH, Maximilian Schaefer, MD
1Department
of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
Methods
Background
Challenges
The Center for Anesthesia Research Excellence (CARE) was established in October
2014 to facilitate all aspects of clinical research within the Department of Anesthesia,
Critical Care and Pain Medicine, with an emphasis on in-hospital, 'boots on the
ground' assistance for researchers.
CARE participates in various research domains including:
Interventional trials
Simulation research
Physiologic studies
Quality Improvement research
Epidemiologic studies Outcomes research
Education research
Communication was vital while we worked remotely. Our team utilized various group
chats (mobile devices), worked simultaneously on shared documents (google drive),
and attended various team meetings (zoom).
We utilized a number of new web applications to communicate within our teams and
to keep our tasks on track, relying particularly on Smartsheet and Asana.
CARE research is also represented in various divisions including Critical Care,
Cardiothoracic Anesthesia, Pain Medicine, Obstetric Anesthesia, General Anesthesia,
and Education / Quality Improvement.
On March 11,2020 CARE implemented an effective remote work model due to the
COVID-19 pandemic, and was able to carry out 11 COVID research studies.
•
•
•
•
Meet the Team
Asana
Asana is a desktop and mobile app that
was designed to help teams organize,
track, and manage their work.
Each research study had an associated
list of tasks that were assigned to
members of the team.
Team members were able to mark
action items as complete and team
managers were notified in real time.
Asana also has a chat function that can
be utilized to communicate within the
team for each individual task that has
been assigned.
Results
•
•
•
Front Row (left to right): Trishna Sadhwani, Melisa Joseph, Valerie Banner-Goodspeed (Program
Manager), Maximilian Schaefer (Program Director), Krystal Capers, Aiman Suleiman Back Row (Left to
Right): Andrew Toksoz-Exley, André De Souza Licht, Evynne Gartner, Danny Le, Ariana Saroufim,
Lauren Kelly, Najla Beydoun, Peter Santer, Felix Linhardt, Tim Tartler, Omid Azimaraghi
Acknowledgements
•
We are particularly indebted to former CARE Project Manager Julia Dwyer for shepherding the group through
the transition to remote teamwork by setting up our electronic platforms, and providing boundless support.
•
We would like to thank the many physicians, nurses, and respiratory therapists who conducted the necessary
on-site work for our research trials in extremely challenging conditions. Of particular note, Elias Baedorf Kassis
MD, Chris Barrett MD, Somnath Bose MD, Joe Previtera RRT, Lenny Rabkin RRT, and Sharon O'Donoghue, RN
A heartfelt thank you to the CARE team, who pulled together, worked long hours, and tackled new projects
during a time of tremendous stress and anxiety. Thank you to former CARE Medical Director Bala Subramaniam
MD MPH for your support during CARE's transformation.
•
Smartsheet
Smartsheet is a web-based
project management program.
It can be used to assign tasks,
track project progress, manage
calendars, and share documents
We utilized Smartsheet primarily
for onboarding new team
members and for project start up
tasks.
Zoom
Zoom was the primary video
teleconferencing program used for our
remote work model implementation.
Our research team members were
accustomed to working alongside each
other, but the video feature allowed us to
see each other from our respective
locations.
The screen share function was utilized to
show our meeting agendas, and also to
navigate study documents and
applications together.
We were successfully able to enroll patients into 11 clinical trials and
observational studies while operating in this remote work model, including:
7 Interventional Trials
3 COVID drug trials
1 non-COVID drug trial
3 device trials
4 Observational Trials
3 Epidemiological Studies
1 Survey Based Study
The rapid conversion to fully remote with solid communication strategies allowed
us to have 3 of the first 5 IRB applications for COVID-specific human subject
research protocols at BIDMC.
Conclusion
Strong communication and technology solutions allowed us to remotely support
departmental research throughout the pandemic.
Demonstrable productivity and continued high work quality enabled us to remain
fully staffed, with no team members placed on furlough or redeployed.
While our team has returned on site, we have adapted this remote work model with
flex remote days and continued electronic project management support.
.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Krystal Capers (<a href="mailto:kcapers@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">kcapers@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Krystal Capers
Valerie Banner-Goodspeed
Maximilian Schaefer
Trishna Sadhwani
Melisa Joseph
Aiman Suleiman
Andrew Toksoz -Exley
André De Souza Licht
Evynne Gartner
Danny Le
Ariana Saroufim
Lauren Kelly
Najla Beydoun
Peter Santer
Felix Linhardt
Tim Tartler
Omid Azimaraghi
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia, Critical Care, and Pain Medicine
The Center for Anesthesia Research Excellence (CARE)
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Conducting Clinical Trials From Home: The Implementation of a Remote Work Model in CARE
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e6c429c19306d29df5c40546b0fb11dd.pdf?Expires=1712793600&Signature=EQla0tYrQckY40d7KYuBltDpRlr0jGp3V3vGGUvMc%7EueztVGPCVAEAHpX5Le6kpZjn-aaJoA8Vhl8INhw%7EILw5bKwMh0SD1KKbyplCkh%7Ecli1ngduB7a4QTaCWwXZQi4nsqZDqqF8lYTJTZ1FH1G9AoTKlunS7T2DV8Eu4r2Lnqvk4GfYJCvvp%7EL2pB-FFPHOkPif5BSv1ykPRZOKSGkRe7hp5Rs0439KaVDKRc8p%7E2YJdgvDYkbFokRg2NoopoMY5I9HxYaEpuwNovhaab7LmTIrzfpb1fkPPcA9St2zOnwdUT-OjG3s3wM0EN7hxhuQXau5jiY3feC1w4MDlaphQ__&Key-Pair-Id=K6UGZS9ZTDSZM
0442b823a4524313c283ff9067082520
PDF Text
Text
Embracing our Humanity while Fostering Resilience:
The Perinatal Virtual Bereavement Debrief
Mandi Sandford MD, Rosanne Buck NNP,
Sheleagh Somers-Alsop LICSW, Dara Brodsky MD
Introduction
Progress to Date (since Feb 2021)
Healthcare workers routinely experience traumatic events and emotional stress, commonly
understood as occupational hazards. When a patient dies, grief, moral distress, rumination
over mistakes, and even impostor syndrome are some possible emotional responses felt by
the team.
At the beginning of the COVID-19 pandemic, a Neonatology Wellness Committee survey
found that staff sought improved debriefing experiences after patient deaths. While the
medical aspects of the cases were reviewed immediately after the demise at well attended
M&Ms, there were limited opportunities to process the holistic aspects of care and the
secondary effects on team members.
Goal
To acknowledge and embrace the emotional impact of caring for a dying patient and to foster
resilience amongst staff, we introduced a multidisciplinary, structured, facilitator-led virtual
debrief session focused on what it meant to care for this patient.
Intervention: The Perinatal Virtual Bereavement Debrief
Infant Death
(NICU, DR,
PPNU)
Pre-Huddle
(SW, hospitalist, NNP,
neonatologist)
Identify perceived
challenges for staff
Delineate themes
Invite all perinatal
clinicians directly
involved in clinical
care of deceased
infant and family
Virtual Debrief
7-14 days after infant death
1-hour meeting
o Intro (purpose, emaphsis on
confidentiality, case summary, review
of family structure and dynamics)
o Moderated open discussion
o Conclusion (“The Pause” to
acknowledge infant’s loss of life and
recognize team’s hard work)
Ethicist invited to relevant sessions
Post-Huddle
(SW, hospitalist, NNP,
neonatologist)
Discuss themes
Review what went well
Identify areas of
improvement
Determine whether
attendee check-in needed
and approach
-14 sessions, multi-disciplinary: neonatologists, NNPs, obstetricians, nurses (L & D, NICU,
Postpartum), SWs, RTs, spiritual care providers, specialists (BCH PACT team, cardiologist)
-n=12 attendees/session (largest - 34 staff from BIDMC, BCH, and a community hospital)
For more information, please contact Dara Brodsky, dbrodsky@bidmc.harvard.edu
Themes
Descriptions
Team members worry: Did I miss
something? Was I present with
parents in the way they needed?
Did I say too much or too little?
Did I do enough?
Team wishes to see patient through
their entire journey and when
absent at the time of death,
perceive a lack of closure.
Unanticipated Team rapidly pivots to meet the
events or rapid clinical and emotional needs of
patients and families in dire
redirection of
situations; yet, the very nature of
goals added
these events results in limited
angst
real-time processing for staff.
Team struggles with need to
Challenge of
balancing hope disclose infant’s expected poor
and reality with outcome and removing all hope.
High standards
of team
members
Impact of Virtual Debrief
Discussions recognize limits of interventions & sense of helplessness one
may feel when those limits are met.
Discussions lifted a perceived burden of responsibility that some providers
were carrying by acknowledging the larger team involved in supporting the
patient.
Sharing the patient’s story and post-discharge family update can provide
closure in a vicarious manner.
Providing this dedicated time signals to healthcare workers that their
emotional responses are normal, respected and valued. While clinician
emotional responses must be deferred in the moments of intense
operational demands, there is time and space for these responses once the
situation is defused.
Discussions allow senior attendees to offer approach, including importance
of titrating information and meeting families where they are at.
Discussions acknowledge that being with a family, supporting and not
abandoning them, provide family with the feeling that they were cared for.
family
Team cares deeply about providing Discussions allow attendees to witness the exceptional meaning in wellPriority of
coordinated family-centered care, show how healing occurs even if
family-centered time for parents to be with their
critically ill baby.
outcome is poor, and inspire providers to look for healing opportunities
care
Team honors cultural differences.
that transcend typical approaches.
Appreciation of Team values supporting each other By offering reflection on the compassionate care provided, team members
can recognize the amazing good that was done even in a bad situation.
neonatal team & during emotionally difficult
Interdisciplinary discussion allows providers to see the case from one
interdisciplinary periods and unexpected
outcomes.
another’s perspective and allows cross-discipline support of each other.
collaboration
Next Steps
1. We plan to evaluate the impact of these debriefs by surveying attendees after a 15-month period.
2. If NICU staff are interested, we plan to broaden these virtual debriefs and hold them during times of
increased stress in our unit such as periods of extremely high acuity, high morbidity, care of a complex
challenging patient, and limited resources.
Acknowledgements: We wish to thank our colleagues in the NICU, L& D, and Postpartum Units for their exceptional
commitment to our patients and families and for their willingness to share the impact these cases have had on them personally.
We thank NICU Leadership, specifically DeWayne Pursley, MD and Kathy Tolland, RN for their commitment to staff well-being.
For more information, contact:
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Dara Brodsky <a href="mail%20to%3A">dbrodsky@bidmc.harvard.edu</a>
Project Team
Mandi Sanford
Rosanne Buck
Sheleagh Somers-Alsop
Dara Brodsky
DeWayne Pursley
Kathy Tolland
Department
Any departments listed on the poster or identified in the spreadsheet.
Neonatology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Embracing Our Humanity While Fostering Resilience: The Perinatal Virtual Bereavement Debrief
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/931246a69776e32060b7afd8d55b831a.pdf?Expires=1712793600&Signature=q%7EwgZJ7Z71fVH87-2NMShO90%7E04ZpBtt24N8uwOl6N%7EayIKmkwVzHVOpa21Fyte1zxM8k0%7EQW4J5v3CFHII%7EsSFz0518uPtr4DKxAYqIc6eD2oZU928NANMqUQvm2NrgvMGLJ-KGTOPfaegCLkW4VN9lHQirxBnN5sll3zqCg181kU-1cnpc-m8CyTZNeCv6ljx%7EJ%7EDcsk4OpMqHgdyrn3iRgDk25ihR2QHJ2kclIyQvaKwNT5Hx4e7rV9lAjkrGrZhPALF-dLd%7EAySerbko6UFQpJfuwgh4n2%7EBxTzPDFp%7ENzZvbGCw6FARi97FlrJaclyxATElTHkJr4%7EoepeCdg__&Key-Pair-Id=K6UGZS9ZTDSZM
a2a8175207d35b305ebf620d4f6c7146
PDF Text
Text
Annual Review of Anticoagulation Management:
Keeping Patients Current, Connected, and Safe
Amber Rollins, PharmD, BCACP; Gina Di Guardi, MS, RN, CNE; Patricia Glennon, BSN; Maria Lee, PharmD; Keshane Williams, LPN; Diane Brockmeyer, MD
Beth Israel Deaconess Medical Center, Anticoagulation Management Service (ACMS)
Introduction
• In 2020-2021 the BIDMC Anticoagulation
Management Service implemented a new
initiative for annual physician reviews of
clinical care for patients on warfarin
Results
133
Warfarin Annual Reviews
Reviews Sent
365
524
• Ensure up-to-date components of warfarin
management including indication of therapy,
INR goal, bridge requirements, annual labs,
and general patient updates from physicians
• Confirm patients maintain active care with
managing anticoagulation physician
• Identify patients who may have transferred
care to a new provider
• Maintain compliance for medication refills
and INR order renewals
Methods
• An “Annual Physician Anticoagulation Review”
form was sent to each provider, totaling 524
reviews
• ACMS staff members supported physicians in
ordering, retrieval and assessment of overdue
annual labs as identified by the review
• Upon receipt of completed form from
providers, ACMS staff entered updated order
within OMR
• Changes selected by provider were updated
within patient's anticoagulation care plan in
OMR
Completed Reviews
Received
517
Overdue labs completed to
date, n (%)
193 (93%)
Updated appointments
made with warfarin
provider to date, n (%)
46 (76%)
Average time to receipt of
completed form (median)
20 days
Healthcare Associates
Gerontology
Clinical Updates to Warfarin Management
Change in Subtherapeutic INR
Management Plan
30
Change in Peri-Procedure
Bridge Requirements
19
4
Change in INR Goal
Initial Assessment of Compliance With
Annual Provider Appointment
11%
7
Change in Indication
0
5
10
15
20
25
30
Labs Ordered by ACMS
3
50
89%
Seen by provider within 1 year
Overdue for annual appointment
• Forms contained individual data specific to
each patient and their current
warfarin management
• Last (kept) appointment with warfarin
provider
• Patient annual time in therapeutic range
(TTR)
• ACMS concerns with patient INR
compliance over last 12 months
• Annual Labs:
Conclusion
o CHEST guidelines recommend annual
CBCs for patients managed on warfarin
therapy
o Patients utilizing low molecular weight
heparin require creatinine levels checked
a minimum of annually (more frequently if
patient has chronic kidney disease)
23
Cardiology
Purpose
Components of Review
Managing Provider Office
154
Both CBC and Creatinine
35
Conclusion
• There are gaps in communication between
patients, physicians and ACMS. The “Annual
Physician Anticoagulation Review” is a useful
tool to improve care coordination
• The annual reviews ensure patient’s safety
while on warfarin and enhance compliance to
ACMS and BIDMC protocols
Acknowledgements
CBC only
Creatinine only
•
The ACMS team would like to acknowledge Anh
Nguyen, PharmD candidate 2022 for her
assistance in the creation of this poster
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Diane Brockmeyer (<a href="mailto:dbrockme@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dbrockme@bidmc.harvard.edu</a>)
Project Team
Amber Rollins
Gina Di Guardi
Patricia Glennon
Maria Lee
Keshane Williams
Diane Brockmeyer
Department
Any departments listed on the poster or identified in the spreadsheet.
Anticoagulation Management Services (ACMS)
Dublin Core
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
Annual Review of Anticoagulation Management: Keeping Patients Current, Connected, and Safe
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/074411c6c4c5bc5ee401715f488156cd.pdf?Expires=1712793600&Signature=S6aT2V5R7isI7E-FUw9Q82cOpsXDxCy3%7EYeOdTeiQoz9rRtYX8LdZWzGzu2HqEGf8VwzwGjjyO%7EcbAwqbd9AzyvXV1BCQ8QqnrAlv9QQ0LgqM2cA-73wOuGUaaBFhOu89niCudP2NoBmg%7ESF8x9wjnStDBgMnsmTrSXcPmaiv5gSzRPexUW9cCzpzD1vOWxNnMrzNsv4lyl8o3rmtHcWm5FrIPU4x7m%7EbY95u1BUOae5RAShsYWE%7EzgrS1jqKgKtPYTUI4KmEuFBRrSMYbTYBfO-h61CucMtYZq04wqHpXy-Nmp48BozpjwV3tll%7EcGAvMvJeaNawp03zMQV9%7ERDDg__&Key-Pair-Id=K6UGZS9ZTDSZM
6cfbc09af4df0dd3096394683a8f3f2c
PDF Text
Text
Another arrow in the quiver of care: PCP perspectives on telemedicine for adults 65+
Gianna Aliberti MD; Roma Bhatia MD; Laura Desrochers MD MPH; Elizabeth Gilliam MA; Mara Schonberg MD MPH
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA
Themes
Introduction
•
•
•
Use of telemedicine for delivery of primary care has
increased, particularly for adults >65 years
Little is known about how to best operationalize
telemedicine for the primary care of older adults
Aimed to learn from primary care clinicians (“PCPs”)
their thoughts on the use of telemedicine in the care
of adults >65 years
1) Optimization of telemedicine
Nation
Health System
Design and Setting
•
•
Assurance of continued reimbursement
Opportunities to improve patient-centered high
value care via telemedicine
Cross-sectional web-based REDCap questionnaire
of all PCPs affiliated with one large health system in
Boston between Sept. 2020 and Feb. 2021
Received a list of all 383 PCP emails from the
health system
PCP
Effective telemedicine platform
Virtual rooming process
More IT and administrative support
Ease with greater years in practice and
comfort/experience with technology
Varying effects on doctor/patient relationship
Ease depends on visit type
Family
Methods
•
•
•
•
•
Assistance with visit preparation
Presence during visit may help for some
Questionnaire included both open-ended and
closed-ended questions about PCPs’ experiences
providing telemedicine to adults 65+
This study focused on PCP responses to the 5
open-ended question
Conducted a thematic analysis to identify themes in
participants’ open-ended comments
Codes emerged from the text
Organized codes to reflect major themes
Sample Characteristics
Female
n (%)
67 (58%)
Non-Hispanic White
93 (81%)
Community-based
87 (76%)
>20 years in practice
83 (72%)
Total
115 (100%)
Patient
Age-related (age, sensory and/or cognitive changes)
Literacy, socioeconomic status, language barriers
Digital divide, access to computers/internet
Need for home equipment (e.g., blood pressure cuff)
2) Integration of telemedicine
Better for chronic “This is a useful modality for maintenance
disease
and surveillance of chronic conditions,
management than however without in person care, new
acute care
diagnoses are difficult to assess fully”
Needs to be more “Implementation needs to be simple, single
efficient
click sign on with minimal technology
knowledge required”
Video is essential “Video essential for all [telemedicine] visitscompared to
enhances understanding and trust and
phone
collaborative care to make eye contact,
note body language, also [assessing] home
[background is] helpful”
Opportunities to
“This [has] been an incredible convenience
make care more
for patients who can't travel to the practice
patient-centered
or are fearful of coronavirus”
Advance prep
“Would be helpful to have patients fill out
needed for
forms and get vital signs done prior to visit”
Medicare AWV
Need for continued “It will have to be appropriately reimbursed
reimbursement
and supported by office staff”
3) PCP attitudes vary towards telemedicine
Effects Strengthens:
Weakens:
on
“I have enjoyed seeing people “It is not good
doctor- through video. The visits are
medicine. You can’t
patient more likely to start on time so I take care of the whole
relation find them less stressful than in patient without laying
-ship
person visits. More relaxed.
hands on them and
Also, I love to see patients in listening to their heart
their homes”
etc.”
Limitations
Conclusions and Future Implications
•
•
•
•
Multiple levels at which to improve the provision of telemedicine in primary care for older adults
Opportunities for integrating telemedicine in primary care, particularly with chronic disease management
Future work should aim to improve telemedicine for: specific visits types, older adults who have transportation
challenges, and/or PCPs who are interested in continuing to use telemedicine
Need to ensure patients receive the training they need for telemedicine and have video capability
•
•
•
One geographic location
Perceptions may be quickly
changing
We surveyed PCPs at one
point in time
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Project Team
Gianna Aliberti
Roma Bhatia
Laura Desrochers
Elizabeth Gilliam
Mara Schonberg
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Gianna Aliberti <a href="mailto:galibert@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">(galibert@bidmc.harvard.edu)</a>
Department
Any departments listed on the poster or identified in the spreadsheet.
Telehealth
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Another Arrow in the Quiver of Care: PCP Perspectives on Telemedicine for Adults 65+
Format
The file format, physical medium, or dimensions of the resource
pdf
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b26c2493b0527d756caeab5ce98f6bbc.pdf?Expires=1712793600&Signature=LLFgXIb4Jc6JXD0yaSTmqaJl9jUVKXlsvicNj%7EI0xHDGL8W7gJ37nw-qxjuivHeoDUv9lM60aaZSBnatz2GCiIMNkQz7TIN4-In-qpIyx6xDs3nbiWzSLKVmkruWhzNq-wZOtyZC9D057XIGJNpmm00-F9n5giHyBJRfVDhxukKKve-n7ayUgjfACfvxq8MNusulmjmo3QQYDhQJy8EZvLkIAl3TkJG0aAAcUDPWUI4vRXrB4c2uVvpQzdrminTVGkLfoQnLHYyxZQmcYy1JlnSopwbxByfby7s550tgIypI6I7ud3ksPG-WCqM5e4IMv90uT4M7l8hZa0ODi5TUFg__&Key-Pair-Id=K6UGZS9ZTDSZM
1db36032a1ddf5f82d1ec7237747c318
PDF Text
Text
What should we do? The patient's stiff!
TAP TO GO BACK
TO KIOSK MENU
Improving intern comfort with chemical restraints and acute dystonic reaction monitoring
Barbara Burton, MD Jessica Dodge, MD Austin Greenhaw, MD Arthi Kumaravel, MD Andrew Wu, MD
Introduction/Problem
Process Map
Initial hypothesis:
Patients on the inpatient psychiatric unit are getting acute dystonic
reactions due to not receiving
appropriate anticholinergic prophylaxis in the ED
Acute dystonic reactions are a rare, but known sequelae of antipsychotic administration that can be
acutely distressing for patients. These reactions frequently occur in the initial stages of neuroleptic
treatment, especially when patients receive intramuscular antipsychotic administration for agitation in the
context of psychosis. Based on our personal experience, managing these reactions tend to occur during
the PGY-1 nightfloat rotation, when interns have not had much educational nor clinical experience
regarding the acute management of ADR. Furthermore, interns do not receive standardized guidance
regarding optimal chemical restraint administration.
Aim/Goal
Improve comfort of chemical restraint ordering and acute dystonic reaction monitoring up by 20% among
interns before and after an educational intervention in a 3 month period
The Team
➢
➢
➢
➢
➢
PGY2 Leaders: Barbara Burton, Jessica Dodge, Austin Greenhaw, Arthi Kumaravel, Andrew Wu
QI project advisors: Rohn Friedman, MD Elizabeth LaSalvia, MD, Psychiatry
Stephenie Loux, Quality Improvement Data Analyst, Psychiatry
Deac4 nursing leadership: Kari Phillips , RN, BSN
OMR consultant: Larry Nathanson, MD
The Interventions
➢ Educational intervention to aid in diagnosis of acute dystonic reactions, risk-factors for ADR, and
guidance on ordering appropriate chemical restraints to minimize ADR
Upon initial process map development, we realized the issue at hand
was far more complicated than we expected which led to an
evolution of the project…
Evolution of the Project
Initial plan
What happened
Adjustments taken
Screening survey to assess intern
comfort
10/10 interns responded
Optimize educational
intervention
Contact ED stakeholders to assess how
they utilize dash recs/order chemical
restraints
No response despite multiple
attempts to ED RN/MD
leadership
Pivoted investigation aims
towards Deaconess4
interventions
Literature is limited, difficult to
Investigate ADR incidence to establish
make firm recommendations on
standardized chemical restraint protocol optimal chemical restraint
practice
Contact Deac4 leadership re: handoff
practices for chemical restraints
There is no standardized handoff
procedure for communicating
chemical restraint administration
in ED.
PGY2 is hard. Further meetings
were not able to be held due to
scheduling conflicts due to call
and rotation responsibilities
Inform interns of most
frequently reported ADR riskfactors based on most
reported/reputable studies
Shelved standardizing
handoffs to future project
aims
Pivoted investigation aims
towards improving intern
comfort
We explored multidisciplinary and multidepartmental approaches towards the problem at hand: PGY-1 psychiatry interns,
ED physicians, Inpatient psychiatric nursing, as well as a detailed look at the literature on acute dystonic reactions and
chemical restraint efficacy
For more information, contact:
Andrew Wu, MD @ awu3@bidmc.harvard.edu
�What should we do? The patient's stiff!
Improving intern comfort with chemical restraints and acute dystonic reaction monitoring
Barbara Burton, MD Jessica Dodge, MD Austin Greenhaw, MD Arthi Kumaravel, MD Andrew Wu, MD
Methods/Pre-intervention Data
Results of Literature Search: Chemical Restraint Efficacy and ADR rates
Prioritized List of Changes (Priority/Pay-Off Matrix)
Educational intervention for interns
Dystonic reaction
9
0
No dystonic reaction
147
160
Olanzapine
Haloperidol + PMZ
0
0
No dystonic reaction
150
150
Create standardized checklist for
chemical restraint ordering
Educational intervention for ED
MDs
Difficult
Easy
Haloperidol + PMZ
Dystonic reaction
Impact
High
Low
Haloperidol
Investigate how ED utilizes dash
recommendations for chemical
restraints
Track chemical restraint orders in
OMR
Investigate ED->Deac4 handoff
procedures with regards to IM
medications received in the ED
Ease of Implementation
Ultimately, we focused on delivering an educational intervention to the interns due to multiple barriers
encountered during the development of our project. Comfort measures were obtained with an electronic
survey using a 1-5 Likert scale and a t-test was used to calculate differences in average comfort level.
The existing evidence base for chemical restraints is limited, though suggests that ADRs can be safely
avoided in chemical restraints by either co-administering with adjunctive anticholinergic medications or
with olanzapine.
Lessons Learned
Post-educational intervention data
➢
Item 1. How would you rate your overall level of
comfort ordering chemical restraints?
5
5
4.5
4
5
4.5
3.57
3
3.5
3.5
3
2.4
2.5
Pre
Post
2.5
2
2
1.5
1.5
1
1
0.5
0.5
0
0
➢
3.86
4
3.29
3.5
➢
Item 3. How comfortable do you feel identifying
and diagnosing acute dystonic reactions?
4.5
4
Item 2. How comfortable to do you feel
monitoring for side effects following chemical
restraint with antipsychotic medications?
2.8
3
Pre
Post
Intern comfort with managing acute dystonic reactions, ordering chemical restraints, and understanding the side
effects of differing chemical restraint formulations was significantly improved following an educational intervention
The literature on chemical restraint efficacy and subsequent acute dystonic reactions is comprised of few good quality
studies, small sample sizes, and reporting bias, which caused significant barriers in the development of this quality
improvement project
Monitoring and improving chemical restraint practices at BIDMC will require multidepartmental and multidisciplinary
collaboration in the future
2.7
Pre
2.5
Next Steps
Post
2
1.5
1
0.5
0
1
Our post-intervention data showed statistically significant improvement in all three measures of comfort.
➢
➢
➢
➢
ADR risk-factor checklist to ED physicians
Create a standardized handoff procedure to communicate ED chemical restraint administration to the
nightfloat MD
Future discussions with OMR leadership to determine how best to monitor chemical restraint practices
Future meetings with ED leadership to determine their decision-making with chemical restraint ordering
For more information, contact:
Andrew Wu, MD @ awu3@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Andrew Wu (<a href="mailto:awu3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">awu3@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
Quality Improvement
Nursing
Emergency Medicine
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Andrew Wu
Barbara Burton
Jessica Dodge
Austin Greenhaw
Arthi Kumaravel
Rohn Friedman
Elizabeth LaSalvia
Stephenie Loux
Kari Phillips
Larry Nathanson
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
What Should We Do? The Patient's Stiff!:
Improving Intern Comfort with Chemical Restraints and Acute Dystonic Reaction Monitoring
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/95b672a20656f9b6717b881390599f11.pdf?Expires=1712793600&Signature=SSVXV35P0KvouTjTocErE5gR%7E3d2iwOqkXf5smx6LMb47-nZVlXcqMdBfYCBIv8BxNAGdHLD7mb4DODJthYex9AwzbUXZ0AMeLQzcTT2Qc182Qwa0-wMuR8q%7Ei6NFW268xQms40m6JP12xxrRhDLDzYUCrYxHWlm5uo7CoXfbiSe8k2Dj3ecYOr9qLQyRImMgFaEVmy-KDVezCp6UpU8Pdg-aiRsQa%7EFtAhZA0iXDfAXDvG2waOY7cvkP%7EY1PRP9Hza%7E3rrC2jJrXyjR0Be70bcl4ntYLlGH%7ELfDS8d9Rfu3Z8YGgikgRHTHE1ggp8g72fwBLL4Dj-%7EfxFCldoKvcA__&Key-Pair-Id=K6UGZS9ZTDSZM
afa25b1c5bd7102ae43c6e4a9e19351a
PDF Text
Text
The ICU Transition Volunteer Program: Improving Patient Transfers from ICU to Floor
TAP TO GO
BACK TO
KIOSK MENU
Abraham Shin, Justin Sun
Introduction/Problem
The Interventions
Central Problem: BIDMC’s ICU Patient and Family Advisory Council reported that
transferring from the ICU to a general medicine or surgical recovery floor can be an
overwhelming and distressing experience for both patients and their family members.
Solution: Volunteer ICU transition guides provide information and non-medical care to
patients before and after the transition.
Aim/Goals
➢ Improve the transition experience for patients and their families before and after transfer
from the ICU to general hospital floors
–
➢ Round on each ICU and collect names of patients who have recently transferred or will soon be
transferring to the floor
➢ Interface with patients in the ICU who will soon be transitioning (help gather patient belongings,
collect family contact information for whiteboard, answer questions/address concerns).
➢ See patients on the floor after transfer (get water, blankets, tissues; ensure that patient can use nurse
call button, help plug in phone charger, address specific requests)
➢ Submit questionnaire to study team to document intervention. Study team surveys patients to assess
benefit of transition guide intervention.
Results/Progress to Date
Reduce anxiety, set expectations, address needs
➢ Improve nursing staff satisfaction with the transition process
➢ Assess the effect of volunteer intervention during ICU to floor transfer on patient
outcomes
The Team
Volunteers
Geoff Bocobo
Daniel Leary
Vishva Patel
Dawn Piccolo
Noopur Ranganathan
Abraham Shin
Justin Sun
Staff
Luke Brindamour, MD
Michael Cocchi, MD
Staff
Barbara Sarnoff Lee, MSW,
Director, Critical Care Quality LICSW
Senior Director, Social Work
Caroline Moore, MPH
and Patient/Family Engagement
Director, Volunteer Services Kathryn Zieja, BS
Stephanie Harriston-Diggs
QI Project Manager, Business
Director, Volunteer Services Transformation
Shannon Lawson, MSHRM
ICU and Med/Surg floor Nursing
Program Manager, Volunteer Leadership and Staff
Services
ICU Transition Guide Program by the numbers: July 2017 – February 2019, 2.5 years.
For more information, contact:
Caroline Moore, MPH, Director of Volunteer Services/ cpmoore@bidmc.harvard.edu
�The ICU Transition Volunteer Program: Improving Patient Transfers from ICU to Floor
Abraham Shin, Justin Sun
Challenges Faced
Anecdotes of Patient Interactions from Volunteers
➢ Depending on many factors, such as time of the day, shift change, and room availability, some
volunteers finish a shift without any patient transfers.
–
Volunteers visit other patients on the floor to provide any non-medical care even if the
patients did not recently arrive from the ICU.
➢ Due to unpredictable transition times and patients’ need for rest, volunteers do not always have the
opportunity to assist patients both in the ICU and on the patient floor.
➢ Communication can be difficult when assisting patients who are hard-of-hearing or do not speak
English.
–
Unit coordinators and nurses in the ICU have started informing the volunteers of any
potential challenges.
➢ Intervention effectiveness is limited by degree of patient consciousness and receptiveness to help
–
Interactions must be tailored to each patient’s unique situation to maximize benefit
“She complained of a headache and I conveyed this
to her nurse. I got her an extra blanket for warmth.
Her voice was a bit weak/hoarse so I had her test
the call button; she was relieved the nursing station
was able to hear her.”
“I stopped by the ICU room that a patient had
been staying in to make sure nothing had been left
behind. I found a crayon drawing that had been
drawn by the patient’s grandchild taped on the
whiteboard, so I brought this to the patient’s new
room and posted it there.”
Overview of Typical Volunteer Shifts
243 Shifts Served since Aug 1, 2018
shifts with patient visits
Shifts with eligible interventions
shifts with no patient visits
Shifts without eligible interventions
ICU only
Floor only
189
186
118
57
Next Steps
Where Did Interventions Take
Place?
Both ICU and Floor
136
“I brought her a pitcher of water. She was concerned
about missing her YMCA appointments. I called the Y and
left a message for her trainer. She was also concerned
about her newspaper delivery; we called to temporarily
suspend deliveries. She expressed concerns about her
future, told me she would need a pacemaker implanted
because she collapsed due to cardiac arrhythmia. I did
my best to talk her through it and she seemed to relax
after speaking with me.”
➢ Staffing volunteer shifts back
to back during peak transition
hours may increase
effectiveness of intervention
by ensuring that more patients
are seen in both the ICU and
floor
➢ Based on positive feedback
from nursing staff and
patients, the ICU transition
volunteer program may
expand to assist patients in
the East Campus.
For more information, contact:
Caroline Moore, MPH, Director of Volunteer Services/ cpmoore@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Caroline Moore <a href="mailto:cpmoore@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cpmoore@bidmc.harvard.edu</a>
Department
Any departments listed on the poster or identified in the spreadsheet.
Volunteer Services
Social Work
Nursing
Business Transformation
Intensive Care Units
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Caroline Moore
Abraham Shin
Justin Sun
Geoff Bocobo
Daniel Leary
Vishva Patel
Dawn Piccolo
Noopur Ranganathan
Luke Brindamour
Michael Cocchi
Stephanie Harriston-Diggs
Shannon Lawson
Barbara Sarnoff Lee
Kathryn Zieja
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The ICU Transition Volunteer Program: Improving Patient Transfers from ICU to Floor
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2116dd6c3bf53a3385d21a827f998ff5.pdf?Expires=1712793600&Signature=PyDHDrflTzbWtrhW2gHjAwsWKhbn2NpA2BM4O2bBkyOIL%7EWcrxcHFX6lKIExXEHqELhUprVOqmz-au3iqTrvPWbU7OWF7znF5yyWUj-X43o-1YnllvDppOp9-aoiKnDACNjckgcQk1fcthZJiI9Txp9RerUODgpCrtd04zD%7Efnjrv0By4VVOfmpBR1kcSzOUaMreoruBfCN%7EQtuePVsURMW98bLG8-%7EV3HCSZ%7EauKpm3NF7dsJxDPv7VbPrFQiVfEC2-tUqrNwPtSififOZ-4RAKY7-Cyxe%7ErzWx%7EX0jvfKSTVHvmeCJA7cukPZoI2bBoRaDx1EcYzvv-0N1w4obaw__&Key-Pair-Id=K6UGZS9ZTDSZM
4a0dbecc2416f183e03b34090e712e5d
PDF Text
Text
The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Introduction
Problem Identification
Variation occurs in any large health care organization when local teams adapt workflows. Some variation is good
and results in improved processes that should be spread. Conversely, too much variability can lead to poor
outcomes and an inconsistent experience for patients, providers, and staff. Hence, large organizations must strike
a balance between standardization and local autonomy. Healthcare Associates (HCA) is an academic primary care
practice where over 300 dedicated professionals care for greater than 40,000 patients. HCA is divided into four
suites - Atrium, North, Central, and South – each serving as a local care team with unique culture and physical
space. As is true in many large practices, standardization and reliability is a challenge for HCA.
In Fall 2017, HCA leadership identified variation in the check in and rooming process. The check in and rooming
process is defined as all tasks occurring during a period beginning when a patient arrives at the practice and
ending when they are seen by a provider in an exam room.Tthis process occurs for every patient at every visit.
Multiple interactions take place that have the potential to positively impact outcomes at the patient, practice, and
system level. The Arrive-Register-Room-Care (AR2C) Initiative was formed to identify opportunities for
improvement and spread best practices.
Aim
To usea rigorous improvement methodology to design a highly reliable process for check-in and rooming
which will improve the health of our patients, lead to better days for everyone, and improve flow while
maintaining high levels of patient centeredness.
The Team
➢ Tobie Atlas, Patient and Family Advisory Council
Co-Chair
➢ Nisha Basu, MD, MPH, former Director of
Population Health
➢ Angela Coppola, Practice Representative and
Medical Assistant
➢ Leonor Fernandez, MD, Physican Lead for
Patient Engagement and PFAC Co-Chair
➢ Stephanie Fryman, former Medical Assistant
➢ Mathilda Ganjoli, Medical Assistant
➢ Whitney Griesbach, former Practice Manager
TAP TO GO
BACK TO
KIOSK MENU
➢ James Heckman, MD, Assistant Medical Director
➢ Brendan Murray, MBA, Practice Operations
Manager
➢ Kayla Tremblay, MBA, Senior Project Manager
➢ Heather Wathey, Practice Administrator
➢ Lauren Wemple, MPH, Population Health
Manager
To better understand the challenges and opportunities in the check in and rooming process, the AR 2C
team created process maps, hosted simulation sessions, and collected baseline data.
Process mapping
Each team participated in process map
development at their suite team meetings.
The process maps were refined with
observation in each suite. The final process
maps visualized variation in processes
between the suites (see Figure 1).
Simulations
To further engage staff in identifying
opportunities for improvement, the AR2C
team organized five simulation sessions. The
sessions took place after hours and
simulated the check in and rooming process.
Staff from all of the suites and a variety of
roles participated. Patients were recruited
from the HCA Patient and Family Advisory
Council. Each simulation ended with a
debrief to share lessons learned and
opportunities for improvement (see Figure 2).
Practice leadership paid staff overtime and
supplied pizza for dinner to encourage
participation. The simulations allowed the
team to truly understand the challenges
facing frontline staff and dive deep into
issues without interrupting day-to-day
operations. This facilitated trust and mutual
respect across the disciplines.
Figure 1: Process maps visually represented significant
variation between the suites (Click to enlarge)
Figure 2: Team debrief after a simulation session.
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Problem Identification (Continued)
Baseline Data
Over four weeks in summer 2018, the AR2C team collected baseline data to understand the performance of the
current check in and rooming process (see Figure 3). The data identified opportunities to improve communication,
prioritization, and flow.
Figure 3: Measures for the ARC Initiative
Measure (click for
definition)
Throughput time
Care Gap Closure
Staff Experience
Provider Experience
Patient Experience
Figure 4 (right):
Format
Type
Paper sheet that follows patient
Chart reviews
Paper or e-survey
E-survey every 2 weeks
Paper e-survey at check out
Process
Outcome
Balancing
Balancing
Balancing
PDSAs
The original concept for the flow management system evolved with each PDSA by incorporating feedback
from providers and staff (see below). A flag system was added to address provider feedback from the
PDSAs. The final system incorporated a whiteboard, algorithm, and flags.
PDSA
Stoneman
Residents
developed a tool to
capture throughput
time.(click to
enlarge)
Learnings & Improvements
1-5, 8
Test whiteboard and
algorithm in each
suite for 1 session
• Removed scheduled patients column
• Maintain HIPPA compliance by writing patients initials and time of visit
on board
• Need a signal that room is empty and ready for next patient
• Use magnets to indicate tasks needed during visit
• Use markers with clicky tops
• Some providers have a long walk to the board from their rooms
• Location of whiteboard needs to be convenient for team
6-7, 9
Test whiteboard and
algorithm with
residents for 1
session
• Consider a signal to indicate when residents are precepting and
almost done with their visit
10-12
Test a flag system to
indicate when rooms
are open and when
residents are
precepting
• Flag system reduced burden on providers
• Residents happy with precepting flag and impact on flow
Intervention
The AR2C team met with HCA Lead Medical Assistants to
understand how they currently manage flow and priorities
within the suites. Several local bright spots were identified.
Furthermore, the Lead MAs suggested re-instating a
whiteboard system that was piloted in the past but not
sustained or spread due to staffing challenges. Using this
information, the AR2C team developed a prototype of a flow
management system.
The initial prototype answered the questions, “What needs
to get done?” and “In what order should I do it?” To
determine if the prototype worked, the team ran over 12,
PDSAs touching each of the HCA suites. See the PDSAs
section for details on the types of tests and improvements
made to the system.
Description
Figure 5 (above): the first PDSA of the
flow management system. (click to
enlarge)
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
The Flow Management System answers two questions:
What needs to be done?
In what order should it be done?
Figure 7: Color coded magnets
correspond with frequently requested
tasks.
Figure 6: A whiteboard, displayed near the MA station, visually shows which
rooms are open and where patients are in the practice. Medical Assistants
update the board as patients check in and arrive for their visit. Providers can
communicate with Medical Assistants for needed tasks using magnets in the
far right column
Figure 8: Flags for each exam
room are visible from the
whiteboard, and indicate when a
room is open (green) or when a
resident is precepting (red).
Figure 9: The flow management system is built on an algorithm that Medical
Assistants use to prioritize tasks. The algorithm prioritizes rooming patients
over other tasks to optimize flow. After completing a task, Medical Assistants
return to the board to determine what task to do next.
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Roll Out and Continuous Improvement
Results (cont)
The flow management system was rolled out first in the South and Central Suites. To
prepare for the roll out, the AR2C team led a primary care practice flow game at suite
team meetings to help illustrate the flow management theory behind the system.
Each team member was invited to take a survey monkey training that quizzed team
members on how the board works and how to use it in different scenarios.
To encourage continuous improvement, a poster was hung next to the whiteboard
where team members could identify issues or opportunities for improvement. The
AR2C team reviewed the list each day and made adjustments or changes to the
whiteboard to improve operations. Changes were shared with the whole team in an
end of the week email.
In parallel to the AR2C rollout, the operations management team held basic
competency training with the other two suites. The emphasis was on what work
needed to be completed prior to each visit but there was not explicit instruction given
on how they should complete the work.
Figure 8: Average care gap closure
rates (click to enlarge)
Figure 10: Average 1st recorded blood pressure
(click to enlarge)
CLICK HERE TO TAKE OUR ONLINE
TRAINING MODULE
Results
Post intervention data was available for the two intervention suites and one control.
Preliminary results indicate that there was a practice wide trend towards increased
care gap closure (figure 8). This trend persisted when data was stratified by suite and
provider type, with the exception of resident providers in south suite. We observed an
increase in wait times in control suites and a reduction in wait times in intervention
suites( figures 9a & 9b). These trends persisted when data was stratified by suite and
provider type. Intervention suites also demonstrated a reduction in first recorded
systolic and diastolic blood pressures (fig 10). Post intervention surveys of providers,
staff and patients were ongoing at the time of abstract submission.
Figure 9a: Wait times in control suites stratified by
arrival times (click to enlarge)
Figure 9b: Wait times in intervention suites
stratified by arrival times (click to enlarge)
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Lessons Learned
➢ Track your learning from PDSAs. We used an ➢
excel spreadsheet to ensure we captured
everything.
➢ Start with a prototype to test feasibility. Our
prototypes were inexpensive and easy to start
with, and we refined our design over time.
➢ An inexpensive low-tech tool, implemented
effectively, can generate results. Whiteboards,
flags, and some arts and craft supplies were all
we used in this project. Using PDSA to test
ensured that our design was effective.
Engage the team in testing and
implementation. The system would not have
been successful without a lot of feedback from
the team directly using the tool.
Next Steps
➢
➢
➢
➢
➢
Roll out in North and Atrium Suites
Conduct statistical analysis on results
Complete provider, staff and patient experience
surveys
Collect more data on South Suite residents
Investigate ways to automate the system
➢
➢
➢
Repeat experience surveys for Medical Assistants
Identify additional opportunities for improvement in
the check-in and rooming process
Use lessons learned to improve other processes in
the practice
Acknowledgments
➢
➢
➢
Thank you to everyone who made this project a success including: Blair Bisher, Marc Cohen, Eileen Reynolds, all
HCA Medical Assistants, all HCA faculty, residents, and Nurse Practitioners,The Office of Healthcare Quality.
Study data were collected and managed using REDCap electronic data capture tools hosted at BIDMC1 REDCap
(Research Electronic Data Capture) is a secure, web-based application designed to support data capture for
research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data
manipulation and export procedures; 3) automated export procedures for seamless data downloads to common
statistical packages; and 4) procedures for importing data from external sources.
1Paul A. Harris, Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, Jose G. Conde, Research
electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing
translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81.
Figure 11: White Board in use
in South Suite(click to enlarge)
For more information, contact:
��Figure 4 (right):
Stoneman Residents
developed a tool (right)
that captured throughput
time for over 90% of HCA
visits.
Click to
return
to slide
�Figure 5: The first PDSA of the flow management system.
�Care gap closure rates
Care gap closure rates increased practice wide. This trend was evident at the provider and suite level
with the exception of south suite resident patient vists.
�Wait times stratified by patient arrival time
In the control suite we observed an increase in median wait times. In the intervention suite we observed
reductions in median wait times.
�First Recorded Blood Pressure
We observed a trend towards reduced first systolic blood pressure among patient seen in an intervention suite. This trend
persisted when stratified by suite and provider type.
�2C
AR
Flow Management System
Whiteboard in use in South Suite 4/12/2019
�Measures defined
Measure
Definition
The time a patient is waiting for their provider. This period begins at the time of check in or the time of
appointment, which ever is later, and ends when the provider enters the room to see the patient.
Wait time
Care Gap Closure
Staff Experience
Provider Experience
Patient Experience
Example:
If Patient A arrives at 8:30 am for an 8:50 appointment and is seen by the provider at 9:10 then the wait time is
calculated to be 20 minutes.
Patient specific tasks that must be completed by an MA prior to seeing a provider:
Examples:
• PHQ2-Depression questionnaire
• Tobacco Screening
• Fall Screening
• Point-of-care Hemoglobin A1c testing
Staff were given a 10 question survey that measured their experience of job stress, team work, provider
interaction, and patient interaction.
Faculty and Residents were given a 9 question survey that measured their experience of job stress, team
work, provider interaction, and patient interaction.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
<p>Kayla Tremblay (<a href="mailto:ktrembl1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ktrembl1@bidmc.harvard.edu</a>)<br />James Heckman (<a href="mailto:jaheckma@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jaheckma@bidmc.harvard.edu</a>)</p>
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Associates
General Medicine
Ophthalmology
Volunteer Services
Patient and Family Advisory Council (PFAC)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
James Heckman
Kayla Tremblay
Tobie Atlas
Nisha Basu
Angela Coppola
Leonor Fernandez
Stephanie Fryman
Mathilda Ganjoli
Whitney Griesbach
Brendan Murray
Heather Wathey
Lauren Wemple
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Arrive-Register-Room-Care (AR2C) Initiative: Designing Reliable Processes at HCA
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness
Timeliness