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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d2029e61cc63be3fb1d3969311cf1150.pdf?Expires=1712793600&Signature=NaDUvw9Htw-TDp5T1-GjUf1k12tutmQ38twQg7owg2lkSrXxQdn0vX-lbcRiJ5Nry5gNeklgxRfYli5ZDaRTg7vfJRohSBqfFkkU8oAitr-Y8q-NXguPYKn8Lo5FKFbDeMn7OtC%7EpQfOBuCTvZhZcTSPReTf7wqeGnSACp8wAtd2rmbsFiwC3uu6oOEvIZsEZuHxEK57xVJGIQ6T-9IE2ggxr0oDm9OI2hmQeKQuyaZCKuz2b%7ECWr9704swFMtT8W7goMPgJZK1qjqpedGk6vo1Yz93KCIkLd1SmfFYhRTehz3DtARpLY1zguuojRMICPwqR6p5Vq0OCzjtLL0qs6A__&Key-Pair-Id=K6UGZS9ZTDSZM
1191e6e85ca53d399588dca53aeb32f6
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Text
The perceived value of just-in-time in-situ simulation training as a preparedness measure
for the perioperative care of COVID-19 patients
Jeffrey R. Keane, R.N.,1 Liana Zucco M.B.B.S.,2 Michael J. Chen B.S.,2 Nadav Levy, M.D.,2 Allison Hyatt, M.D.,2 Richard Pollard, M.D.,2 John D. Mitchell, M.D.,2 Satya Krishna Ramachandran, M.D.2
1. Unit Based Educator, Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Introduction
•
•
•
Training of redesigned perioperative workflows was urgently required due to COVID-19 pandemic.
Just-in-time (JIT) training is known to promote confidence in specific tasks.
COVID-19 Training was set up and delivered via JIT, in-situ simulation, team training.
Results
•
Up to 12 sims run per day over 3 weeks, through March-April 2020.
•
Trained 428 BILH perioperative staff members, across multiple sites.
•
Survey responses (n=110) revealed the following regarding all 4 simulation stations:
Methods: Implementation of Training
•
•
•
•
JIT in-situ simulation stations focused on minimizing viral exposure & transmission risk [Fig. 1].
Core group of faculty trained to run simulations in vacant OR’s.
Single page checklists created as cognitive aids.
Training delivered throughout Beth Israel Lahey Health Network (BILH) across disciplines.
(anesthesia, surgery, nursing, technicians) [Fig. 2].
Daily feedback & debriefing from faculty allowed for iterative changes to SOP’s & sims.
•
•
•
•
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Methods: Assessment of Training
•
Post simulation training surveys (Likert scale and free text) administered via email & QR code to assess
knowledge & comfort of COVID protocols, pre vs. post-simulation, and belief of impact on practice.
March-August 2020: reviewed anonymized HCW infection rates amongst perioperative staff and
compliance with COVID-19 protocols for COVID cases in the OR.
•
A
Knowledge of and comfort in adopting new workflows increased post-sim
(all p-values < 0.001; all means increased by ≥ 1.2 points on a 5-point Likert scale).
> 90% of respondents agreed or strongly agreed that this training would impact their future practice.
Free text responses appreciated timeliness of training, hands-on nature and inter-professional collaboration.
Constructive feedback through facilitated iterative changes to training and organizational SOP's.
95% compliance with COVID precautions in perioperative setting (121 of 127 cases through March – August 2020).
Network’s perioperative HCW test positive rate was < 1% (March – August 2020).
B
62% 65%60%64%
31%
25%
0% 0% 0% 0%
Strongly
Disagree
0% 1% 0% 0%
Disagree
35% 33%
7% 9% 6% 4%
Neutral
Agree
Strongly Agree
Belief that the simulation will create an impact on their clinical practice
Sim A - Pre-op Huddle (n=90)
Sim C - ICU Transfer (n=104)
C
D
Figure 1: JIT in-situ simulation training stations.
A: Pre-op huddle & OR set up for COVID-19 case.
B: Donning & doffing PPE.
C: Transfer of a COVID-19 patient from the ICU to the OR.
D: Airway management with enhanced infection control measures.
Figure 2: Schematic representation of the simulation
implementation team and framework. The core development
team (blue) trained the faculty trainers (grey)—who in turn
trained the rest of our network’s inter-professional perioperative
staff (green). Daily feedback was obtained from participants and
faculty trainers following each simulation, and regular updates
on changes to materials or SOPs were communicated through
faculty trainers or directly to staff members.
All of our up-to-date
COVID-19 perioperative
resources are available
online by scanning QR code:
(Includes resources on OB / GI / IR and more)
”Simulations provided an
opportunity to hear about the most
up-to-date protocol/policy changes,
and also about complaints."
Figure 3: Survey
results for perceived
impact of JIT
simulation training
on clinical practice.
Results expressed as
percentage of
responses for each
simulation drill.
X-axis represents a
5-point Likert scale.
Sim B - Don & Doff PPE (n=103)
Sim D - Airway Management (n=83)
"It really helps the nursing staff in
preparing to care for these patients
and increases communication
between the disciplines."
"Simulation got you thinking about
the issues in dealing with a COVID19 patient, and helped you learn
from others' trial and errors."
Discussion:
•
In context of COVID-19 and personal risk to HCW’s, we speculate “hunger for information” and
•
increased anxiety about a lack of knowledge on viral exposure risk & transmission served as drivers for
change.
This method of training facilitated “error proofing” of our newly designed workflow;
on-site observations, daily feedback and survey responses from participants triggered iterative
changes
to help refine our COVID-19 perioperative workflow.
Conclusions:
•
JIT in-situ simulation training is not only an effective education method in preparing our perioperative
HCW’s for COVID, but also an effective way to implement updates to perioperative workflows. Training
was highly regarded by participants, we observed high precaution compliance, and low test-positive
rate.
QR Code to
view online
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jeffrey R. Keane (<a href="mailto:jkeane1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jkeane1@bidmc.harvard.edu</a>)
Project Team
Jeffrey R. Keane
Liana Zucco
Michael J. Chen
Nadav Levy
Alison Hyatt
Richard Pollard
John D. Mitchell
Satya Krishna Ramachandran
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Anesthesia, Critical Care and Pain Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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Title
A name given to the resource
The Perceived Value of Just-In-Time In-Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3e5c68ecd9057853b7833000d572b910.pdf?Expires=1712793600&Signature=AuRvElrGCs-WD8EOVmxd9B2lnYIhg1-HkGDrcvmu%7ETjBfUiqj6j9EyRPHQXWVThWXtKFIXoaMi%7EXrcSVPgxxrGscp3ZMjWFaQGb8T-FNPTrhN-D3wwGgwAsUqA2ETPMnzlTiYLOa-S3ClU6a257LS5qWiyeMfnZXOTRNIhkc4LpD0ezI%7E5ILDJqQFgqFTC76aKIv3KabC4Wr%7EwzJoSt22ymRfucbsdBJyAAUxle9MMDdEPLnCl7ecYvXO02Gh68I0yduxufELkJFvRUFUSJk9xrLvRjHFfncN1zanCaIrw02-1ivR9fUH4ZG3xNZaKZiz5hil7WzBf08b4HEVpz2HQ__&Key-Pair-Id=K6UGZS9ZTDSZM
b090ba29bfef97a2ac7b5dcce2071a9f
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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.
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
<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
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Title
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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
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20257a05ba80a7fd75fdd4146658dc74
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Doubling ICU Capacity by Surging onto Med Surg Units during the COVID- 19 Pandemic
Sharon C. O ’Donoghue, DNP, RN, Nurse Specialist, Barbara Donovan, MSN, RN, Nurse Specialist, Joanna Anderson, BSN, RN, CCRN, CNRN, Jane Foley, DNP, RN, Associate Chief Nurse, Jean
Gillis, MSN, RN, Nurse Specialist, Kimberly Maloof, MSN, RN, Nurse Specialist, Andrea Milano, MSN, RN, CCRN, CMC, Nurse Specialist, John Whitlock, MS, RN, Nurse Specialist, Susan DeSantoMadeya, PhD, RN, FAAN; Weyker Chair for Palliative Care/Associate Professor Nurse Scientist
The Team
Introduction/Problem
•
•
•
•
•
•
•
As COVID-19 was sweeping through the nation, Beth Israel Deaconess Medical Center (BIDMC) in Boston,
was preparing for a projected influx of critically ill patients in need of hospitalization
While it was anticipated that workflow would need to change, the full impact of the pandemic for the medical
center was unknown, causing increased uncertainty.
It rapidly became apparent that a plan for the arrival of highly infectious critically ill patients, as well as a
strategy for adequate staffing, protecting employees and assuring the public that this could be managed
successfully, was needed.
A hospital’s response to a large-scale event is greatly impacted by the ability to surge, and depending on the
type of threat, to maintain a sustained response. Planning for alternate critical care space has many
challenges, the need for a hospital to surge critically ill patients and care for them outside the ICU footprint is
referred to as an ICU surge. To identify surge capacity, an organization must first consider the type of event to
appropriately plan resources.
An epidemic surge drill, conducted at BIDMC in 2012, served as a guide in planning for the COVID-19
pandemic.
The principles of Crisis Standards of Care and a Hospital Incident Command Structure (HICS) were used to
clearly define roles, open lines of communication and inform our surge plan.
Preparation began by collaborating with multidisciplinary groups to acquire the most appropriate space,
adequate supplies, and identify and train staff.
Sharon C. O ’Donoghue, DNP, RN, Nurse Specialist, Barbara Donovan, MSN, RN, Nurse Specialist,,
Joanna Anderson, BSN, RN, CCRN, CNRN, Jane Foley, DNP, RN, Associate Chief Nurse., Jean Gillis,
MSN, RN, Nurse Specialist, Trauma/Surgical Intensive Care Unit, Kimberly Maloof, MSN, RN, Nurse
Specialist, Andrea Milano, MSN, RN, CCRN, CMC, Nurse Specialist, John Whitlock, MS, RN, Nurse
Specialist, Susan DeSanto-Madeya, PhD, RN, FAAN; Weyker Chair for Palliative Care/Associate
Professor Nurse Scientist
The Interventions
Aim/Goal
• An ICU Surge Planning Committee was convened and served as a subgroup of HICS.
• At the first planning committee meeting, a walkthrough of all units identified as potential surge spaces
was completed, and specific units were chosen to best meet the surge needs.
• Issues discussed were unit layout, proximity to existing ICUs, ability to close doors, and ventilator and
hemodynamic monitoring capabilities.
• The planning phase began in February, well before it was needed.
• The leadership team was informed by HICS that the trigger to escalate and open the surge areas
would be when ICU capacity reached 70 patients.
• Once this occurred, there was a twelve-hour window given to open the surge areas.
Teams were formed to identify the necessary resources to expand the ICU environment quickly and efficiently.
Educational training was developed for redeployed staff.
Shadowing experiences prior to the actual surge were extremely valuable.
Having NS support with Just in Time training and twice daily huddles to update staff on current PPE, any policy or
supply updates during this rapidly changing environment were highly valued by the staff.
ICU surge spaces varied from Post Anesthesia Care Unit (PACU) to 2 Med Surg (MS) Units both RB6 and RB7 .
36 bed MS unit was converted to a 36 bed ICU.
At the surge peak, 34 ICU level patients on RB 7 were being cared for with team nursing with both ICU and MS
nurses caring for a patient
Results/Progress to Date
•
•
•
•
•
BIDMC experienced the largest surge of ICU patients within a hospital system in the state of Massachusetts.
ICU capacity was expanded by 93% from 77 to 149 beds; and the surge was maintained for approximately 9
weeks.
Planning for the surge of critically ill patients required a thoughtful, collaborative approach. The preparation
phase was an important time where teams were formed to identify necessary resources in order to quickly and
efficiently expand the ICU environment.
Educational training including shadow experiences prior to the actual surge were valuable. Ongoing staff
support and communication from nursing leadership was necessary to ensure safe, effective care for critically
ill patients in a new and dynamic environment.
MS floors needed to have equipment and supplies for traditional ICU but we quickly learned the Covid patients
had specific supply needs such as each patient need 5-6 IV pumps, arterial lines, vents, pillows for proning
etc. and we were constantly readjusting our supplies to keep up with the demand
For more information, contact:
Barbara Donovan RN MSN, Nurse Specialist, bcdonova@bidmc.harvard.edu
�Doubling ICU Capacity by Surging onto Med Surg Units during the COVID- 19 Pandemic
Sharon C. O ’Donoghue, DNP, RN, Nurse Specialist, Barbara Donovan, MSN, RN, Nurse Specialist,, Joanna Anderson, BSN, RN, CCRN, CNRN, Jane Foley, DNP, RN, Associate Chief Nurse.,
Jean Gillis, MSN, RN, Nurse Specialist, Trauma/Surgical Intensive Care Unit, Kimberly Maloof, MSN, RN, Nurse Specialist, Andrea Milano, MSN, RN, CCRN, CMC, Nurse Specialist, John
Whitlock, MS, RN, Nurse Specialist, Susan DeSanto-Madeya, PhD, RN, FAAN; Weyker Chair for Palliative Care/Associate Professor Nurse Scientist
1.
1
2
3
2.
3.
4.
More Results/Progress to Date
Windows were cut into doors to allow better
visibility of the patient
WOWs downloaded with Metavision™
outside the patient rooms allow a nurse
workstation in proximity to the patient room
Rolling PPE carts at the doorway
IV pumps were moved outside some rooms
with IV extension tubing used to run it under
the door
Both RB 6 and RB 7 were modified to allow the nurse to have close proximity to the patients and alarms as well as
best visualization of the patients
The ICU/MS nurse teams cared for 2 or 3 critically ill patients. The 2 nurse to 3 patient ratio was very stressful for the staff as
these patients could be critically ill and very unstable. Two resource nurses were staffed to make the assignments, deal with
staffing issues and support acuity. Staff was supported by ICU and MS nursing directors, MS and ICU NS and UBEs.
Lessons Learned
The ICU leadership team carefully chose patients who could transition to the newly built ICUs. Patients chosen were stable on
their ventilator settings, as well as pressor and sedation regimes. Initially, the plan was to admit all patients from the
Emergency Department (ED) to the original ICU spaces with the goal of stabilizing them before transfer to the newly developed
units. This was not always possible and there were times when patients were admitted directly from the ED to the surge units.
There were several issues with the MS space and steps were taken to improve workflow and the safety of the patients. Of the
36 beds, only 2 rooms had windows built into the doors and the nurses quickly identified this as a safety concern. Within two
days, windows were cut into all other doors by the maintenance department which allowed for visualization of the patients
Next Steps
•
•
The MS floor was divided into 4 pods which functioned as 4 ICUs with physician and nurse teams working
with RT and pharmacy support to care for these critically ill patients.
These maps were posted to assist staff to know locations of Omnicells, supplies and emergency equipment
Unfortunately we had to surge again in the fall of 2020. We recalled the ICU/MS nurse teams who had previous training and
were able to use the PACU for Covid negative ICU patients and use RB 7 for Covid positive patients.
We were very nimble reopening the surge space. We were able to open 2 pods on RB 7 and the PACU in a short amount of
time.
We have learned it is more difficult to close the surge space and maintain our ICU capacity in the original ICU footprint
For more information, contact:
Barbara Donovan RN MSN, Nurse Specialist, bcdonova@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.
Barbara Donovan (<a href="mailto:bcdonova@bidmc.harvard.edu">bcdonova@bidmc.harvard.edu</a>)
Project Team
Sharon C. O ’Donoghue
Barbara Donovan
Joanna Anderson
Jane Foley
Jean Gillis
Kimberly Maloof
Andrea Milano
John Whitlock
Susan DeSanto-Madeya
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
MedSurg Units
ICUs
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
Doubling ICU Capacity by Surging onto Med Surg Units During the COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/53452562af5b1b4e2be0a6f2a01f738e.pdf?Expires=1712793600&Signature=PQmYMvSrtygbKmKA12keMdN-9XO3-HIypQt-fQmbGllaVqciGtGais8%7EaCKmj3POny8nl2VeJiMJH3b1bSk%7EBx8ZZMQptym%7En9L0ZdFzBlXwnyzDSDTjcjtXNx%7EUEEv0ffLpRfibQGn953-CXuOzYlELEbHLg3sZ0RWaYYJRdgndCEuc9QnBew9T52VQQa5jiclBMzzpz8hwJzpr9OGoDBYtzDq9QGJdmW%7Ez-NW8JmskzF%7EDKosOEWFhgp7gnNZHtF34JNjL-QvsSPbVmse2luCM6Pm2TTZbSdZf%7EoA4axYLl7k-vnxkBgdKw-NZoJiXNxVseNkf18lz-vm11zVcAw__&Key-Pair-Id=K6UGZS9ZTDSZM
2a231b62089c47f4e60db3a741ba1e14
PDF Text
Text
COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
Introduction/Problem
The Interventions
* March 2020 World Health Organization declared a global pandemic
* Massachusetts was one of the first states affected by COVID 19
* Skin impairments noted on COVID 19 patients evolved differently from Deep
Tissue Injury (DTI) despite similar appearance.
* COVID 19 skin impairments were identified on areas on the body that were not
on pressure points.
* Review of literature: dearth of data related to novel virus
* NPIAP white paper validated our suspicions that these skin manifestations were
a result of a systemic process . Patients had coagulopathies, multisystem
organ failure , hemodynamic instability
•
•
•
•
Prevent pressure injuries
Optimize nutrition
Meticulous local wound care
Safety for patients and staff
Wound care for COVID 19 patients was approached with a conservative manner honoring the principles
of topical therapy
Bundled Care: repositioning patients every 4 hours, decreasing amount of PPE used by staff,
decreasing exposure
Education: pictorial resources for pressure injury prevention, application of foam dressings and offloading techniques
A mobile cart for the proning team and ICU staff. This cart included a checklist and readily available
supplies
Alternate air mattresses from in-house distribution
Debridement avoided due to risk of bleeding; conservative topical therapy
Results/Progress to Date
Aim/Goals
The Team
Covid skin Manifestation: top down injury located on soft tissue , lacy appearance , intact and non-intact
skin with epidermal sloughing to reveal partial thickness skin loss. Lesions very friable
D. Loehner
A.Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
For more information, contact:
Donna Loehner RN BSN CWON Clincal Director Wound Ostomy Nursing Team
�COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
More Results/Progress to Date
Impaired blood flow to epidermis due to COVID 19 systemic coagulopathies. Top down injury that can
lead to partial or full thickness skin loss.
Covid skin manifestations most commonly seen on lower extremities , hands, feet, trunk.
Lessons Learned
•
•
•
•
DTPI defined as injuries that can have both intact and non-intact skin with localized area of persistent non
blanching deep red maroon pigment change resulting from prolonged pressure and shearing forces. If
not reversed can evolve into unstageable PI
Tissue Injuries seen on Covid patients appeared as DTPI but were found to have a vascular etiology as
evidence by histological tissue analysis and are now classified as Covid Skin Manifestations
Patients that require proning cannot be placed on low air loss support surfaces, this is a
contraindication
Coagulopathy caused by the Covid -19 virus require a conservative approach to Wound Care, surgical
sharp debridement is to be avoided
Is it possible that not all DTPI's are from pressure but rather from systemic inflammatory conditions?
Next Steps
Education of Medical and Nursing staff on the etiology and management of Covid skin manifestations
Further exploration and research into whether Covid skin manifestations could be classified as Acute Skin
Failure and if so, is this applicable to other critical ill patient populations that develop skin impairments
Further investigation into the progression and deterioration of some Covid skin manifestation into full
thickness wounds
For more information, contact:
Donna Loehner RN BSN CWON Clinical Director Wound Ostomy Team
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Donna Loehner (<a href="mailto:dloehner@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dloehner@bidmc.harvard.edu</a>)
Project Team
D. Loehner
A. Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Wound Ostomy Nursing Team
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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Title
A name given to the resource
COVID-19 Skin Manifestation in the Acute Care Setting
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4ae528ce9f9d839f475a82b29a5e17a5.pdf?Expires=1712793600&Signature=vFLsJuyK8qQoxTLd33xYR4RIYiq5X2pLhson2xbusD9a1jYJ7IQZETbNpm1lowsUprlp7B9bvKN0fRpxepw%7EyViV1MNN417zrXYKmVY8yMN5Uzv8pbGubgMNh1dYBLSFrvqiQkaicv2Irk4zK4TGONlfvhEFg%7ETAFvqUUyIXPBQO%7ErvaYtlQ7gDjs011oolR847oDakHlmEa4BCLw4iatvEPzo-zsgPPv-NST5L9tpT2uAkIc6bE9KPYPcRPPNygzZpsmTjPD5bxjEWGsmlc5ccbZ15nINCNSl%7Eqd7oJOf3vH4u%7EXlwpne4LHe3Ap5Lmhf-2TbE7cTzFkIjm37htCA__&Key-Pair-Id=K6UGZS9ZTDSZM
a645b9158e660ba2e3730907bfdab848
PDF Text
Text
Relationship of Viral Load and Infectivity to the Limit of Detection of SARS-CoV-2 Antigen Tests
James Kirby1*, Stefan Riedel1, Sanjucta Dutta1, Ramy Arnaout1, Annie Cheng1, Donald Hamel2, Phyllis Kanki2
1Department of Pathology, Beth Israel Deaconess Medical Center, 2Harvard School of Public Health
1.0
0.0
6
AUC = 0.92
2
109
0.5
0.5
AUC = 0.94
0.0
2
109
0.0
0.5
105
104
103 102
log10 v.l.
107
6
AUC = 0.94
4
108
1.0
105
104
103 102
sensitivity
6
4
108
2
109
1-specifity
0
0
5
10
log10 sample viral load
in genome copies/mL
Figure 2. Quantitative Relationship Between
Culturable Virus and Sample Viral Load. Day 3 viral
culture supernatant for each sample was analyzed by
RT-qPCR. The viral load in log10 genome copies/mL of
culture supernatant is plotted against the log10 viral
load in genome copies/mL of the original patient
sample. Linear regression (solid line) with 95%
confidence intervals (dashed lines) shown. R2 = 0.55
log10 v.l.
AUC = 0.97
0.5
103 102
log10 v.l.
8
6
AUC = 0.97
4
108
2
109
0.0
8
107
0.0
104
0.5
1.0
1-specifity
E
106
105
107
0.0
0.5
106
0.5
2
109
0.5
1.0
8
sensitivity
106
0.5
0.0
1.0
1-specifity
1-specifity
5
8
D
1.0
10
log10 v.l.
4
1.0
C
0.0
Sensitivity/Specificity versus Viral Culture
LumiraDx 90% (83-94% C.I.) / 70% (59-79%)
Other Ag 74% (65-82% C.I.) / 92% (84-96%)
102
6
107
1-specificity
0
Figure 1. Antigen Testing Results Compared
with Log10 Viral Load. Viral load in genome
copies/mL POS = positive antigen test result.
NEG = negative antigen testing reslt. Lumira =
LumiraDx Ag test; BD = BD Veritor Ag test.
103
104
108
0.0
log10 day 3 culture
supernatant viral load
105
106
sensitivity
sensitivity
Log10 Viral Load
B
log10 v.l.
10
4
1.0
From Arnaout et al. CID. PMC7302192
102
8
107
0.5
0.0
INFECTION VERSUS INFECTIVITY
INFECTIVITY SURROGATE =
VIRAL CULTURE
103
108
sensitivity
PCR
SLOW
EXPENSIVE
SENSITIVE
5
Lu
m
ir
Lu a P
O
m
ira S
N
EG
B
D
PO
S
B
C
ar D N
eS
EG
ta
C
rt
ar
eS PO
ta
S
rt
N
O
sc EG
ar
P
O
sc OS
ar
N
EG
ANTIGEN TESTS
RAPID
INEXPENSIVE
POINT-OF-CARE
INSENSITIVE?
104
105
106
1.0
Figure 3. Receiver operator curves (ROC) comparing
SARS-CoV-2 sample viral load levels as a predictor of
viral culture and antigen detection. For each plot,
sensitivity versus 1-specificity was plotted for each viral
load value (genome/copies/mL) determined by RT-qPCR
for each sample in our study when used as a lower limit
threshold for scoring positive and negative detection for all
other viral load results with qualitative viral culture or
antigen test determinations, respectively, as the
comparators. (A) Log10 viral load (v.l.) in genome copies/
mL versus detection by viral culture. (B) Log10 viral load
versus LumiraDx antigen detection. (C) Log10 viral load
versus BD Veritor antigen detection. (D) Log10 viral load
versus Oscar Biosciences antigen detection. (E) Log10
viral load versus CareStart antigen detection. Viral load
values along the ROC curves are labeled in log10 intervals
and demarcated in color as indicated in accompany
heatmap legend bar. AUC (area under the curve) for each
ROC curve is denoted on respective plots.
109
108
107
106
105
104
103
102
101
100
infectious risk
1.0
viral load
A
10
QUESTION:
When/how should we use SARS-CoV-2 antigen
versus PCR tests?
LFAs
LumiraDx
PCR
-5
0
5
10
15
days post symptoms
Figure 4. Model of Infectious Risk versus SARS-CoV-2 Detection by
RT-qPCR and Antigen Tests. Both Lumira and lateral flow-based antigen tests
(e.g., BD Veritor, CareStart, and Oscar Biosciences) are able to detect individuals with viable, culturable virus and who therefore pose an immediate infectious
risk to others. Dotted lines indicate reliable detection threshold predicted for
each method. Presumptively, infectious risk is proportional to the amount of
culturable virus which is roughly proportional to the viral load in samples.
Antigen tests are excellent in detecting patients with the highest viral loads
which may be four to five log10-fold greater than viral loads detected at the
lowest levels where virus can be consistently cultured. PCR and to a lesser
extent, the LumiraDx test, can detect individuals before and after the expected
infectious period and therefore may be more appropriate for screening
programs where testing is performed at longer intervals. The viral load curve
shown is for representational purposes and may not reflect viral load kinetics in
any specific individual.
Conclusions:
1.
Use Ag tests to identify infectious individuals at time of testing. Will allow isolation of significantly
infectious individuals from communal events, same-day healthcare procedures, communal travel
arrangements, and other functions with significant person-to-person contact in settings where universal
masking is neither feasible nor desired.
2.
PCR tests for no-margin-for-error situations (hospital admission), vulnerable populations; sample pooling
strategies; and screening of cohorted populations (e.g., school) at decreased intervals.
Support:
Accelerating Coronavirus Testing Solutions Grant from the Massachusetts Life Sciences Center; Ag tests donated
by LumiraDx, Ginkgo Biosciences (CareStart Ag test), and Oscar Biosciences.
�
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.
James E. Kirby (<a href="mailto:jekirby@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jekirby@bidmc.harvard.edu</a>)
Project Team
James Kirby
Stefan Riedel
Sanjucta Dutta
Ramy Arnaout
Annie Cheng
Donald Hamel
Phyllis Kanki
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
Harvard School of Public Health
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
Relationship of Viral Load and Infectivity to the Limit of Detection of SARS-CoV-2 Antigen Tests
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4d0a1d14314fe0b450fa0bee22224cc9.pdf?Expires=1712793600&Signature=j6FHaYCQF1%7ExK5LSMGYNQ9DT66owFfldrCGMSsetFX-y9UiCgLyKASV2m4UQ3BiRZsr8bBawFH%7EIeG0FRJsWpb-s-yPX%7E3KU6M2NmeO4eKc-pAou%7EjDZEZnfPzgh5chkPXM5RxOCZngrOigoY2ifzFX9y3KbFNYRzhYNG80%7E6xRWJXFomyRw9cq9hLhPqE9UAuh-uxMpJD4zFKhEcA0dxWQ51HGsFRaXb7VozR-3-OtIXCF7avjdIvDUIZvCir3FecDKY7GMF-%7EVTa4gZoBQkxAaE8z7kQ7bmEs3U5ZrN5Lz%7Eq-6jX1x%7E1imCc9xXFcRmLbYPl-Pu9WWThnHwTYaKA__&Key-Pair-Id=K6UGZS9ZTDSZM
98e9e892dc3235754c30237015852f05
PDF Text
Text
Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
In February of 2020, our group purchasing organization announced concerns for supply chain disruptions
given the reliance on active pharmaceutical ingredient (API) production from China. Conversely, none of
the wholesale distributors were experiencing any supply disruptions and that they anticipated none.
Historic experience with high acuity influenza surges (2009, 2017) and natural disasters (Hurricane
Maria) lent perspective to the potential impact of manufacturing and disproportionate demand leading to
shortages. However, the trajectory of this yet to be defined global pandemic left Pharmacy Operations
and Clinical Management without a clear direction for anticipatory purchasing or a watch and wait
approach.
After weeks, medications of concern affected were agents thought to treat CoVID-19 (e.g.
hydroxychloroquine, azithromycin), and agents to treat the symptoms of CoVID-19 (e.g. respiratory
medications-inhalers, nebulizers).
As the pandemic intensified, agents to address the influx of intensive care admissions (e.g.,
vasopressors, sedatives, intravenous opioids, neuromuscular blockers) became on short supply. The
shortage list continued to expand faster than any other time period across multiple categories threatening
to interrupt patient care.
Aim/Goal
To balance unclear and fast evolving demand with supply chain availability, fiscal responsibility, clinical
evidence, and avoiding a hoarding process, to avoid negative consequences in patients. There are no
available benchmarks for shortages other than avoiding stockouts, implementing therapeutic
substitutions and forestalling negative clinical outcomes.
The Team
John Hrenko, PharmD
Operations Supervisor
Gordon Hubbard
Purchasing Manage
Jamie Levash RN
Project Manager
Margaret Stephan MS
Chief Pharmacy Officer
Ifeoma Eche, PharmD
Clinical Manager
Howard Seth Gold, MD
Clinical Director
Julius Yang, MD
Clinical Director
Christopher McCoy, PharmD Clinical Manager
Department of Pharmacy
Department of Pharmacy
Health Care Quality
Department of Pharmacy
Department of Pharmacy
Health Care Quality, Infectious Diseases
Health Care Quality
Department of Pharmacy
Given the escalation and dynamic nature of supply chain disruptions daily huddles and communications were
enlisted,
Purchasing and Pharmacy Operations Administration continuously monitored supply chain announcements
from multiple sources, the group purchasing organization, manufacturers, wholesalers multiple times a day.
Purchasing sought out alternate suppliers and allocation methods to order/purchase items in high demand
continuously.
Pharmacy Operations used tactics including centralization of product supply, alternative route selection.
Clinical Pharmacy Managers worked with Infectious Diseases/Antimicrobial Stewardship to investigate and
reported out guidance relative to CoVID 19 therapeutics (e.g. high demand for azithromycin and
hydroxychloroquine). Alternate dosing strategies and algorithms for pain management, sedation and
neuromuscular blockade were created to standardize practice.
Invocation of the Drug Shortage Task Force including Health Care Quality was used to prioritize care, build
consensus with thought leaders and experts and devise algorithms and protocols.
A continuous modification of Provider Order Entry clinical decision support was designed and implemented to
guide best care and avoid shortages
Detailed interventions
Identify the key medications to
treat the complications of CoVID
19 infection.
• Dypsnea/Pneumonia
• Inhalers/nebs
• Antitussives
• Expectorants
• Sepsis
• Vasopressors
• Sedatives
• Antibiotics
• Analgesics
• Supportive meds
• Neuromucscular
Blockers
• Experimental CoVID tx
• Antibiotics
• Antivirals
Drugs completely out at the manufacturer and wholesaler level
Respiratory
Albuterol Inhaler
Albuterol Neb
Budesonide NEB
Epoprostenol IV
Ipratropium Bromide Inhaler
Ipratropium Bromide Neb
Tiotropium inhaler
Electrolytes
Calcium Gluconate IV
Magnesium Sulfate IV
Vasopressors
EPINEPHrine IV
NORepinephrine IV
Phenylephrine IV
Vasopressin IV
Intensive Care Unit Supportive
Artificial Tears
Chlorhexidine Gluconate PO
Sodium Bicarbonate IV
Sedatives
Dexmedetomidine IV
Ketamine IV
Midazolam IV
Propofol IV
Antibiotics
CefePIME IV
CefTAZidime IV
CefTRIAXone IV
Piperacillin-Tazobactam IV
Vancomycin IV
CoVID experimental therapeutics
Azithromycin IV
Azithromycin PO
Chloroquine PO
Cobicistat PO
Darunavir PO
Doxycycline PO
Doxycycline IV
Hydroxychloroquine PO
Lopinavir-Ritonavir PO
Neuromuscular Blockers
Cisatracurium Besylate IV
Etomidate IV
Rocuronium IV
Analgesics
Symptom Care
Benzonatate PO
GuaiFENesin PO
Fentanyl IV
HYDROmorphone IV
GuaiFENesin-Dextromethorphan PO
Ondansetron IV
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy .
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Therapeutic specific
demand and utilization
during surge 1 & 2.
Introduction of a
Performance Manager View
Overarching Planning and Execution detailed for our team
Continuous
monitoring of
demand and
retrospective
lookbacks:
Antibiotic demand during the first surge of 3 months dwarfed antibiotic use for
years prior and patients with CoVID were 10x more likely to receive antibiotics.
Continuous shifts directed by our team were necessary to keep supply.
Tracking and movement of key meds
with grading of next phase readiness.
• Par levels needed to be adjusted to
the new normal for daily/monthly
utilization
• A safety stock to get through
national shortages was required
but had to balance fiscal
responsibility and good global
citizenship (e.g. no hoarding)
• Omnicell (floor supply) had to be
readjusted to meet new floor
demands and centralization.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Situational awareness and community
building
Standard processes for ordering preparing
and administering meds all required
reframing across disciplines
Example of adjustment to steep demand
curves through therapeutic substitutions, in
this case from IV to PO for sedativeswithdrawal meds.
Example communications to all Hospital Staff
Early pandemic guidance suggested that all
items be disinfected to protect staff
In order to rein in the reflexive use of
agents thought to aid in treatment of the
infection given short supply and
prophylactic use.
Inhalers became in such short supply but critical
to care of all inpatients
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Drug substitutions were necessary but required
education and communication.
Drug Shortage Task Force Prioritization Schemes
Example communications and clinical therapeutic
summaries
Cisatracurium outages
Midazolam critical lows
Lessons Learned
Fentanyl Mitigation
Therapeutic demand and supply chain interruption is nearly impossible to predict during a global pandemic
Interdisciplinary involvement and broad communications are essential to keep available supply and ensure public health safety
Time required to address all the clinical decision making, inventory control and supply allocation is more than 50% of dedicated
time.
Next Steps
Utilize similar tactics for management of acute shortages early with engagement of therapeutic area leads, inventory tracking
and demand curves.
Apply modeling for network engagement and resource sharing.
Utilize global facing platforms like PowerBI through Performance Manager.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
John Hrenko
Gordon Hubbard
Jamie Levash
Margaret Stephan
Ifeoma Eche
Howard Seth Gold
Julius Yang
Christopher McCoy
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Healthcare Quality and Patient Safety
Infectious Diseases
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
Pharmaceutical Supply Chain Management Before, During and After the Inpatient CoVID 19 Pandemic Surge(s)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b4021f2b223c5abadd774ed9b8f1d4b7.pdf?Expires=1712793600&Signature=FYASO4RkMm0xnp5GLu-i4Fhb7wwHSRz%7EbKO2yNmT83SqI98ulBRpJIDTN7oeaUGgzCQqswqr6nm0IyQHRBAd%7Ezv9DaSOkwjoupnLorIKk5ty9vaVM15lwZcxR5eVxb8-dzgnLmoxH3TwdOT-tUHjtKseUKCtIdTCt3JpyBqOlWMZ3sss8fbDRJMWZluX6cxpx3qAc07Nb9at1yVY2LJp1o-0Z8MJ38q%7EKxN9Lx2JgJFygJpZH8OS7dzCkwyeQkpOc-Q-habs12R94ZRj44yHszpAPdwvbOIDzdsZXjbGbVgFZyHrtB1w7l4Xwmu4ChhUapKIRx1lzIouOVFusBgelw__&Key-Pair-Id=K6UGZS9ZTDSZM
b82a5f46d6b6bd429361c72940ef9715
PDF Text
Text
Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
Remdesivir was an early front runner for therapeutic agents of interest given activity against other
coronaviruses, some experience with Ebola and a relatively clean adverse event profile.
Notably the agent was used in the first published experience of a patient in Washington state who received the
drug as part of his hospitalization for CoVID-19
Gilead and the NIH had designed early trials to examine its usefulness in hospitalized patients in a placebo
controlled fashion but also in trials to examine the duration of therapy (5 vs. 10 days) in patients with varying
degrees of illness
Prior to initiation of these trials, the only access to the agent was through compassionate use via the FDA and
Gilead.
Once BIDMC was selected as a trial site for two trials, a process of rapid evaluation and enrollment was
necessary before patients received unapproved therapies, notably hydroxychloroquine which would become
exclusionary.
Remdesivir was then approved for Emergency Use Authorization just four months into the pandemic requiring
a level of regulatory compliance not seen at BIDMC.
Four months after EUA approval, the drug was FDA approved in full with limited restrictions to use lending to
the need for a stewardship process to ensure safe, equitable and responsible prescribing.
Aim/Goal
To enable access to remdesivir through its life cycle from compassionate use to emergency use to FDA
approval while meeting regulatory requirements and conscious stewardship.
The Team
Jamie Levash, MSW
Project Manager
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Disease
Julius Yang, MD
Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
Healthcare Quality
Infectious Diseases
Pharmacy
Health Care Quality
Health Care Quality, Infectious Dis
Pharmacy
Initiated compassionate use access to remdesivir through an FDA-Gilead-BIDMC pathway for patients with limited treatment
options
Incorporated remdesivir into treatment guidelines for review for research enrollment
Reviewed CoVID 19 admissions for hydroxychloroquine initiation requests through stewardship and directed primary teams
to the remdesivir local study team
Developed the Emergency Use Pathways for important inclusions and exclusion details and daily treatment tracking with
Health Care Quality
Once study results were published, provided education and review for the treatment collaborative
Tracked adverse events of concern from the Emergency Use experience
Worked with Health Care Quality to devise an allocation scheme when early release of product did not meet demand
With EUA transition to FDA approval, worked collaboratively to develop a treatment guideline and stewardship review
Continually reviewed study data publication, local results, national guidance and provided BILH network guidance for best
practice
Results
Early review of
access limited to
a restrictive
compassionate
use process with
limitations to
degree of illness
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
K Stephenson/BIDMC
selected as site for two
trials
US Clinical trial
development and linkage
Work with trial team and
Research Pharm given rapid
enrollment
Initiated compassionate use
prior to study launch
38 yo M transferred from BI-Milton
for ICU admission
Patient excluded from two trials due to
need for ventilation enrolled in
compassionate use protocol
58 yo M, high risk w/ obesity,
hypertension had to be rapidly
intubated.
Created a reference document,
snippet below for compassionate
use consideration to ensure
accepted and not study eligible
24 yo F pregnant excluded from trials
enrolled in compassionate use acces
Developed an early review
by Stewardship team for
potential enrollment in
remdesivir trials
Developed a primer for
primary teams to enable
study drug release given
high volume
Response to primary team demand
May 2020 Emergency Use
Authorization granted but
allocation process in
question
1 Completed 5 days hydroxychloroquine
2 Completed 5 days hydroxychloroquine
3 None
4 Hydroxychloroquine
5 None
6 Hydroxychloroquine
7 HCQ 3/17-18, stopped
8 Lopinavir/ritonavir
9 Hydroxychloroquine
10 Hydroxychloroquine
11 Hydroxychloroquine
12 Hydroxychloroquine
13 Hydroxychloroquine
14 Remdesivir compassionate use
15 Completed 5 days hydroxychloroquine
16 Completed 5 days hydroxychloroquine
17 None
18 Hydroxychloroquine
19 None
20 Hydroxychloroquine
22 Lopinavir/ritonavir
23 Hydroxychloroquine
24 Hydroxychloroquine
25 Hydroxychloroquine
26 Hydroxychloroquine
27 Hydroxychloroquine
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Remdesivir EUA guideline
developed locally
Algorithm for trial versus EUA
Includes an algorithm to allow for
continued enrollment in the clinical trials
to avoid dipping into the EUA limited
supply
Stewardship team daily tracking
and dose release approval to
avoid waste
Development of unique guidance for
an Emergency Use Authorization to
meet regulatory compliance and
receive further allocation
Built cPOE screens to encourage
laboratory screening before
entry as well as special
considerations for other study
meds
Engaged Drug Shortage Task
Force for prioritization
scheme
Developed and sent out
Communications given
limited supply and
restrictive criteria
June 2020: Remdesivir
supply opens up lending to a
transition to Stewardship
only approval
Tracking sheet developed to
communicate between Health Care
Quality and Stewardship team
Last COVID
Admission Date
Test
MV at Enrollment
Priority
05/11/2020
05/11/2020
No
3
05/09/2020
05/08/2020
Day 1
1
05/03/2020
05/03/2020
DAY 9
2
05/11/2020
04/26/2020
DAY 2
1
05/11/2020
05/02/2020 Not at enrollment, now intubated 3, now 1
05/12/2020
05/10/2020
DAY 2
1
05/10/2020
05/12/2020
dAY 1
1
05/11/2020
05/11/2020
DAY 3
1
5/15/2020
5/15/2020
No
3
5/15/2020
5/15/2020
No, O2 sat<94%
4
5/14/20
5/15/20
Day 3
1
5/16/20
5/16/20
No, 02 sat <94% RA, 3L
4
5/15/20
5/16/20 No, 02 sat <94% RA, oximizer 10L
3
5/17/20
5/17/20
Date
Approved
05/12/2020
05/12/2020
05/12/2020
05/12/2020
05/12/2020
05/14/2020
05/14/2020
05/14/2020
5/16/20
5/16/20
5/18/20
5/17/20
5/17/20
5/18/20
Consent
Completed
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Planned
RegimEn
(day)
5
10
10
10
10
10
10
10
5
5
5
5
5
5
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
June 2020
BILH Network Remdesivir EUA review
done
FDA approves Remdesivir fully
and it earns a brand name
Approval is broadly permissive
for inpatients with CoVID-19
A more transparent and
functional tracking system of
remdesivir developed for
Performance Manager
Examination of ethnic/race
diversity
OMR Macro development
to ensure data integrity and
documentation
Stewardship group engages in a full review of remdesivir trial
publications, local experience and FDA submission to present to
treatment collaborative, local and system P&T
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Final recommendations for approval with restrictions
Formulary Review: Study Details
Lessons Learned
Fielding the “in time” trajectory of drug research, compassionate use access, expanded use access and translation of published
experience to best practice requires collaboration and human resources to avoid unintended consequences and optimize
efficiency.
Education, intensive tracking and communication are key to meeting regulatory compliance and optimizing care
Open discussion and collaboration during an acute stressful surge allows for more transparent decision making and engagement
Remdesivir Stewardship across the Network
Next Steps
High utilization at low volume hospitals
High demand and utilization necessitated
network shifts of supply
Use the experience from remdesivir to build upon future Emergency Use Guidance
Continue to steward remdesivir to gain benefit in the early infection stage of viral replication
Optimize Stewardship resources for the network to build upon experience and higher level controls
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Jamie Levash
Katy Stephenson
Ryan Chapin
Julius Yang
Howard Seth Gold
Christopher McCoy
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Quality and Safety
Infectious Diseases
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Remdesivir: From Research to Emergency Use to FDA Approval and Stewardship
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/8c3cf010b56fccf6495e21fb86001593.pdf?Expires=1712793600&Signature=dWn0Owc6u0s-eDFvDIE3k52Ot-3MxxNUmRvePm9cY%7EjnBFQ0NoirZTQiHpJDtSVAidvdwqRIlsaZFsDAky7i7m6LBESug32e0LQcoB0lKfgyYwYVHWWrhO4OxzS69s3pbIFZ%7Er1dnq%7EAFkGORedHAdfdHRK14c15PHQlVtgQO32ZPxZwaOIwix6wnmIestfMGtXccGPAMOipiHGVuc7sBnLZNmrcSM51JpRSKBFTiWOqclqq6hS7d20fWolvoOWAeGYmA5tMHVh5uPlDQov1m-z6rq4LRfaUZuZCJRmPtEKMLuWeIPTgNUwyvAn%7EzUPVp%7EmCTJn1GHWOiYv-Xq5uww__&Key-Pair-Id=K6UGZS9ZTDSZM
39171dfad4e8ec20a27153eae4f10b9e
PDF Text
Text
Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
With the impending pandemic and its unclear impact, we convened a multidisciplinary workgroup across
Pharmacy, Infectious Diseases, Research, Transplant, Hematologic Malignancy, Critical Care and Health
Care Quality and others to begin to plot out a treatment guideline for CoVID-19.
The unknowns were many given the lack of approved treatments, the lack of peer reviewed published
literature and unclear trajectory for the breadth and depth of care at our institution.
The need for a rapid response and clear guidance became increasingly pressured during the first surge as
our census for those infected went from 3 to 192 from March to April 2020 with a high percentage of patients
requiring ICU level care and many remaining here for weeks.
Sources of data were limited to a World Health Organization outline, preprints from China and Italy and basic
science reviews of agents thought to have antiviral activity.
Early guidance were often completely refuted by well controlled trials, e.g. recommendation to given empiric
antibiotics to all patients with SARI, avoidance of systemic corticosteroids.
Over 273 medication shortages were making broad treatment recommendations difficult.
Active research protocols had to be introduced to promote systematic exploration
Aim/Goal
To provide a central and locally balanced resource for clinicians for the treatment of CoVID-19 bifurcated by
disease severity and predictors for advanced disease based on an ever evolving evidence base.
To grade therapeutic modalities and frame experimental therapies with risk considerations and newly
launched local research.
The Team
Roger Shapiro, MD
Attending Physician-HIV researcher
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Diseases
Sabrina Tan, MD
Attending Physician- Viral Researcher
Margaret Hayes, MD
Attending Physician- Critical Care Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
CoVID 19 Treatment Collaborative
Infectious Diseases
Infectious Diseases
Pharmacy
Infectious Diseases
Critical Care Medicine
Health Care Quality, Infectious Diseases
Pharmacy
Built a multidisciplinary team with incorporation of the network and representation from key clinical areas
Developed a review process for preprints through MedrxIV, national guidelines (NIH, IDSA)
Scribed a treatment algorithm by severity of disease presentation.
Continuously evaluated and incorporated best practice for collection and interpretation of biomarkers and
laboratory values as well as comorbidities for risk stratification
Reviewed investigational therapeutics for linkage to local research studies (e.g., remdesivir, favipiravir)
Researched and provided dosing, drug interaction, screening and place in therapy guidance for all agents
Facilitated weekly data/literature summary meetings across a BILH network collaborative to build consensus for
guideline changes.
Reviewed drug shortage updates to alter treatment guidance toward a prioritization scheme
Directed restrictive criteria/clinical provider order entry guidance for therapeutic agents to promote safe and
evidence based utilization of scarce resources
Results: Data Review
Early but
continuous
review of
prepublished,
published
and
guideline
data.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Most basic outline created Feb 2020
Basic tenets from WHO and CDC
Ongoing trial of remdesivir
Weblink guidance for early therapeutics
From basic science to WHO guidance to
National guidelines
US Clinical trial
development and linkage
HIV Antiviral adaptive
research
Agents not recommended
Earliest treatment algorithm
incorporating a single experimental
agent
First iterative
multidisciplinary multisite
algorithm: March 20
Early investigational
Agents with unknown utility
Severity graded guidance
Lab and Imaging guidance
Risk analysis for progression
Special Populations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
Late March 2020
Began populating an ever growing
annotated citation list
Held first in a series of
Network Meetings
April 2020
Invited content experts and leaders
across the BILH network to build the first
Network treatment algorithm
Introduced Nephrology research on
niacinamide and conditional framework
Expanded sections on
Immunomodulators
Worked with EP/Cardiology
to enhance guidance
evaluation of therapeutic
agents with QT prolongation
concern
Built links to ongoing trials to boost
enrollment
Tocilizumab guidance
Hydroxychloroquine utilization
Hydroxychloroquine +/- Azithromycin
Adverse Event Investigation
JAMA Cardiology Publication
Did quality review of local tocilizumab
utilization and infectious complications
Added more evidence based guidance
for patients who may benefit from IL-6
modulation
Linked ICU teams with ongoing IL6
modulation trial-sarilumab
Identified hydroxychloroquine and
azithromycin utilization as concerning
Removed darunavir-cobicistat from
therapeutic recommendations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
April 2020
Anticoagulation Prophylaxis and
Treatment Guidelines
Convalescent Plasma considerations
added
Tocilizumab Plan
Tocilizumab shortage management
Remdesivir approved for
EUA utilization: need for
local guidance and
separation from clinical
May 2020
trials
National allocation was
small for MA hospitals
requiring prioritization
scheme
July 2020
Communications to staff regarding
remdesivir
June 2020
Network Remdesivir Experience
Exploration
Presented and added dexamethasone
to treatment guidance
Removed hydroxychloroquine and
azithromycin as treatment agents
Lack of HCQ benefit
Added additional sections on
culture based antibiotic
utilization with rapid tailoring
for negative cx
Based on study data, limited
treatment duration to 5 days
Identified population with
benefit with moderate 02
requirements
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
July 2020
Baicitinib initial review
August 2020
October 2020
Convalescent Plasma considerations
clarified given Mayo closes enrollment
BIDMC local abx utilization
and collateral damage
review published
FDA opens Remdesivir to all inpatients
Concern about Bamlanivumab
launch
Remdesivir EUA ends: FDA
approved
November 2020
First CoVID monoclonal Ab
Approved via EUA process
Guidance prepared
Baricitinib EUA guidance prepared
Dec 2020
Resources turn towards vaccine
approvals and EUA rollout
Incorporation of NIH figures
Remdesivir EUA supplies dwindle
prompting network utilization review
% utilization growth
50%
45%
40%
35%
30%
25%
On hold for vaccine launch
20%
15%
10%
5%
0%
Despite high census, BIDMC has strict
control on remdesivir use
For more information, contact:
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Milestones
Ivermectin review
Jan 2021
Infographics for antibiotic overuse
Continued tocilizumab evidence evaluations REMAP-CAP redirecion
February – November 2021
Outpatient and Employee vaccine rollouts
Vaccine recommendations for immune compromised host
Third dose and half dose boosters launched
Monoclonal Antibodies reviewed and infusions begun in June 2021
Additional antibody combinations reviewed and added given variants of interest
Regulatory reports for EUA allocation established and submitted
Tocilizumab shortage addressed with introduction of baricitinib via EUA and other
mitigation processes
Vaccine AE warnings added to screening documents for selection
Lessons Learned
Therapeutic review and guidance for an entity and a pandemic not seen before requires significant human resources to vet
hundreds of citations and build consensus.
A network wide guideline posted to institution specific intranet sites to accommodate resources of size and demand is an
achievable goal with regularly scheduled meetings.
Version control and edits can be daunting
The process of review and utilization reports revealed the potential for reflexive prescribing
Next Steps
Continue network collaborations across the CoVID 19 trajectory, vaccines and preventive therapies.
Determine ways to communicate more broadly and efficiently
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Roger Shapiro
Katy Stephenson
Ryan Chapin
Sabrina Tan
Margaret Hayes
Howard Seth Gold
Christopher McCoy
COVID 19 Treatment Collaborative
Department
Any departments listed on the poster or identified in the spreadsheet.
Infectious Diseases
Pharmacy
Critical Care Medicine
Health Care Quality and Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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
Development of a Living Guidance Document for the Therapeutic Evaluation and Treatment of Patients with COVID-19
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/588e43923a06a7c3816453f145b7c9aa.pdf?Expires=1712793600&Signature=BNPhklk9TB4agdrhX%7EG6tnIhHIwLmanllQJ2FB65VXCuyICpZYqwbYBRNUUStOskki%7ERGeizszBi%7E1gVC9TibPsEqFbUbYsbdJmoJKRpPzoUO078bh464jZnYlWlE5WigHCUwIIWcH-aYMrU1tmZhoZyptwD3NjfijQ6-iPoxZMlTo6MREF7tSc3GGvfdpIr9jcM4RPXkdmgJ5LxXzMn1SMK7d2A5HpeVHd5Sr4Db3DYA00%7EP%7EVmpSiWuRtJFOqSGDv4zotzCdbMrHFC5qwRyKVVYAH2CIX7Byrn8F4HGUTGoqohM1bLyYhIj%7ExpSMRYFvVG4inUu7VM9Y2YRMpW3A__&Key-Pair-Id=K6UGZS9ZTDSZM
15a3ba7c19d9cca2f7da49c53f661859
PDF Text
Text
Use of Prone Positioning in Awake, Non-Mechanically Ventilated Patients with COVID-19
Bridgid Joseph, DNP, CCNS, RN, Lynn G. Mackinson, MS, ACS-BC, RN, Lauge Sokol-Hessner, MD Anica C. Law, MD, MS, Susan DeSanto-Madeya, PhD, CNS, RN, FAAN
BIDMC
Introduction/Problem
➢ In April 2020, Massachusetts was a “hot spot” of COVID-19 pandemic and was third in United
States for overall COVID-19-related deaths (Center for Disease Control and Prevention, 2020).
➢ From March through June 2020, COVID-19 admissions peaked in Boston
➢ BIDMC reached a peak intensive care unit (ICU) census of 135 patients and 346 MedicalSurgical (Med/Surg) patients.
➢ The influx of patients who were COVID positive and COVID suspect significantly impacted bed
availability, throughput and staffing at BIDMC.
➢ To avoid further strain on hospital resources, clinicians searched for ways to support oxygendependent patients so that they might recover faster and avoid deterioration and subsequent
ICU transfer.
Aim/Goal
Based on research supporting use of prone positioning with intubated patients in critical care but
limited evidence in spontaneously breathing patients, we aimed to create a process and protocol to
place awake, spontaneously breathing patients with COVID-19 in a prone position in an effort to:
*Facilitate the patient’s recovery
*Prevent further respiratory decline
*Preserve ICU beds for the most critically ill patients
The Team
Bridgid Joseph, DNP, CCNS, RN
Lauge Sokol-Hessner, MD
Susan DeSanto-Madeya, PhD, CNS, RN, FAAN
Hospital Incident Command
Lynn G. Mackinson, MS, ACS-BC, RN
Anica C. Law, MD, MS
All In-Patient Leaders
The Interventions
➢ Process and protocol to guide nurses on
Med/Surg units developed and
implemented in April, 2020
➢ Targeted patients required supplemental
oxygen via low flow nasal cannula or face
mask, with difficulty weaning or increased
oxygen requirements
➢ Rolled-out to inpatient leaders during a
Hospital Incident Command daily huddle
➢ Email sent to all staff with information
about protocol and roll-out
➢ RNs educated locally during daily huddles
➢ Infographic created and sent to PCS
inpatient leaders to educate Med/Surg
staff. Included:
*Appropriate patients to pronate
*Contraindications
*Talking points for patients
*Tips for positioning
➢ Critically ill patients were sent to the ICU
➢ Prone positioning was used to prevent
COVID-related respiratory
decompensation and not as rescue
therapy
pr
be
plac
ed
pro
ne
des
pite
oxy
gen
nee
ds
For more information, contact:
Lynn Mackinson MSN,RN, ACNS-BC lmackins@bidmc.harvard.edu
�Use of Prone Positioning in Awake, Non-Mechanically Ventilated Patients with COVID-19
Bridgid Joseph, DNP, CCNS, RN, Lynn G. Mackinson, MS, ACS-BC, RN, Lauge Sokol-Hessner, MD Anica C. Law, MD, MS, Susan DeSanto-Madeya, PhD, CNS, RN, FAAN
BIDMC
*The protocol required a written order under the “General Orders” in POE.
However, prone positioning was often implemented after conversations
among team members and patients. As staff became more comfortable with
the protocol, it was implemented more informally without a written order.
Post surge #1 Med Surg Staff Survey
More Results/Progress to Date
Supplemental information sent to staff regarding appropriate
patient choice for awake prone positioning
Lessons Learned
➢ Implementation of prone positioning protocol required a multi-disciplinary approach to ensure
a comprehensive educational plan that would maintain safety and consistency
➢ The HICS team provided a structured communication network that facilitated smooth
implementation of the intervention
➢ Creation of 1-page infographic expedited educational process for clinicians and patients
➢ Infographic provided a quick reference for front-line nurses, who were ultimately the end
users of prone positioning protocol
➢ Intervention was implemented following team rounds
➢ Order for prone positioning was not always reflected in POE, thereby limiting ability to
capture and track patient outcomes
Next Steps
➢ Creation of a POE Awake Prone Positioning order set would help sustain this multi-disciplinary
intervention, allow for more accurate tracking of patients and improved ability to collect data
➢ Document and collect data on patient outcomes and the patient experience
➢ Gather additional information on nurses’ experiences to further evaluate the success of the selfprone positioning protocol
For more information, contact:
Lynn Mackinson MSN, RN, ACNS-BC lmackins@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.
Lynn Mackinson (<a href="mailto:lmackins@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">lmackins@bidmc.harvard.edu</a>)
Project Team
Susan Desanto-Madeya
Bridgid Joseph
Lauge Sokol-Hessner
Anica Law
Lynn Mackinson
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.
Hospital Incident Command
ICUs
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
The Use of Proning in Awake, Non-mechanically Ventilated Patients with COVID-19
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e77164b53da3fa18ca9587ea3c0e065c.pdf?Expires=1712793600&Signature=e81apZEKzBdMnz-NAjnpzG1ueo%7Er8gwu6FvgsK-xfHMD0V7Hxb%7E1X7ZJbFaVGkRIBoJQ07uT340%7EZ7A%7EqKYUyDZOV-PZUBRKi3%7ECxHT4xhI74AjpTQezkVgKpODyDLQ2%7EEygFBDYvGg0nD70dzr7UU%7ElKjoFSbgKSk4hBu98mRBkXHOcRxNlPdmUjAWMkFv2bANoYqdm5vm8Rbt8HC1zC6TmhI3wVR3KfUQomPVs3G7AbgIzr%7EQHppaOIvW9hE5Ky1FfbVZ%7EpAdTdBM6N5gUm5phjvGBjSPV%7EuZx6G8gnCf5ZYGwodakoBjWpgUrsEAKaOKE8WrxPT96f%7E8QeCTneA__&Key-Pair-Id=K6UGZS9ZTDSZM
cd6a42c09a2967c2c4767321243d6398
PDF Text
Text
Large-Scale In House Production of Viral Transport Medium and 3’ N95 Mask Disinfection Using Universally Available Materials
VTM: Kenneth P Smith1,2 , Annie Cheng1, Amber Chopelas#1, Sarah DuBois-Coyne#1,3, Ikram Mezghani#4, Shade Rodriguez#1, Mustafa Talay#5, James E Kirby6,2 1Dept. Pathology, BIDMC, 2HMS, 3Depart.
Biochemistry, U MA Boston,4Dept, Surgery, BIDMC, 5Dept. Molecular & Cellular Biology, Harvard University, #Contributed equally. N95 Mask: Katelyn E. Zulauf,#a,b Alex B. Green,#a Alex N. Nguyen Ba,c
Tanush Jagdish,d,e Dvir Reif,f Robert Seeley,g Alana Dale,g and James E. Kirbyh; aDet. Pathology, BIDMC, bHMS, cDept. Organismic and Evolutionary Biology, Harvard University
dProgram for Systems, Synthetic, and Quantitative Biology, Harvard University, e Center for Computational and Integrative Biology, MGH, fDepart. Molecular and Cellular Biology, Harvard Univ., gEnvironmental
Health and Safety Department, BIDMC, h,6Corresponding author, #Contributed equally.
Viral Transport Medium (VTM) for SARS-CoV-2
diagnostic laboratory testing– NONE available!
N95 mask disinfection for reuse
SARS-CoV-2
Nine personnel in two isolated
VTM production teams
Sourced available pre-sterilized
medium (HBSS, FBS,
antibiotics), CDC VTM recipe
with added phenol red for visual
QC
MS2 phage – tougher
RNA virus surrogate
4000
per day
Sourced tubes from donors
around Boston (until commercial
supplies available)
Titering MS2 virus plaques
Tissue culture rooms in CLS6
(8 biosafety cabinets)
Liquid handling automation
KP Smith, PhD, with permission
Rock climbing tape (donated) to
prevent repetitive use injury
Accelerated stability testing
Arrenhius equation –
pharmaceutical approach
2 weeks to predict >4 month
room temperature outdate,
sterility, robust support of
SARS-CoV-2 RT-qPCR
Daily QC (each run/lot)
Ref: JCM. PMC7383539
12 member kit assembly team
(added 3-D printed swabs et al.)
in Leventhal Conference Room
>100,000 VTM
collection kits for all
of BILH. Production
March –June 2020,
used into fall of
2020.
Method
1. Add concentrated M2 RNA phage virus to mask.
2. Glass dish, 1/4 cup water, grocery store web
mesh, rubber band, microwave 3 minutes
3. Count phage plaques (number of viable virus
remaining) compared with no treatment control
1.
2.
3.
4.
5.
Ref: mBio. PMC7317796
>150,000 downloads
MS2 phage = norovirus >> tougher than
SARS-CoV-2
> 6log10 MS2 virus titer reduction.
Performed 20X without loss of N95 fit
or filtration
Battelle vaporized hydrogen peroxide
system: >$ 6 million, centralized
Microwave decontamination, point-ofuse, <$10 setup using existing
microwave
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
James E. Kirby <a href="mailto:">jekirby@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
Kenneth P Smith
Annie Cheng
Amber Chopelas
Sarah DuBois-Coyne
Ikram Mezghani
Shade Rodriguez
Mustafa Talay
James E Kirby
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
Surgery
Environmental Health and Safety
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Large-Scale In House Production of Viral Transport Medium and 3’ N95 Mask Disinfection Using Universally Available Materials
Date
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2021
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pdf
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Environmental Sustainability
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/fa25a1b499e04b708cc1845f8403343f.pdf?Expires=1712793600&Signature=e5k6VOgq92L9%7EyY5uYvvvo-iQN36SG0xlJjfLl1CB7t34I71ZjTQACMyOVOh-dDm6c9rAjPoM3CHwSD9WgVWE9nSPdZOvTbPH6UKoylfoH8hUcc8oDCBA0IoGpYEBMtUk2E60VMSHqvnXsVhWPMn29UUbzxj2psrEXx60OBHmPw17l4jzDP2a2LNDd%7E-EbMNYoovMVdcODVBtYijUnxjokBuqQdkxbGBq5afgWA7rhM2uX-22guMQ8IOpxQMsavd4WVHFX4qj4ubS2ieCHthqIudBkz6Qz0kriI9s1wjgkRdaepMjg8Mdp-dlHrkIKM15HlDsVVA0nI%7EceOtTzpeiw__&Key-Pair-Id=K6UGZS9ZTDSZM
41a1a2cd4c4c7d88a2f709035489dd3e
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Text
Leveraging a Real-Time Spatiotemporal AI Model for Surgical Resident Training and Education With
Implications during Pandemic-Related Surgical Volume Changes
Yilun Zhang1, Emmett Goodman2, Chris Kennedy1, Jevin Clark1, Hao Wei Chen1, Maren Downing1, Jordan Bohnen1, Serena Yeung2, Gabriel Brat1
1. Beth Israel Deaconess Medical Center, Boston, MA; 2. Department of Biomedical Data Science, Stanford University, Stanford, CA
Introduction/Problem
The Intervention
The COVID-19 pandemic exposed the existing need for more opportunities to
provide real-time feedback for surgical skills for surgical residents.
Real-Time Spatiotemporal AI Model
Aim/Goal
To Provide Automated Classification of Surgical Skill and Incorporate
Real-Time Feedback
The Team
Gabriel Brat, MD, MPH
Serena Yeung, PhD
For more information, contact:
Ilonzo, Nicole, Issam Koleilat, Vivek Prakash, John Charitable, Karan Garg, Daniel Han, Peter Faries, and John Phair. 2021. “The Effect of
COVID-19 on Training and Case Volume of Vascular Surgery Trainees.” Vascular and Endovascular Surgery 55 (5): 429–33.
�More Results/Progress to Date
Towards Understanding Surgical Skill
From Understanding Surgical Technique...
For more information, contact:
�More Results/Progress to Date
Model for Implementation
PGY1
Lessons Learned
Baseline
Next Steps
N = 104
For more information, contact:
�More Results/Progress to Date
Model for Implementation
PGY1
Lessons Learned
Baseline
Work on economy of motion by:
Reduce distance traveled by needle
driver hand
PGY1.5
Work on economy of motion by:
Continue to reduce distance traveled by needle
driver hand but also that of suture hand
Conserve hand pose by reducing unnecessary
rotation
Next Steps
N = 104
For more information, contact:
�More Results/Progress to Date
Model for Implementation
PGY1
Lessons Learned
Baseline
Work on economy of motion by:
Reduce distance traveled by needle
driver hand
PGY1.5
Work on economy of motion by:
Continue to reduce distance traveled by needle
driver hand but also that of suture hand
Conserve hand pose by reducing unnecessary
rotation
PGY2
Next Steps
New Baseline! Pred: PGY 3
Focus on conserving suture hand pose by reducing
unnecessary pronation
N = 104
For more information, contact:
�More Results/Progress to Date
Model for Implementation
Lessons Learned
Surgical Residents Require More Feedback during Case Load Changes
PGY1
Baseline
Automated evaluation of surgical skill is possible
Work on economy of motion by:
Reduce distance traveled by needle
driver hand
Providing “Just in Time” feedback after engaging in a task increases retention
PGY1.5
More discrete levels of training could allow for better than a binary skill
classification
Work on economy of motion by:
Continue to reduce distance traveled by needle
driver hand but also that of suture hand
Conserve hand pose by reducing unnecessary
rotation
PGY2
Next Steps
Improve integration of automated and remote forms of real-time feedback
for surgical trainees
New Baseline! Pred: PGY 3
Potential for other situations whenever the training path could be disrupted
Encourage increased collaboration between institutions
Focus on conserving suture hand pose by reducing
unnecessary pronation
PGY3
N = 104
Thank you to the peri-operative staff, the Shapiro Clinical Center, and
the residents who helped make this possible!
For more information, contact:
Contact: gbrat@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Gabriel Brat (<a href="mailto:gbrat@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">gbrat@bidmc.harvard.edu</a>)
Project Team
Yilun Zhang
Emmett Goodman
Chris Kennedy
Jevin Clark
Hao Wei Chen
Maren Downing
Jordan Bohnen
Serena Yeung
Gabriel Brat
BIDMC Location
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BIDMC
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Surgery
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Title
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Leveraging a Real-Time Spatiotemporal AI Model for Surgical Resident Training and Education with Implications during Pandemic-Related Surgical Volume Changes
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
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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.
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
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
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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/2261faa049a2d385ea1fddc15d803b0b.pdf?Expires=1712793600&Signature=NoqaHnwNflFtkChSRjCqzrRHuoljLhfVh5RfyGw7SsrCoOHbb60eh5QaafqHF8MQzhIUMChNuHP-e8X98%7EftiXWHyaBie-yf%7EcvYwzAF6y7TgQbOE9WN6Q5jFzj1ytbTecaUvee8UJQTvC4wgxuMB4qsS3sNRUhUVX5YY64bsXPlOC2iSI8t2Za9Un7J%7EuX8RHZLizaWpm1zSCMZFb0rOma0gWhwKxpwrzQ7S80amTbfZicYXLTxYNe3MD0Ckb79EAFzchNnHb7of%7EPfNWr5o%7Ed56a7sku%7EZTtTVlncIQlCKVFTnXUFsFNLN02J-qeqmlQBUQQUlqqHo51oKiOKA9g__&Key-Pair-Id=K6UGZS9ZTDSZM
24087c16fc1d0fc5b1c7dd73cc1715ad
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Text
Use of Intrathecal Dexmedetomidine for Cesarean Analgesia
in Parturients with Opioid Use Disorder (OUD)
Sichao Xu, Lior Levy, JoAnn Jordan, Yunping Li and Philip Hess
Beth Israel Deaconess Medical Center, Boston.
Background:
• Cesarean analgesia in OUD patients is
challenging
• Some clinicians use IT morphine or IV PCA
for postop pain
• Spinal dexmedetomidine (IT DEX) has been
effective in some patients
Hypothesis
IT DEX would produce analgesia similar to
IT morphine or IV PCA
Primary outcome
Visual pain scores (VPS)
Secondary outcomes
Hydromorphone equivalent dose
Hypothermia, sedation
OUD (n=44)
IT Bupivacaine 11.25 mg
+ Fentanyl 25 mcg
High dose home
opioid (n= 26)
Low dose home
opioid (n= 18)
IT Morphine
(n=4)
IT Morphine
(n=13)
IT Dex (n=8)
IT Dex (n=1)
PCA (n=14)
PCA (n=4)
�Fig. 1 Visual pain scores (VPS) and
hydromorphone equivalent dose (HED) in
the PACU and over 36 hours post-cesarean.
Fig. 2 Rescue TAP/QL blocks in PACU
�KEY POINTS
Primary Outcome
• IT DEX:
Lowest VPS in the PACU with no difference afterward
Fewest patients required rescue blocks in the PACU.
Secondary Outcomes
• HED (24 hr) lowest with IT morphine
• No difference in HED between IT Dex and PCA groups
• IT DEX not associated with postoperative hypothermia or sedation
CONCLUSION
• IT dexmedetomidine has a profound, but short-lived analgesic effect
�
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.
Sichao Xu (<a href="mailto:sxu5@bidmc.harvard.edu">sxu5@bidmc.harvard.edu</a>)
Project Team
Sichao Xu
Lior Levy
JoAnn Jordan
Yunping Li
Philip Hess
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Labor and Delivery
Dublin Core
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Title
A name given to the resource
Use of Intrathecal Dexmedetomidine for Cesarean Analgesia
in Parturients with Opioid Use Disorder (OUD)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/47d07ae0897abff317ec841a89f78ebb.pdf?Expires=1712793600&Signature=d05lXgLtDTlC6M%7EUKaj0loIxB6yYQcgyAV%7E3F1UOMbQqRS2yEukmrsmbyzYjhG7FOLh6HtXrKeRUXOEGeCzXqZft38tZrG4VBUOQrTwE0i75wAjgNSOHXWWh9S3wQKSTK9qcSI3Hmai0UCHNtw6pvJ%7Ehoe796rs8MOI50oJbP62WU18M08JIYAFCboVJtUl18bv6sDXrmMKdOoCoq7tR3nvDkeCLqE5SYMNKHq0WmjltWfEjfYvdRb7BXOCjf1jw9b1dAdFBSv6M5imiYnR%7EXs3BBflMmcvTvW0Z-CCS9wF51MFmjlVzbbd3hoiHZqKCrvKnN29GCWliE%7EIregd70w__&Key-Pair-Id=K6UGZS9ZTDSZM
983b2fde039858475cc30617371dfc59
PDF Text
Text
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
Introduction/Problem
When the COVID-19 Pandemic began, obtaining essential supplies from existing supply chain channels
became an urgent challenge due to significant shortages in supplies. At the same time, there was an
influx of support from community volunteers and alternative manufacturers that needed and wanted to
pivot from their traditional products and apply a variety of technologies and skills to producing products in
response to COVID-19. The volume of innovations coming to the surface required a team and a process
to effectively catalogue, test, source, and ultimately add alternatively sourced products to supply chain for
purchasing.
Aim/Goal
The goal of this work was to alleviate the shortages of essential supplies that were in short supply during
the COVID-19 surges, and create processes to be more prepared with alternative supply changes for
subsequent pandemics or other major public health emergencies.
The Interventions
Coordinated BILH system-wide sourcing & testing of alternative PPE
Developed and implemented BILH evaluation algorithm for PPE sourcing
Provided business and legal guidance for alternative RT-PCR kit sourcing
Provided business and legal guidance for open source 3D printed swab project
Communicated BIDMC PPE needs to COVID-19 Massachusetts Manufacturing Emergency
Response Team (M-ERT)
Brought >20 alternatively sourced products into the BILH supply chain
Results/Progress to Date
The Team
Administrative Project Team
• Emilie Downing, BS; Director of Market Analytics & Intelligence, BILH
• Catherine Gill; Senior Research Administrator, BIDMC
• Andi Hernandez, BA; VP of Research Operations, BIDMC
• Olivia Potvin, PhD; Research Program Manager, BIDMC
• Gyongyi Szabo, MD, PhD; Chief Academic Officer, BIDMC and BILH
• Eleanor Torrey, MPH; Senior Project Manager, BIDMC
• Tod Woolf, PhD; Executive Director of Technology Ventures Office, BIDMC
Research, Clinical, and Administrative Contributors
• Ramy Arnaout, MD, DPhil; BIDMC
• Sana Ata, MD; Lahey Hospital
• Alana Dale, BA; BIDMC
• Abby Flam, MCP; BIDMC & Atrius Health
• Heung Bae Kim, MD; BCH
• James Kirby, MD; BIDMC
• Jeffrey Lamson, BS, RN; BIDMC
• Stanley Lewis, MD; BILH
• Chip McIntosh, NP, PhD; BILH
• Phillip Mears, MHA, JD; BILH
• Christopher Minette, MBA; BIDMC
• Peter Shorett, MPP; BILH
• Thomas Siepka, RPh, MS, FASHE; BIDMC
• James C. Weaver, PhD; Wyss
• Marten H. Wolckenhaar, MD; Lahey Hospital
• Sharon B. Wright, MD, MPH; BILH
• Mark Zeidel, MD; BIDMC
1. COVID -19 Innovation Hub. Alternative manufacturing and methods project categories:
1) PPE Products, 2) PPE Sterilization for Re-Use, 3) Ventilators (parts, repair and novel simplified
designs), 4) Assays (COVID PCR and serological assays), and 5) Therapeutics and Vaccines (discovery
research and clinical trials).
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
2. Community Support Overview.
3. BILH Evaluation Algorithm for PPE Sourcing. The BILH COVID-19 Innovation Hub 1) organized the
flow of PPE donations, and had the PPE evaluated for suitability, and 2) consolidated requests and
sources of PPE from pivoted manufacturers and tracked which items could be cleared for use at BILH.
4. Covid-19 Diagnostics. 1) James Kirby at BIDMC quickly developed a Q-PCR assay with a local
company that was used early in the pandemic and other area hospitals for clinical diagnosis of COVID-19
when CDC tests were unavailable (not shown here). 2) A multidisciplinary team of experts led by Ramy
Arnaout at BIDMC collaborated with 3D printing companies and other Medical Centers to develop open
source 3D printable swabs used for COVID-19 testing (above).
5. Alternative N-95 Elastomeric Respirator from BCH/Wyss/BIDMC. This alternative respirator was
developed with readily available locally sourced filter modules and a 3D printed adaptor. The product was
found to be effective, but was not deployed as it was not NIOSH approved.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
6. Massachusetts Manufacturing Emergency Response Team (M-ERT). Mark Zeidel and Tod Woolf
communicated BIDMC PPE needs on weekly M-ERT conference calls. Our work with the Covid-19 MERT had an impact in Massachusetts and beyond, and the M-ERT has been cited by government officials
as a model for innovative manufacturing responses to emergencies.
8. Summary. Our Innovation Hub reviewed over 156 alternatively sourced items, with >20 items passing
the evaluations and being approved to enter the BILH supply chain. We have established work flows for
evaluating novel supply chains during future emergencies.
Lessons Learned
7. Alternative Manufacturing of Disposable Face Shields from Lacerta. James Weaver from the Wyss
Institute led this project (https://wyss.harvard.edu/news/seven-million-face-shields-and-counting/). These
masks were produced at very large scale (millions) by local manufacturer of food packaging (Lacerta).
We coordinated with environmental health at BIDMC to have these evaluated and they were added to the
BIDMC supply chain.
We learned that making products which require governmental approval is quite challenging, and
requires input from regulatory agencies, engineers, environmental safety and end users. Some
items, like face shields and ethanol hand sanitizer, were relatively easy to find alternative sources,
but complicated items like the specialized materials used in N-95 masks was much more difficult and
time consuming to obtain from alternative manufacturers.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tod Woolf <a href="mailto:%20">woolf@bidmc.harvard.edu</a>
Project Team
Emilie Downing
Catherine Gill
Andi Hernandez
Olivia Potvin
Gyongyi Szabo
Eleanor Torrey
Tod Woolf
Ramy Arnaout
Sana Ata
Alana Dale
Abby Flam
Heung Bae Kim
James Kirby
Jeffrey Lamson
Stanley Lewis
Chip McIntosh
Phillip Mears
Christopher Minette
Peter Shorett
Thomas Siepka
James C. Weaver
Marten H. Wolckenhaar
Sharon B. Wright
Mark Zeidel
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Tech Ventures
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Title
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BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/46667bf0ba7d16a0b0ca4b7d3fc67105.pdf?Expires=1712793600&Signature=noGyre2cykO0STGoaegBNNtA6V8qGnl5aB3zHzic196o7KoAIYHJHF0LoV9ZPFiEvnmaMVyJjr3smHHD3hpVDR2F4efaL40FVVbs95AjjOlaLwrV8shUIc1VQTn6gqd80etnV0mpLmEmLYCc3rMy0k8uL6ptDQeh3lDymLvAVOWgokg2nGoIyMzLz1DUT2XMIIopXTc%7EOC7TBRgT14ZTZyypEnBCIoDoyyHO6JU99%7EKUFpg7TFRwdfwtKVt%7E5pFOeZogYhYHRjt95%7E1KTtgem6eQNL2rM0qsvk8NzeoiWMolav%7EZUnal1IO5KGheLNRQDop8FSPL60fgSLJyVqdqkQ__&Key-Pair-Id=K6UGZS9ZTDSZM
a73135d6dd6939caa6a88e1a94e37e3e
PDF Text
Text
COVID-19 Staff Vaccine Clinics
#Thisismyshot
Allison Wang, Lori DeCosta, Mo Ortega, Liz Haftel
Results
Background
•
•
•
•
As COVID-19 became a worldwide pandemic, urgency
for a vaccine became paramount as hospitals were
overwhelmed
The COVID-19 vaccines were the first brand new
vaccines to be granted an Emergency Use Authorization
(EUA) in the USA
In conjunction w/ EUA approval, we rapidly planned &
setup COVID-19 vaccine clinics for staff while dealing
with widespread supply/staffing shortages
Multi-disciplinary effort w/ coordination across ~15
departments (see next slide for team)
Planning & Implementation
Logistics
• Hospital Incident Command System (HICS) Structure
enabled rapid collaboration & streamlined decision
making and authority
• Space- Vaccination clinic location needs & considerations
(i.e. Social distancing, observation space etc.)
• Prioritization Scheme – based on federal/state /BILH
guidelines
• Day of Clinic - Designed new workflow
& simulated to increase efficiency
Planning & Implementation (cont.)
Figure 10
Figure 2
Nov
2020
Figure 6
Shapiro 10 Flow &
Signage Walkthrough
Figure 5
12/1 12/2 12/3 12/4 12/5 12/6 12/7 12/8 12/9 12/10 12/11 12/12 12/13 12/14 12/15 12/16
Pfizer
Submits EUA
Pfizer EUA/DPH
Approval
Moderna
Submits EUA
•11/30 –
Planning kickoff
Combined
Clinics 2/15
Pfizer Shapiro 10
Clinic Go-Live
•Prioritization sent to managers
•COVAX testing & schedule build
•Clinical protocols
Scheduling
Open to Phase 1
12/28
Moderna Shapiro
3 Clinic Go-Live
Clinic
Simulation
Figure 3
Design Session
Figure 9
Figure 7
Figure 4
Figure 11
* Refer to figure appendix on slide 3
Feb/Mar
2021
Moderna EUA/
DPH Approval
Figure 1
Supply
• State & BILH allocation management & strategy
• Vaccines –medication storage/delivery process/prep, etc.
• Medical and non-medical supplies
IT Processes
• COVAX - Scheduling System – how to integrate systems
that didn’t talk to each other
• Agility -EOHS
Jan
2021
Outcomes
Figure 8
Figure 12
Staffing
• SOPs/ Standing Orders/ Reactions & Contraindications
• Training - vaccinators/observers/front desk staff/
manager
• Innovative use of Labor Pool
Communications
• Signage and media relations
• Staff outreach & education
• Interpreter services (iPad & multi-language docs.)
Continuous Improvement
Managing a Variety of Challenges & Barriers
• Day-to-day supply instability (i.e. supply allocations,
Walgreens extra doses etc.)
• Sourcing proper equipment (i.e. Ultra cold storage, 1
ml syringes, research space usage etc.)
• Phased vaccine rollout troubleshooting
• Collaboration across BILH as a NEW hospital system
Check & Adjust
• Frequent reassessment of operations as new approvals
and guidance was released
• Strategies to reduce or limit vaccine waste
• Continuously adjusted capacity to increase
appointment access for staff
• Open 2nd clinic/Combined clinics
Sustainment
• Patient clinics & inpatient vaccinations
• Vaccine hesitancy work
• DEI campaigns
• Partnership w/ Red Sox for vaccine clinics
• Boosters
Created By: Allison Wang
Last Updated: 10/28/2021
�COVID-19 Staff Vaccine Clinics
#Thisismyshot
Allison Wang, Lori DeCosta, Mo Ortega, Liz Haftel
Team Members
The Teams Who Made This Happen!
The Clinics
Collaborators for Poster
•
Allison Wang & Jasmine Cline-Bailey (I2 - Improvement
and Innovation)
•
Lori DeCosta (Clinical Nutrition)
•
Mo Ortega (EM - Emergency Management)
•
Peggy Stephan, Liz Haftel, Julie Lanza (Pharmacy)
•
Matt Rabesa (Employee Health Management)
•
Dr. Mary LaSalvia (HMFP)
Additional Key Departments
Larry Markson, Carolyn Conti, Jim Arrington, Venkat
Jegadeesan & Team (IS)
• Jarrod Dore & Team (Facilities)
• Buzzy Abrha, Gordon Howard, Jinkyu Lee, & Vaccinators
(Pharmacy)
• Kyle Franko (Communications)
• Sarah Moravick & Kristin O’Reilly (I2)
• Declan Carbery (EM)
• Bridgid Joseph (Emergency Procedures)
• Brian Bertrand & Eric Acevedo (Distribution)
• Lori Cunningham & Team (Human Resources)
• Paula Stering (Clinical Advisor)
• Dr. Ed Ullman (Medical Director Fenway Clinics)
• PCS & Retired Nurses
• HMFP
• Vaccinators
• ID
• EVS
• Food Services
• BILH
And so many more….!
•
Created By: Allison Wang
Last Updated: 10/28/2021
�Figure Appendix
Figures (1-12):
1.
Draft of an iteration of the vaccine clinic flow
2.
Draft of the vaccine clinic setup
3.
Phasing from Gov. Charlie Baker’s Massachusetts vaccine distribution plan
4.
Brainstorming from the Design session on clinic throughput scenarios
5.
Staff Member getting vaccinated
6.
Pharmacy technicians prepping vaccines
7.
Acting out an emergent scenario during the simulation of the clinic prior to opening
8.
Simulation scenarios used to practice and work through issues prior to opening
9.
Construction of Shapiro 3 Moderna Clinic
10.
Color coding of Pfizer vs. Moderna syringes to prepare for combined clinic
11. Progression
12.
through BILH Phases (Sarah Moravick Leadership Presentation 1/25/21)
Stats (Sarah Moravick Leadership Presentation 1/25/21)
�
Dublin Core
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Allison Wang (<a href="mailto:aswang@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">aswang@bidmc.harvard.edu</a>)
Project Team
Allison Wang
Lori DeCosta
Mo Ortega
Liz Haftel
Peggy Stephan
Matt Rabesa
Jasmine Cline-Bailey
Julie Lanza
Mary LaSalvia
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.
Improvement and Innovation
Clinical Nutrition
Emergency Management
Pharmacy
Employee Health Management
HMFP
Information Systems
Facilities
Communications
Emergency Procedures
Distribution
Human Resources
Clinical Advisor
Fenway Clinics
Environmental Services
Food Services
BILH
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Title
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COVID-19 Staff Vaccine Clinics
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
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pdf
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Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/81f2187ca92e086e0344033b61ff7daf.pdf?Expires=1712793600&Signature=obHg82pop0rrIx8WAZgIvMa5XIKWC9lZLRPtOQGYEekcypo4sz8M5W7xjJw6VYHJHaebw5yZweV9b0g3kxsxhqwV1nEdnU2ovJSQVGIvaHV2914vJPHGuTd3P0VlnOwU83GtpynugdgNXtbHnR6v4KGhuhsSOniAwwp0%7E302fId2IqotpTCzPbH1kk5CGjJLbPq1p6pzkyFxiLSplzlrGkDpb0zJi8CSux496RMT5AaQFzVprK1XYV8svhCRVOdau0p8%7EWgjVi01gnlS7LeF5Tm5dLWtgBZ3Cz-QS3XWYehUyOUbB59sfDEjfKsDX0uPeTAcon5hBZD9ck8ivjManA__&Key-Pair-Id=K6UGZS9ZTDSZM
e03ba8654f0aa704eba32c3fc03838b8
PDF Text
Text
Telehealth Consultations for Traumatic Brain Injury
Neurosurgery: Dr. Martina Stippler (Neurosurgeon and the Director of Neurotrauma at BIDMC, Senior Author) Dr. Ron Alterman (Chair Neurosurgery)
Emergency Medicine: Dr. Carlo Rosen (Executive Vice Chair BIDMC), Dr. Jonathan Anderson (Chief BID-Milton), Dr. Bryan Stenson (Associate Director BID-Needham), Dr. Kyle Trecartin (Associate Director BID-Plymouth)
Introduction/Problem
The Interventions
• Traumatic brain injury (TBI) leads to an estimated 2.5 million emergency department visits annually1.
• The majority of cases are mild (Glasgow Coma Scale, GCS, of 13-15)
• The increasing use of CT scan has identified increasing numbers of patients with mild TBI with
associated intracranial hemorrhage, known as complicated, mild TBI (cmTBI)
• An ED observation pathway was implemented at BIDMC to reduce admissions of cmTBI2
• 138 patients enrolled and analyzed
• 113/138 (81.9%) discharged home
• 91/111 (81.9%) transferred from outside hospitals subsequently discharged home
• Seven (5.1%) return visits to the ED within 7 days; three (2%) related to the cmTBI
• No patients required neurosurgical intervention
1) American College of Surgeons. ACS TQIP Best Practices in the Management of Traumatic Brain Injury.; 2015.
2) Singleton JM, Bilello LA, Greige T, et al. Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage. Am
J Emerg Med. 2020. doi:10.1016/j.ajem.2020.08.093
Aim/Goal
1) Implement Tele Brain Interprofessional Consult (TBIC) to triage patients with cmTBI at the Beth Israel
Deaconess Community Hospitals in order to triage patients for local care or transfer to BIDMC
2) Decrease the transfer rate for cmTBI from the Beth Israel Community Hospitals within 3 months of
implementation
The Team
Neurosurgery: Dr. Martina Stippler (Neurosurgeon and the Director of Neurotrauma at BIDMC,
Senior Author) Dr. Ron Alterman (Chair Neurosurgery)
Emergency Medicine: Dr. Carlo Rosen (Executive Vice Chair BIDMC), Dr. Jonathan Anderson (Chief
BID-Milton), Dr. Bryan Stenson (Associate Director BID-Needham), Dr. Kyle Trecartin (Associate
Director BID-Plymouth)
A. Inclusion Criteria
–
GCS 15 (14 if intoxicated)
–
Minor CT findings of traumatic head injury:
•
Traumatic SAH
•
SDH < 1 cm
•
Contusion without midline shift or mass effect
•
Skull fracture without associated ICH
B. Indications for Transfer
–
ED attending or neurosurgeon discretion
–
Any focal or lateralizing neurologic deficit
–
Epidural hematoma
–
Skull fracture with ICH
–
Post-traumatic seizure
–
Any anticoagulation or anti-platelet agent (excluding aspirin)
–
Signs of basilar skull fracture with CSF leak
C. Responsibilities of the telehealth neurosurgeon
–
Telephone consultation initiated by ED attending with neurosurgery attending
–
Discussion of history and neurologic exam findings
–
Neurosurgical attending reviews images
–
Neurosurgical attending writes a note in Meditech
D. Medical treatment then provided, as necessary, at the Beth Israel Community Hospital
For more information, contact:
Kyle Trecartin, MD, Associate Chief of Emergency Medicine Beth Israel Plymouth, ktrecart@bidmc.Harvard.edu
�Telehealth Consultations for Traumatic Brain Injury
Neurosurgery: Dr. Martina Stippler (Neurosurgeon and the Director of Neurotrauma at BIDMC, Senior Author) Dr. Ron Alterman (Chair Neurosurgery)
Emergency Medicine: Dr. Carlo Rosen (Executive Vice Chair BIDMC), Dr. Jonathan Anderson (Chief BID-Milton), Dr. Bryan Stenson (Associate Director BID-Needham), Dr. Kyle Trecartin (Associate Director BID-Plymouth)
Results/Progress to Date
Table 1. Descriptive Statistics
Total Cases
19
Age
71 (Mean)
Female
12
Chief Complaint
Fall
14
Motor Vehicle Collision
2
Syncope
2
Assault
1
CT Findings
Subdural Hematoma
9
Subarachnoid Hemorrhage
8
Intraparenchymal
2
23-98 (Range)
63.2%
73.7%
10.5%
10.5%
5.3%
47.4%
42.1%
10.5%
Figure 1. Disposition
21%
Home
Skilled Nursing Facility
11%
68%
•
•
•
•
•
•
No patients required transfer to BIDMC
Only 1 patient on aspirin
All patients that were admitted were admitted for a non-TBI related reason
No patients were readmitted within 30 days
No patients died within 30 days
No patients needed neurosurgical intervention within 30 days
Lessons Learned
Telehealth consultations for cmTBI are safe and effectively avoid transfer to a tertiary care center
Consults were successfully carried out by inpatient teams as well (ex. fall while in the hospital)
Different EMR platforms within the network creates challenges for documentation and scan review
Credentialing of the neurosurgical consultant at each site was the most significant hurdle
Next Steps
Advocate for universal credentialing system across BILH
Ensure billing supports a sustainable system
Expand to all hospitals in the BID Network
Expand to include other neurosurgical issues (ex. non-traumatic hemorrhage, spine pathology etc.)
Expand to other specialties
Admitted to Community Hospital
For more information, contact:
Kyle Trecartin, MD, Associate Chief of Emergency Medicine Beth Israel Plymouth, ktrecart@bidmc.Harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kyle Trecartin (<a href="mailto:ktrecart@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ktrecart@bidmc.harvard.edu</a>)
Project Team
Martina Stippler
Ron Alterman
Carlo Rosen
Jonathan Anderson
Bryan Stenson
Kyle Trecartin
Department
Any departments listed on the poster or identified in the spreadsheet.
Emergency Medicine
Neurosurgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID-Milton
BID-Needham
BID-Plymouth
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
Telehealth Consultations for Traumatic Brain Injury
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/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
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
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
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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/c7a2573acfc20a9ed3efa005c41687c7.pdf?Expires=1712793600&Signature=WCFbWsn%7E5gRdjXeWHTZKQSSwYlJ%7EnYp8OIXd7QonoiT7Edx3kx3Lsfk3AtyHNv6Ns57jBNvkIUhCQEM0-6TqjEfTWwD5xVQh4Q4btblVfo-0ffNI0N0sFEhI5HX4Wu1bEE64GKCBesLBh951d-UQ8WZ1yw%7EUc3PPdMSTzGUZB%7EjbZlH0O73IIpWrHqOXltUF171obXTkFRWHpWxjRpurgNq7UwDBRkycceK14VuseaYZ7ypXbYPvMgMlAz8DezQXvHh1Yb3tMJaCWjB79LQgRGCDWMSBCe7updoxXt-asX5-xjeHH4jNyngOsrKBjacGt73bErPaX4qi6baKgmg1Bg__&Key-Pair-Id=K6UGZS9ZTDSZM
c8481cdd573f037f539b955c8e8808b1
PDF Text
Text
Rapid Cycle Implementation and Retrospective Evaluation
of a SARS-CoV-2 Checklist in Labor and Delivery
L Zucco, N Levy, Y Li, T Golen, S Shainker, P Hess, C Stewart, S Nabel, SK Ramachandran
RESULTS
INTRODUCTION
• The redesign and implementation of a perioperative workflow for obstetric patients was necessary in preparation for
a COVID-19 outbreak.
• L&D units are unique perioperative areas as they are designed to create a shared experience for family members.
Labor rooms, nursing stations and ORs are often within close proximity, resulting in overlapping foot traffic.
A single COVID-19 parturient presenting for care would pose significant risk of viral exposure and spread, especially
if emergency cesarean delivery was required.
• The Consolidated Framework for Implementation Research (CFIR) is often used post-implementation of an
innovation to retrospectively assess factors influencing implementation successes and failures. However, there are
few studies on factors influencing implementation outcome in the setting of rapid change to manage pandemic
spread within hospital units.
• Analysis of factors influencing implementation using CFIR
revealed domains of process and innovation characteristics as
overwhelming facilitators for success.
• Constructs within the outer setting, inner setting, and
characteristics of individuals (external pressures, baseline culture,
and personal attributes) were perceived to act as early barriers.
Facilitators of Implementation of L&D Workflow
8%
Process
31%
34%
Innovation characteristics
Inner setting
Characteristics of individuals
• Constructs such as communication culture and learning climate
shifted in terms of their influence over time.
27%
CFIR Domains Influencing Implementation of L&D Workflow
STUDY AIM: Identify factors that influenced implementation of perioperative workflow for care of COVID-19 parturient
by performing a retrospective analysis using The Consolidated Framework for Implementation Research (CFIR)
Charcteristics of Individuals
60%
40%
Outer Setting
METHODS
Inner Setting
64%
13%
Process
7%
88%
10%
0%
• Rapid cycles of real time testing, focused debriefing, and
on-site walkthroughs were carried out over a two week
period with obstetric, anesthesia and perinatal team
members, to identify areas of optimization (Fig 1).
25%
29%
Innovation Characteristics
• A novel checklist was created for use in real-time as a
cognitive aid for the perioperative care of a COVID-19
parturient.
80%
10%
20%
Barrier
30%
40%
Facilitator
50%
10%
60%
70%
80%
90%
100%
No Effect
DISCUSSION
• To identify factors influencing implementation, retrospective
analysis was done using the Consolidated Framework for
Implementation Research (CFIR). CFIR classifies intervention
characteristics defined by operational domain, that have
been shown to influence implementation success.
• Assessment of the implementation experience was ranked
by a panel of 6 experts from the departments of Obstetrics,
Anesthesia and Quality and Safety. A group deliberation
approach was used because of the extensive history of
collaborative work that existed in the L&D unit.
75%
• Process implementation and innovation characteristics were overwhelming facilitators of implementation. We
believe that transparency in the development and implementation plan along with the design and content of the tool
were significant influencers.
• Constructs within the inner setting like implementation climate and readiness for implementation likely acted to
support the time pressure. We believe that clarity in the prioritization and readiness of senior leadership to support
this innovation facilitated its rapid change implementation.
Figure 1. CFIR Consolidated Framework for Implementation Research
• Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into
facilitators once a perceived benefit was experienced by healthcare teams.
• These key factors provide important information for the implementation of rapid change during a time of crisis.
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Catriona Stewart (<a href="mailto:cstewar8@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cstewar8@bidmc.harvard.edu</a>)
Project Team
L Zucco
Nadav Levy
Yunping Li
Toni Golen
Scott Shainker
Philip Hess
Catriona Stewart
Sarah Nabel
Satya Krishna Ramachandran
Department
Any departments listed on the poster or identified in the spreadsheet.
Labor and Delivery
Anesthesia
Healthcare Quality and Patient Safety
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
Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/662ee820b2ed0da3a60f2c8fa9714454.pdf?Expires=1712793600&Signature=o2SKkn9FEKrFjMzhub0izR9l6IMbOdFKTc9njVa6MtPRJSyFEaSCQUZOuXl7xpGiAsPxfaiOSLb7ryk6Oiz7RETb0gJTAm1BQO9wACZYvaRmXl1%7EbhfWltdM5k6C0aG98tt7ab2hqYJxm5TkcW0VEdRmvdmr1i%7E99i0exBrIUAOUltMOoTOkRTF5jB7J1bRGZtH8QhtFy0d%7ETprEMAeOt9u7kD88Ghw9T3TT8wskfEPHKKa11-R3nUP5ks4l1Bb6vpxTnU3mEa0Y6oko62fmsuRhUjsmUQszcOx3p1ypwkpbP-MC3gISHHQ5GRRlLPFFp%7EH88oV02zAkYpcI3wQ9mg__&Key-Pair-Id=K6UGZS9ZTDSZM
4f7acf7822674c593cc0ded37fd7a2be
PDF Text
Text
The Importance of Keeping Teams Engaged during COVID 19 - 1st Case Starts
Ross Simon, BA; Ruben Azocar, MD, MHCM, FCCM, FASA; Elena G. Canacari, BSN, RN, CNOR; Mary Francis Cedorchuk, BSN, RN, CNOR; Jane Cody; Jennifer Ducie, MD; Mary Ellis, BSN, RN; Kelly Gamboa, DNP, RN, CNOR; Jacky Glenn, MBA, RN;
Mary Gryzbinski, MSN, RN; James M. Haering, MD; Senem Hicks, PhD, RN; Scharukh Jalisi, MD, MA, FACS; Maryanne Kelly, BSN, RN, CNOR; Matthew Needham, MD; Janet Orr, RN; Jason Pittman, MD, PhD; Eswar Sundar, MD
Background
One of our key performance metrics, on-time starts, declined in recent years.
We set an ambitious goal for 90% on-time starts with a 50% reduction in
holding area delays. Using many of the key elements of the AORN Guideline
on Team Communication, we engaged a multidisciplinary team during a time
of great stress to improve organizational effectiveness. Continuing, rather
than abandoning the project helped teams come together, focusing on a
common goal in organizational improvement. It helped assure team members
we would return to normal as the pandemic subsided allowing them to keep
their attention on the important work they do for patients – beyond the many
challenges associated with COVID-19. We focused efforts on services with
more complex procedures and the most delays.
Goals
Delays & Interventions
On-Time Rate
• Surgeon delays
Greatest Delays:
• Surgeon late
• No surgical consent
Number of Delays
• Surveyed high performing surgeons to identify best practices to start cases on-time and shared
responses with all surgeons
• Providing surgeon delays data to department chairs
• Roll-back
• Room ready checkbox education
• Difficult line placement
•
•
•
Greatest Delays:
• Surgeon late
• Surgical team not available
Education
Ultrasound guided placement of arterial line
Backup help available
• Implemented Regional Anesthesia huddling with Nursing at 0630 to determine which patients will
need to block and to leave patients on monitor at that time
1. Achieve 90% 1st case start times as follows
• 0740 on Monday, Thursday & Friday (Cardiac – 0725)
• 0810 on Tues. (Cardiac - 0755)
• 0940 on Wed. (Cardiac – 0925)
2. Reduce Holding Area delays by 50% from 40 to 20
• Missing paperwork in Holding Area
• Consent patient on day of PAT visit by midlevel Vascular Anesthesia provider
• Consent prior to day of surgery in Vascular Anesthesia Clinic and in Plastic Service
Standardized Process
Educated surgeons, anesthesiologist and nurses to Standard Holding Area Workflow
Surgeon Timeliness
Surgeon Recommendations
• Arrive to pre-op 20 to 30 minutes prior to
case.
• Check to make sure H&P completed, site
marked, consent signed and matches
booking, and complete Part B.
• Confirm with pre-op nurse that all
components of pre-op check are
completed and make sure nurse has no
concerns that would delay going to the
OR.
Plastic Surgery
Patient Arrival Timeliness
Results
Vascular Service
Performance
Plastics Service
Perform block in OR for complex 1s t case Plastics – Surgery procedures
• Removes one activity in Holding Area to improve patient
experience and workflow
Patient Timeliness
“I reiterated to the residents the
importance of being in the holding area
at 725am to be available to bring patient
to OR.”
“Having consent done in
advance makes my life so much
easier.”
Surgeon
Survey
“I huddle with the anesthesia team for
the day and go over needed antibiotics
and airway needs (LMA vs ETT).
Sustainment
• Hold-the-gains bulletin boards in
operating rooms to communicate
status and maintain awareness
• Monthly review by team of key
metrics including on time starts
East and West Campus operating
rooms, Acute Care Service,
Plastics Service, delays by Anes,
Nursing, Patient/System, Surgeon
Lessons Learned
• Combining our pre-op COVID testing criteria with standard processes to
prevent roll back delays and waits due to late consents and regional anesthesia
was key to success.
• Raising awareness of the importance of why this single measure is the greatest
predictor of organizational efficiency and excellent patient care helped all team
members realize their part in the shared results.
Next Steps
Post key metrics in OR and coach staff as necessary.
Meet monthly to review metrics and take action as necessary to sustain the gains.
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Ross Simon (<a href="mailto:rwsimon@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">rwsimon@bidmc.harvard.edu</a>)
Project Team
Ross Simon
Ruben Azocar
Elena G. Canacari
Mary Francis Cedorchuk
Jane Cody
Jennifer Ducie
Mary Ellis
Kelly Gamboa
Jacky Glenn
Mary Gryzbinski
James M. Haering
Senem Hicks
Scharukh Jalisi
Maryanne Kelly
Matthew Needham
Janet Orr
Jason Pittman
Eswar Sundar
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.
Surgery
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Title
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The Importance of Keeping Teams Engaged During COVID 19 - 1st Case Starts
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
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4eb298bfa83e7f40ad45a140d7ab2244.pdf?Expires=1712793600&Signature=kxdDSV8fzzqxMjQhxCSiZN7w5cyJZ81tLRss-okLNkBjdF1RzfweG7KOuES4it5TQ-sJGeoB3DD66tockCWD%7E2-rJXHvhgVU7%7EhLtGVA3ssYfQnNWPPd8iNCcacHwgWqoSFKomyIiqN5YQWlx0OEmMLkos75Wadu5gAfTPy5qgVNJrYNhGIqPnLR2INfl1qL4EoWUaA2LXyeUc1b4wXC7gE1zZ6TXzL%7ERwy%7EHk6MZzWla5KCarFzpKR8vamsiNo3c33JEmysRfRpMGlgZZOVhLNTDCVG7JQRmIFRd58Nfd5tiiF4k6cEMDK4VWpG2F01tclkM08fmQcZjse93VIt1Q__&Key-Pair-Id=K6UGZS9ZTDSZM
ac4c93063ed59d0e037d552f9223ae8a
PDF Text
Text
Research Pharmacy in COVID-19
Introduction
Research Pharmacy :
A specialized area that facilitates the
conduct of clinical trials using research
medications in human subjects
Each campus has a Research
pharmacy
• West Campus:
Non-oncology trials, primarily
inpatient studies
Outpatient ambulatory clinics
• East Campus:
Both Oncology and Non-Oncology
trials
Ambulatory clinics
Clinical Research Center (CRC)
Research Pharmacy Responsibilities
To provide preliminary pharmacy review and approval prior to IRB submission:
•
Feasibility
•
Potential benefit outweighs risk to human subjects
•
Accuracy of application to protocol
Preparation and Dispensing:
•
•
•
•
Introduction
A typical clinical trial life-cycle (nonCOVID):
Pre-review prior to IRB submission
(3-5 business days)
Review during the IRB process
Preparation for activation/dispensing
(2 weeks post IRB approval)
Typical process (non-COVID-19):
A couple months from pre-review to
patient dispensing
During COVID: Average turnaround
time 24 hours for pre-review
Dispensing to patients in less than
a week (typically within 24 hours of
research medication receipt)
•
•
•
•
To facilitate research medication dispensing and accountability to ensure compliance with the
protocol and all applicable regulations, policies, and procedures
Protocols are dissected by the pharmacists for preparation and dispensation details
Guidelines are created prior to enrollment to ensure safe and accurate preparation and
dispensing for the entirety of the protocol
There is a USP <797> compliant cleanroom for preparation of sterile products including
Chemo/hazardous medications
Pharmacists create example order templates (POE) for the providers to use
Pharmacists build the protocol in the pharmacy system/POE
Provide prompt review of protocol amendments to ensure compliance throughout the study
Facilitate audits by sponsors and regulatory agencies
Inventory control :
•
Strict adherence to inventory control procedures
•
Internal ordering and receipt of supplies for each trial
•
Protocol built in Vestigo (inventory /accountability)
•
Inventory management to ensure adequate supplies for study subjects
•
Perpetual accountability (every vial/bottle/tablet)
•
Strict temperature monitoring for storage conditions
•
Internal destruction of expired/unused materials
Results
26 Therapeutic trials opened
Including:
Remdesivir (NCT04292899/NCT04292730
Sarilumab
Alteplase (NCT04357730)
Hydroxychloroquine (NCT04332991)
Leronlimab (NCT04347239)
Various platform studies
Compassionate use
119 patients (796 dipensings)
3 vaccine trials opened
(NCT04611802/NCT04436276)
181 patients (551 dispensings)
Conclusion
We are not done yet!
3 therapeutic trials still open
ACTIV-3 (NCT04501978)
HIBISCUS (NCT04860518)
ACTIV-2 (NCT04518410)
More in the pipeline
Additional vaccine trials in the pipeline
Research pharmacy team:
Heena Patel, manager
Non-oncology RPhs: James Arrico, Kim
Kocur, Melissa Sciola, Ayu Tesfaye
Oncology RPhs: Sneha Hunjan, Jill
Keough, Renee Manolian, Andrea Mark
Pharmacy Technicians: Frank Man, Brenda
Nguen, Mai Nguyen, Viviana Reyes
�
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.
Melissa Sciola (<a href="mailto:Msciola@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">Msciola@bidmc.harvard.edu</a>)
Project Team
Heena Patel
James Arrico
Kim Kocur
Melissa Sciola
Ayu Tesfaye
Sneha Hunjan
Jill Keough
Renee Manolian
Andrea Mark
Frank Man
Brenda Nguen
Mai Nguyen
Viviana Reyes
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Pharmacy Technicians
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
Research Pharmacy in 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
Safety