1
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1687
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/39fe6ef3569a2dfbed6763933c827685.pdf?Expires=1712793600&Signature=VxoKhf2b04uLGuorh1E6CIvvkPSfISwEDO3llo6ERmx3Ll8PNnRJnwI63pRz1E4wDd07eSJ98IpN2Nb5LNB%7E1CdkvtlXeRvIdh531dgluNTtwHt5x3esPNdvNUm8VVzkcyK3mEsZ38zaBRJv36xwdE4MVuMnQsahYQcYOv%7EoC8nkdvvpO92%7EPyhqPNPHJl9HgfYWHV8i8lQdv-Yl5uQe0N8CxPEMhnblt%7EAcca4G6HQQdl8yYlTrMrFg1weomX1x6DgOXQo4NrvoSviBaq1Dtz2%7EqKrAGpAMPSeH-q5ZfQGKX7v%7EN1za52bDKMKdX44EMrApBYcseODtbA0-GKmWrg__&Key-Pair-Id=K6UGZS9ZTDSZM
c30c2f70dcfbe40f56922a0eda37c6ed
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A “Spaced Education” Pilot at BID-Needham
The Problem
The Results/Progress to Date
Earlier this year, as a result of an assessment of safety culture and risk conducted by
CRICO, BID-Needham began to work on initiatives to improve. They found that
engaging busy clinicians in an educational program is a challenge.
Feedback was generally very positive and overall participation exceeded
expectations: 73% of those invited fully completed the course and 87% participated.
Aim/Goal
To develop and introduce an effective, user-friendly online learning tool that
respondents would enjoy using and therefore utilize on a regular, on-going
basis.
To make it fun by introducing an element of friendly competition among
teams.
To achieve a 50% participation rate among clinicians.
The Team
Kevin Ban, MD, Chief Medical Officer – BID-Needham
Dana Palka, RN, MS Health Care Quality – BID-Needham
Melinda Van Niel, MBA, Health Care Quality – BIDMC
The Interventions
BID-Needham took the lead to pilot a new educational tool, Qstream,
involving over 400 staff across several clinical and administrative
departments. The curriculum for the pilot course was Joint Commission
Safety Standards.
BID engaged Qstream, an online spaced-learning educational tool that
delivers questions on patient safety content to staff via email, computer or
iphone in a competitive, game-type Q&A format.
One question is delivered every few days. Each question is repeated at
least twice and gets “retired” when answered correctly the second time.
Competition can be individual or team based. Points are assigned based on
performance. Educational material related to the question is presented to
the user in real-time.
Participation in the Pilot was encouraged by leadership, managers talked to
their staff about the importance of playing, and it was marketed with posters
in participating departments. A leaderboard was posted and a prize was
offered to the winning team.
Lessons Learned
The “fun factor” provided in the Qstream platform made it more engaging
and interesting to users. Be creative and include pictures in the quizzes
(especially of co-workers in their work setting), use imaginative team names,
display a leaderboard and offer prizes.
The wording of questions must be clear, specific and unambiguous to avoid
confusion. Include robust explanations with the answers for maximum
learning and retention benefit.
While question repetition has the benefit of improved retention, this method
needs to be explained in advance.
Next Steps/What Should Happen Next
Develop and launch additional Qstream curriculum at BID-Needham and
across the BID enterprise.
Spread additional course content on a variety of safety-related topics.
Continue to solicit feedback from user groups for ways to improve the
Qstream gaming experience and get suggestions for safety topics to be
covered in future courses.
For more information, contact:
Katie Scalzulli, QI Project Manager
kscalzul@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.
Katie Scalzulli (<a href="mailto:kscalzul@bidmc.harvard.edu">kscalzul@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
BID-Needham
BIDMC Health Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Needham
Project Team
Kevin Ban
Dana Palka
Melinda Van Niel
Dublin Core
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Title
A name given to the resource
A "Spaced Education" Pilot at BID-Needham
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/231b973b22cd6e98f08254b32b6d89c8.pdf?Expires=1712793600&Signature=DIPPTMUQZN-k%7EMABR%7E5Jrj3V24E2yjyVERx-7iYHn3n5GXlb88jlmDqkWJex577NEbf2hlNMonqrUcmzAhrlRdQX2le8tx6cDSb2i2mbNL5qG4YaT5OJ4hf9LcocHpWjbVGapnq7YUne6S9qzzSTT3geipcNLvJHeRI-GLlAYUC8PJ1NeuYzPFbQh-81i6bP6mgg6kqWVPq%7Es0xj%7EcOxXk-QAA6XeVo2L1bvQLUwyaPysCf8mT3G5Bj3BsCzoht0g5HLL3SXiY4gP23PZN-o5XzxNDt7y5sl8vpa-zY-CGttXmJdABLyLEhRY9Dmw7pBrWPH8V1DoM46cbmEeaF%7Eng__&Key-Pair-Id=K6UGZS9ZTDSZM
3965fec6596cd291f131837fce67e412
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Text
A Common Approach to Problem-Solving
The Problem
Examples of Practitioner Improvement Projects
Every day BIDMC staff members encounter problems in their work areas. While it is easy
to jump to solutions, solving these problems with a common approach provides
opportunities for idea sharing and cross-functional collaboration. There is a need to drive
continuous improvement competency in the organization to enhance the value and results
of improvement activities by BIDMC staff.
Aim/Goal
“I knew we needed to improve,
so I outlined current issues and
figured out a new method using
the principles I learned in the
Level 1 Course”
– Redesigning Copay Processing
4
-Kristin Donnelly, APG Practice
Coordinator
Diffuse problem solving thinking throughout the organization so that everyone, every day,
can solve problems at their appropriate level.
The Interventions
Develop a lean certification practitioner program that teaches a common and scientific
problem solving approach. Certify 400 people in year 1.
Teach
DO!
Classroom Session (2 hrs)
There are 3 options for a homework
assignment to be completed to receive
Level 1 Practitioner certification. The goal
is to engage participants in continuous
improvement work in their own workplace
by doing one of the following:
1 Identify each of the 8 wastes within
their work area
-John Goulart, Director - Compliance
3 3 – “5S” the Team Shared Drive
Homework (2 hrs)
Business Transformation has
developed a comprehensive, multi-level
Lean certification practitioner program
that teaches a common and scientific
problem solving approach with the
following course objectives:
Know a common approach to
solve problems: A3 Problem
Solving
Explain the value of going to see
Identify the 8 wastes of Lean
Understand the importance of
making problems visible
“Because my team went through
this training together, we agreed
on an approach. We all own this
project – we discuss it, and
that’s why it works.”
.
2
Identify and eliminate 3 of the 8
wastes in their work area
3
“5S” their work area
4
“Our improvements have been successful in reducing registration times per patient, but we aren’t
finished. Providing the best care possible is about adjusting and continuously making
improvements.”
Solve a problem using A3 thinking
Includes over 80
participants from BID
Needham, BID Milton,
and BIDCO
Westwood!
-Nate Beyer, Administrative Lead - ED
3
– “5S” ER Registration Desk
Sign Up Today!
Offered Monthly
https://research.bidmc.harvard.edu/Training/ClassRegistration.aspx
For More Information Contact
Alice Lee, alee1@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Bonnie Baker (<a href="mailto:bbaker2@bidmc.harvard.edu">bbaker2@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Business Transformation
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Alice Lee
Bonnie Baker
Dublin Core
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Title
A name given to the resource
A Common Approach to Problem-Solving
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b65141d4c48a66be17039af315e65274.pdf?Expires=1712793600&Signature=o2ZudNDdg1A1w66Piu6rX1a7bBG65IzG0Dqu99cG8fL1fNHi8vyhk5Mic8AdJ9ayTXSGkAkoTWldF7J4uBBaDzkun0cRbad0W6msWdL6096BVvRKBEqs0099HcCQLyvP5X7u01DjMDPrLZDWBfKfH7fNTqlBBXUaUpiXEHmzLnsp3INZSLOeIL5qij%7EbpdIk5gJxmY3s7YXLOYCncvayjJEhfwXV6DqbbkFGWkhAiAxt0cB27lYgrGl3lmwlvO9LKNsBud-6HS0g7qW0cbGo19UP05nynkUrrm5%7E0n9JaGFYuUIiMbXXaUgB9UVe-mcVjSZXUkACg3jLqDDbFPVi5A__&Key-Pair-Id=K6UGZS9ZTDSZM
9b301ddfb065547fa1393e709dcba107
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Text
A Motion-less Blood Bank
The Problem
Excess human movement is one of the 8 wastes of LEAN.
The Results/Progress to Date
The layout of the East Campus Blood Bank impeded workflow adding excessive
human steps and double-backs for medical technologists in the preparation and issue
of blood products.
Aim/Goal
Our goal is to streamline the layout of the blood bank, by removing obstacles and
decreasing the number of steps required to prepare and issue blood components.
The Team
Blood Bank Team - Medical Technologists, Leads and Manager
Business Transformation- Alice Lee, Vice President, Business Transformation
Facilities management- Doug Barletta, Senior Project Manager, Facilities
Total length 156ft
Total length 61ft
The Interventions
39% decrease in walking length
The opportunity to implement a LEAN project in the blood bank arose due to a broken
sink. The affected plumbing was under a counter that was a known obstacle in our
daily workflow.
Blood bank requested a GEMBA walk from the Business Transformation
team. They agreed with the inefficiencies of our workflow. An increase in the
scope of the project was then approved and budgeted.
A team effort was undertaken on all shifts to map out potential solutions by
using sticky notes for equipment placement and suggesting different
workflow patterns. Ultimately a mutually agreeable proposal was conceived.
Blue prints were drawn and work proceeded in stages, minimizing disruption
to patient care.
Lessons Learned
Including staff from all roles and shifts is critical when reconfiguring a
shared space.
Planning the staging of construction project in a busy 24/7 location is
critical.
The timeframe for involvement from IS, telecommunication and other
non-project staff needs to be carefully mapped out.
Once construction started some adaptations to the plan were made,
but the final result was very close to our original plan and on budget.
Staff report increased satisfaction with the layout.
For more information, contact:
Pamela Doty, Blood Bank Medical Technologist
pdoty@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.
Pamela Doty (<a href="mailto:pdot@bidmc.harvard.edu">pdot@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Blood Bank
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Blood Bank Team
Alice Lee
Doug Barletta
Dublin Core
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Title
A name given to the resource
A Motion-less Blood Bank
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4046f2a0ff5630f293816a088ae8c822.pdf?Expires=1712793600&Signature=PMezhn-W4GUOOGh78iFyHzZ1tXeYcM%7EwRM6PlNc7F2BsomW7kk3CdmEt23IRiH5C4QIN87-TmyyqLovutEoDVogI%7ENfAg68lh7nfCz8kscZaPOE7Jb%7EKjD%7Ep4uC8JzOBNdoFdnVV0-NQR8ZprMBG0SskD069fbM1pMHysV%7ER9cRcoDhjvJicg2X5MLPx7mD2ZKBxwVk%7EQuR71ICEzzqIC1%7EdbEkniYVU4xOkLDwY9D0YGXqGSum9DWn9%7ERZgAlOJGs7kI0IIl6fi9Q7qB5%7EDRcPQ7GN0BgFO399Zi0PvoDJOja6ByGUIC7hl60GR0okEs8U95xIn8%7EuLdzE3OSZRnQ__&Key-Pair-Id=K6UGZS9ZTDSZM
70e35aec7b5441c4d5a480e335ee48b0
PDF Text
Text
A Post-Acute Care Transition (PACT) Program: Targeting 30-Day Readmissions
Beth Israel Deaconess Medical Center, Boston MA
The Problem
The Results/Progress to Date
Avoidable 30-day readmissions represent unfavorable health outcomes for patients and
are now associated with significant financial penalties for hospitals.
• Our hospital’s readmission rate was too high.
• Care transitions post-hospitalization were fragmented and confusing for patients.
• Changes were needed to smooth care transitions for patients across all diagnoses in
order to improve outcomes and avoid costly readmissions.
We have achieved a significant reduction in 30-day all-cause readmissions over the
first 12-months of the three-year demonstration project.
Aim/Goal
To improve patient outcomes and prevent avoidable cost in the high-risk 30-day period
following acute care hospitalization.
The Interventions
• Program deploys a nurse and a pharmacist to visit newly admitted patients and to
provide 30 days of telephone support following discharge.
• 2011-12 pilot achieved a 20% reduction in readmission rate for the targeted
population and led to an expanded program with $4.9 million funding from the
Center for Medicare and Medicaid Innovation.
• Innovative staffing model employs 10 nurses and 5 pharmacists who are each paired
with one of six primary care practices, facilitating collaborative relationships with
primary providers.
• PACT clinicians visit patients from their assigned practices who have been
hospitalized and facilitate all aspects of post-discharge care according to patient needs:
ensuring medication compliance, facilitating in-home and outpatient support,
communicating with primary care team, helping to ensure patient gets to follow-up
appointments, and more.
Lessons Learned
• Intensive care management takes time but yields results.
• Inpatient nurses have been well suited to the PACT role, being familiar with
acute care needs of newly discharged patients.
• Aligning care transition staff with particular practices enhances communication
but creates variation in caseload for PACT staff.
• Having PACT team members sit in an open space facilitates cross-fertilization
of ideas and sharing of information on community resources.
• Patients at home will almost always respond they are “doing fine.” PACT nurses
have learned to unpack “fine” and assess how the patient is really doing.
Next Steps
•
•
•
•
Continue to refine systems throughout the demonstration period.
Enhance relationships with post-acute care facilities and home care organizations.
Refine metrics to measure effects of particular interventions.
Identify populations that benefit most from PACT services.
Team
Julius Yang MD
Lauren Doctoroff MD
Sarah Moravick MBA
Norma Wells RN
May Adra PharmD
PACT Nurses and Pharmacists
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Norma Wells (<a href="mailto:nwells@bidmc.harvard.edu">nwells@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Julius Yang
Lauren Doctoroff
Sarah Moravick
Norma Wells
May Adra
PACT Nurses and Pharmacists
Dublin Core
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Title
A name given to the resource
A Post-Acute Care Transition (PACT) Program: Targeting 30-Day Readmissions
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c560234d75b58a78a8448e04259b68ce.pdf?Expires=1712793600&Signature=WWooE-bSLz6fuBQPa7N0CCQBXkPyPiYa1fSrWD5DtdYkQxIghJK0QFiDEYRxhQwdYSoSkIqaPGIl6wtloHOfmYb2mw36BtFI1QSr-RhrHbtw9bTWfHpvBOgAxEDqRa7st2d6QTrXjDLR7ipClf-968-qRoxA2MLb560C9yGlwB5JOHsSVHo1zlsgCKEFykaYskaBxoYNs46W8vhP7mvbTGJIX2CCjSHUy%7E-I0018rKTcUm7i%7En6dbiZzF0to%7EcHtXqr%7E9uK2Lpoga1IBlliJNmgsNAYw8F-qTpMxUzccoXOhO22zokLBa%7E-RtkoVqvT82sh1wc70wufPn3388H5LYQ__&Key-Pair-Id=K6UGZS9ZTDSZM
dbbc676dd4e127119b7538e5679a9173
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Text
A Team-Based Approach to Identify Health Care Proxy for Patients
with a Chronic Disease in Renal Clinic: Results one-year later
The Problem
Documentation of a health care proxy (HCP) is essential to insure that patients'
wishes are understood, particularly in circumstances of a serious illness, or
accdent, when patients may be unable to express their preferences.
Patients with advanced chronic kidney disease may, at some point in the clinical
course, be unable to speak for themselves.
We measured the designation and documentation of HCP in those patients with
advanced chronic kidney disease (stages 4 and 5) who receive care in the
ambulatory renal clinic at Beth Israel Deaconess Medical Center, and an
intervention was inititated to promote an increased level of designation and
documentation of HCP in this setting.
The baseline rate for HCP for patients with CKD in the renal clinic was 62.4%.
In the pilot phase, rate increased to 72.6%.
Aim/Goal
To increase identification and verification of a health care proxy (HCP) for
patients with CKD Stages 4, 5 or ESRD in the Renal Clinic, as evidenced by
documentation in patient profile.
To develop and evaluate team approach for health care proxy discussion as
potential model to increase identification for patients with chronic and end stage
diseases.
The Team
Division of Nephrology
Robert Cohen, MD; Kerry Falvey; Whitney Morgan; Donna Daly, RN
Department of Medicine, QI
Lynde Lutzow , Dorian Rodriguez; Scot B. Sternberg, MS, Mark D. Aronson, MD.
Interventions
Developed team-based intervention with administrative support, practice
assistants, nurse and physician, including the following:
Administrative support pre-round patients who are scheduled to come to the
clinic the next day to identify those patients for whom HCP has not been
discussed or verified within the past 2 years (i.e., documented in OMR profile).
Practice assistants and nurse present information on HCP to identified patients at
check-in and have patient complete HCP or verify and document in OMR profile.
If patient has more questions or is not ready to complete at that time, information
is provided and hand off to MD who will then discuss and document.
HCP talking points for clinic staff and MDs developed and shared.
Intervention presented at faculty and practice meetings for review and input.
Performed medical record audit of HCP for patients with visits monthly.
Identified any barriers/gaps each month. Strategies to streamline and address
gaps included differentiating patients who just needed to verify HCP and those
who did not have one; making HCP available in multiple languages so it could be
available to patients with limited English proficiency even while they await
interpreter services; and using stickers as visual signals to physicians on patients
vitals sheet so they know HCP has been addressed and the patient may need to
discuss with him/her.
The Results/Progress to Date
Nephrology Clinic: Patients with CKD Stages 4 & 5 and Healthcare Proxy
Measure period: FY2012 Pre‐Intervention Baseline and FY2013 HCP Intervention
FY2012 Baseline
Pre‐Intervention
Patients with CKD Stage 4 and 5 with visit
in Oct 2012 ‐ Sept 2013
FY2013
HCP Intervention
654
1039
Health Care Proxy Discussed And/Or
Verified within 2 Years
408 (62.4%)
798 (76.8%)
Health Care Proxy Discussed but not
readdressed nor verified in last 2 years
148 (22.6%)
78 (7.5%)
No evidence of Health Care Proxy
discussion
98 (15.0%)
163(15.7%)
Lessons Learned
Patients are generally open to discuss issues, such as identification and/or
verification of HCP, with the broader care team, including practice assistants and
nurses, in collaboration with MDs.
Practice and clinic staff can successfully help MDs to identify, address and track
interventions to meet a need for a specific targeted population.
Efforts to address HCP in the renal clinic may also offer a model for improvement
that can be generalized to other ambulatory clinics.
Next Steps
Continue intervention
Evaluate opportunities to generalize HCP intervention for patients with other
chronic and end stage diseases.
Coordinate efforts with institution-wide Conversation Ready initiative.
For more information, contact:
Scot B. Sternberg, MS/sbsternb@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Scot Sternberg (<a href="mailto:sbsternb@bidmc.harvard.edu">sbsternb@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Robert Cohen
Kerry Falvey
Whitney Morgan
Donna Daly
Lynde Lutzow
Dorian Rodriguez
Scot B. Sternberg
Mark D. Aronson
Dublin Core
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Title
A name given to the resource
A Team-Based Approach to Identify Health Care Proxy for Patients with a Chronic Disease in Renal Clinic: Results One-Year Later
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/8d2c3eb55e0f08a5c09c2a0a7b196db9.pdf?Expires=1712793600&Signature=nLYb-OiCtCg-nFrceXnJhgdH3MzQV1hFK5NVqp9fq8Xh5OONu8P-A74pPJbG7KocsFTrWK813%7ERJB0hP7vtZTOaweWXu2e3%7EMZaBGMmy5wXNgwctjXGY7a0VjrCzD1AlOfDRBYIW3bNRaP%7EqDnWIHW-zRaIWvKd2nQEV5Chz7GS5Y8JE-aSPPRKn-d3Iqq6dg2ltI7FjrApbAFRjxP2gB9CzSvcpCNf8tGGaZAjvlp4KhxlmPr1J0tpIXw8%7E%7Ee8zcIX0elE1bBu86pze8T0AmHEqD2%7EaC13gFTrcmP9yYZNbyxEhiLLOuvqh-n3-03Zu3lgycK0Bq4GkjU6g%7EyZKaQ__&Key-Pair-Id=K6UGZS9ZTDSZM
cd59f57bdfdfebe3f215bc4549b0e620
PDF Text
Text
Beth Israel Deaconess Hospital-Milton
Achieve Leading Practice Designation in Operating Room Turnover Times
The Problem
The Results/Progress to Date
In May 2013, an onsite audit was performed by an external vendor specific to
peri-operative services at Beth Israel Deaconess Hospital-Milton. The objective
of this internal audit was to review the hospital’s Operating Room (OR)
scheduling process and staffing, as well as to evaluate opportunities to enhance
OR efficiency and utilization. The measurement period for this audit was from
April 2012 through March 2013.
LOWER IS
BETTER
Audit
completed
Interventions
implemented
From this audit, one of the opportunities for improvement identified related to
the timeliness of OR turnover between operative cases. The established industry
standard for this process is <25 minutes, however the actual time for BID-Milton
was 43 minutes.
G
O
L
Aim/Goal
Reduce OR Room turnover time between surgical cases to achieve leading
practice goals, i.e., 20-25 minutes for inpatient surgeries.
The Team
OR Staff
Environmental Services
Department of Anesthesia
Department of Surgery
Lessons Learned
The Interventions (Select Actions Taken)
Reviewed AORN recommended practices on room cleaning to expedite
room turnover and terminal cleaning of ORs – no opportunities identified
Considered eliminating the OR RN in the patient transport process from
the PACU – could not be implemented
Allowed for patient early entry into the operating room (prior to completion
of room setup) to maximize effects of parallel processing (LEAN – optimize
‘External Setup’)
Led by a new Interim Director of Surgical Services in November of 2013,
performance expectations set with staff as a means to modify historical
behavior/practices
Staff held accountable for performance – times tracked and shared with
staff – overall, by OR room and by responsible individual staff member
OR Manager performed daily rounds
Worked collaboratively with Anesthesia at start-of-day “flow” meeting
Engagement and education of CSR staff on their role in OR flow
Decreased OR room turnover times allowed for daily “add-on” cases to be scheduled
during normal OR hours – i.e., decreased incidence of OR day being extended beyond
normal close time (decreased use of overtime)
Accountability and data transparency drove changes required to improve OR
utilization and efficiency
Next Steps/What Should Happen Next
Celebrate leading practice achievement in room turnover time with staff
Continue with interventions and monitor ongoing success relative to goals
Build on this success through other in-progress PI initiatives to address additional
opportunities identified as part of audit, e.g., first case start times, block booking,
OR room utilization etc.
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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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.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Operating Room Staff
Medical Staff
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Operating Room Staff
Environmental Services
Department of Anesthesia
Department of Surgery
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Title
A name given to the resource
Achieve Leading Practice Designation in Operating Room Turnover Times
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3bc1c7a5aac3e15dd1092735abecb03f.pdf?Expires=1712793600&Signature=aXPnmld82XP01VMsTyuilLpxFcG3PJL0LKTx0bbCCZcOP12NuUrxmGPEyLX65sn41%7E%7E3p68i60WiX5QPezauAEWw6NMogL4bGFWEmrxiujZu0XF7cvTRQFnVhYOSBJ7Qqg%7Em5bQXj6TiSr8aaandDw5jXiYuLyte19Yb-gQZbZbIC5p1TdknQYDIzFC7Ng7qjiPrI7ccA1HpNXj5whuAHRcS2nRxRiHg5EdOY5I5MWuucbDK5fQCsQHhlQ0k6bpV7FUxhQt5JOh14Bb2-6g6AbHCO3ncVu2ew3m%7EYMVsJo4PNtS9Fdi3xeQGZkBdimeMGryTzpXLeIfBxnJcyfvZkg__&Key-Pair-Id=K6UGZS9ZTDSZM
6621e9089de2e16cd656d356efe1c4b6
PDF Text
Text
ACMS Stable Patient Extended INR Protocol as a model for reviewing, assessing, and
implementing new clinical guidelines into patient care practices.
men
Jennifer E. Mackey, PharmD; Lynde K. Lutzlow, Scot B. Sternberg, MS; Diane M. Brockmeyer, MD;
A teaching hospital of
Harvard Medical School
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Problem:
The 2012 update to the American College of Chest Physicians (ACCP) Guidelines included
a recommendation that patients with “consistently stable INR results” on warfarin may extend
the INR monitoring interval from the every 4 week standard to “up to 12 weeks.”1
Anticoagulation Management Service (ACMS) patient care practices must continually evolve
to incorporate updated evidence-based guidelines. A formalized process is necessary to
review, evaluate, and implement new procedures to reflect current recommendations.
Objectives:
Establish a model process for review of new clinical recommendations and patient care
protocols as they pertain to BIDMC Anticoagulation Management Service (ACMS) patients.
Create a protocol that incorporates updated INR testing frequency recommendations and
standardizes anticoagulation clinic practices.
Reduce patient INR testing burden while maintaining safe warfarin therapy.
Context and Intervention:
The BIDMC ACMS is composed of nurses, pharmacist, and a medical director who manage
warfarin care for about 800 patients with primary care doctors in a large academic care
practice.
ACMS established the below process for new evidence review to be utilized:
Identify new
published
practice
guideline
Review
primary
evidence
and expert
opinions
Draft new
patient care
protocol
Multidisciplinary
external review,
input, and
approval
Staff Training,
Pilot the protocol,
Assess staff
compliance
Assess outcomes
and revise
protocol
The updated ACCP Guideline INR frequency recommendation and supporting clinical
studies were critically evaluated by the ACMS team.
Review of primary data led to team assessment that the data for extending test interval
to 12 week INR checks are not robust. The team decided on a conservative approach
of maximum duration between INR tests of 6 weeks.
A Stable Patient Extended INR Testing Protocol was created.
Inclusion, exclusion/discharge criteria were defined:
General inclusion criteria: patients enrolled in ACMS with therapeutic INR results
and no maintenance warfarin dose changes for the previous three months.
General exclusion/discharge criteria: 80 years or older; home INR monitor use;
recurrent thrombotic event or major bleeding history; recent INR values less than
1.5 or greater than 5.0; episodes of being overdue for an INR; requests for more
frequent testing.
Eligible patients were offered the option of extending their INR testing frequency to
every 6 weeks. The standard process followed by the ACMS includes:
Reminding the patient to contact ACMS if there are changes to medications, diet,
scheduled procedures, and/or clinical status. This occurs at the time of protocol
enrollment and with each subsequent INR assessment.
Informing the patient that more frequent INR tests will be required if subsequent
results are outside of goal range; clinically significant to medications, diet, or clinical
status occur; warfarin is held as part of a peri-procedural plan; or episodes of being
2 weeks or more overdue for an INR test arise.
Standardized documentation in the electronic medical record was defined.
The protocol was reviewed and a plan to pilot over a 6 to 12 month period was enacted:
Healthcare Associates QI Committee and ACMS Leadership approved the protocol.
ACMS staff were trained regarding the new protocol and completed a competency
test before proceeding independently with patient assessment and enrollment.
The protocol was initiated into ACMS daily practice in February 2013.
Measurements of Improvement:
Clinic adherence to the protocol.
Decreased INR test burden and increased convenience for patients.
Maintenance of INR results within range and overall safe warfarin care.
Findings to date:
Patients were enrolled in the extended INR testing protocol and electronic medical records
were reviewed to assess outcomes at 6 and 11 months following piloting of the protocol.
Overall staff adherence to the extended INR testing protocol process was 95%.
Analysis was performed on patients with at least 12 weeks of data over the last 11 months:
58 patients enrolled
41 males (71%), 17 females (29%)
Average age 67 years (range 41-79)
45 anticoagulated for cardiac condition (78%; 37 patients (82%) with atrial fibrillation/flutter), 13 for DVT/PE (22%)
Duration of anticoagulation: <1 year: 2 (3%) ; 1-5 years: 31 (53%) ; 6-10 years: 16 (28%); >10 years: 9 (16%)
46 patients with > 12 weeks data
Average length of time on protocol 40 weeks (range 14-48)
402 INR results were recorded:
Reasons for early
Days
INR tests
between
INR results
[Average
(range)]
INR results
INR results Reasons recorded for Dose adjustments
within goal range outside goal out of range INRs
(% of occurrences)
range by
>0.2
29 (1-88)
315 (78%)
MD appointment
Hospital admission
Pre/post procedure
Antibiotics
Last INR outside goal
38 patients (83%)
had >65% INRs
within goal range
88 (22%)
Unknown (48%)
Illness (18%)
Dietary change (16%)
Periprocedure (8%)
Dosing error (7%)
Interacting med (3%)
66 one time changes
32 weekly changes
Clinical events that were noted during the pilot period included:
2 patients stopped warfarin (failure to thrive and apixaban conversion, respectively).
1 patient moved out of state and transitioned to a local anticoagulation service.
13 hospitalization episodes involving 9 patients: influenza-like illness (#2), mechanical fall
(#2), failure to thrive (#2), TIA/stroke (INR within goal) (#1), epistaxis (INR 3.39) (#1), atrial
fibrillation (#1), atrial tachycardia s/p PVI (#1), leg injury (#1), non-warfarin allergic reaction
(#1), ileus (#1).
o 2 patients were discharged to rehabilitation facilities following hospitalization.
9 patients had procedures performed: colonoscopy (#3); endoscopy (#1); epidural steroid
injection (#1); eye surgery (#1); prostate biopsy and seed placement (#1); PVI (#1); rectal
banding (#1)
4 patients were 2 weeks or more overdue for an INR tests. One patient had four overdue
episodes of 2-4 weeks. Six subsequent INR tests (86%) were within goal range.
No patients met protocol discharge criteria.
Key Lessons Learned:
A standardized multidisciplinary process for addressing new clinical guidelines is an
effective method for evolving patient care in safe manner.
Extending INR interval to 6 weeks in stable patients appears to provide safe care in pilot.
Next steps include continuing to monitor and track patient success in the pilot program;
refining protocol inclusion criteria based on additional data; and standardizing protocol
resumption following temporary discontinuation (e.g. out of range INR, overdue episodes).
Acknowledgements:
BIDMC Coumadin Clinic team members include: Patricia Glennon, RN; Lisa Jachowicz, LPN; Marie
Mahony, RN; Colleen Monbleau, RN
For More Information, Contact Jennifer E. Mackey, PharmD: jemackey@bidmc.harvard.edu
¹ February 2012; 141(2_suppl) Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines
�
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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.
Jennifer Mackey (<a href="mailto:jemackey@bidmc.harvard.edu">jemackey@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Patricia Glennon
Lisa Jachowicz
Marie Mahony
Colleen Monbleau
Dublin Core
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Title
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ACMS Stable Patient Extended INR Protocol as a Model for Reviewing, Assessing, and Implementing New Clinical Guidelines into Patient Care Practices.
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/fa44939ad883df39e08b672b7f88244d.pdf?Expires=1712793600&Signature=PXNP-hjBu3ZQ9oLNLNCh6WY3iI9cxqyYhFORl0sm7cV5Qmsutm3sSpMAz3MsCJS6S%7Ea7IrAtS56BZINxhwTsdsHDiHL0Piv2PnSkW1XDG9qq4xgufz7bTP9BDC14MUxR2WIzASaGe6cLW5y9FIM5vWE9TzKK-GJLMRii6%7E9GupCbI4X6OAIbHYjyxMrBtmcXJsHa7%7EC-hO7q2O2ZHpczxmq%7ELZyrXZMviNPvfLZNo5ZNxBa7lv8GL56rUqW9eHwtQWLkoZ6W0Uj275JO5UPlEtS7oBGwWsUsLplMbHGBeRH5LcqmH6nUcD6dGJbQ6T94KKanyQUE1YMGlZgO2qFu-A__&Key-Pair-Id=K6UGZS9ZTDSZM
2bd089c9ad8473d914a11c3237b88960
PDF Text
Text
Adding Value- The New Glover Cafe
The Problem
The Glover Café at BIDN has been a tradition in the Needham communityserving the hospital’s many employees, patients, and even local residents. Until 2013,
the Café stood in its small corner of the old hospital wing with a handful of tables and
limited food production capabilities. Though the old Café was a favorite of many, wait
times were long, food production was limited, and there was little room for growth. As
a result, the potential for increased sales and transactions was minimal. With the
hospital continuing to expand, there was a need for a larger facility in order to provide
the best service possible to our many loyal customers.
In July 2013, the new Glover Café opened. More than triple the size of the
previous space, it now offers a variety of cold and hot food and beverage options. The
Café includes a hot entrée line, a salad bar, a deli station, a soup station, smoothies,
coffee, cold foods and beverages, and more.
The Results/Progress to Date
53.8% increase
frpm FY2012
Aim/Goal
Our goal was to increase the value in the new Glover Café, as measured through
both qualitative measures (customer comments, feedback forms) and quantitative
measures (revenue, average sales, transaction average, rate of capture).
Katie Laycock- Sodexo, General Manager
Michele Morgan RD LDN Sodexo Clinical Nutrition Manager
Erin Boudreau- Sodexo, Executive Chef
Monica Vasquez, Francesca Serpa, Don Regan- BIDN Staff
Lois Marks, Helaine Yanofsky- BIDN Volunteers
The Interventions
“The space is
really inviting
and uplifting”
‐ customer
In January 2013, the old Glover Café closed.
An interim Café was established from January-June 2013
The new Glover Café opened its doors in July 2013.
Quantitative measures of value were gathered, including revenue, average
weekly sales, average rate of capture, and transaction average
Qualitative measures of value were gathered, including customer comments
and feedback forms
Customer-oriented initiatives in the Glover Café:
o
o
o
o
o
Lessons Learned
The Team
Meatless Mondays and Wellness Wednesdays
BIDMC Chef Series
New Product Tastings
Pedometer Challenge and Employee Wellness
Seasonal Farmer’s Market
The new Glover Café has resulted in increased annual revenue, average
weekly sales, and rate of capture. The trends for these quantitative
measures of value have not plateaued and continue to increase.
o Annual revenue in 2012 was $143,412.00 and annual revenue in
2013 was $203,018.00.
o Average Weekly Sales skyrocketed from $13,000/week in 2012 to
$20,000/week in 2013- these continue to increase in 2014.
o Average Rate of Capture for 2012 was 21% and for 2013 it
increased by 14% to 35%.
Though many are nostalgic for the old café, customer comments about the
new Glover Café have been overwhelmingly positive. We continue to see
more and more customers in the new space.
Customer-oriented initiatives, such as the Farmer’s Market and Product
Tastings, have helped bring awareness to the new Glover Café and its many
offerings. These initiatives have also helped to add value to the space.
Next Steps
Continue to track quantitative and qualitative measures of value
Continue to promote the new Glover Café and increase rate of capture
Continue with customer-oriented initiatives and other community activities
For more information, contact:
Jeanine LeDoux, MS RD LDN
Sodexo Food and Nutrition at BIDN
jledoux@bidneedham.org
�
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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.
Jeanine LeDoux (<a href="mailto:jledoux@bidneedham.org">jledoux@bidneedham.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Food Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Needham
Project Team
Katie Laycock
Michele Morgan
Erin Boudreau
Monica Vasquez
Francesca Serpa
Don Regan
Lois Marks
Helaine Yanofsky
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Title
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Adding Value - the New Glover Cafe
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2ebaeedf43d8d81d5f469a9e96f1107b.pdf?Expires=1712793600&Signature=t3aPJHRxADbjhkkSidkCAjtz3hEzfu2HhB33uR%7EiPcxJ5mtVEBe0GZ%7E7ay3YOtFjLuXVW24KFbp2OhFe%7E6P3NdPYTmxG0yKdCNnCV2D26GR88uDzK3Y6yaS1DvR3RznsEmaFEvpHCpQIPEUaDNKTDowEp-GrOoVGjSY3To8wTZBK5D3YJMIEQDVm%7ElxONVf5VtXH3IZoUjsHr363kCaj5m2Vzq6Sgm6u0C%7EQT-tyxqVrY6Vkj%7ES3SUxHU64NO%7EZyQbwu6p4qPazeGHe2oaf3KofR0EHobwwsocu8OagNv60XF8Pb8vGlzSrymh8dPoj2i7JkK6SD4kt6ALHYpzBLuw__&Key-Pair-Id=K6UGZS9ZTDSZM
5967d3a93da7129834614d6252f717e1
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Text
Add‐On Team
A Faculty Hour Team
IV. Solution
I. Background
Unscheduled cases that unexpectedly require surgery and must be added on to the OR schedule represent both a high priority and a
dilemma to the OR care team. How should cases of varying levels of urgency and emergency be classified and handled while continuing
to provide optimal care to all surgical patients? How can the needs of urgent, complex surgical patients be met, particularly when
resources are constrained on nights and weekends? How can a communication system be instituted to serve all team members in a
timely and reliable way? This team will benchmark other institutions that have re‐designed perioperative flow and test best ways to
improve access, safety, and efficiency as well as clinician satisfaction regarding add‐on cases at BIDMC.
GOALS:
1. Develop and implement a priority‐based system to define the order of cases. Concerns include:
• When booked?
• Urgency?
2. Make resources evident and ensure that they are communicated early
3. Optimize matching of resources and expectations
4. Improve the communication system between the anesthesia floor manager, front desk, surgeon and resident
Project Team
Mary Austin
Seema Chowdhury, MD
Jane Cody
Jonathan Critchlow, MD
Alok Gupta, MD (Co‐Leader)
Stephanie Jones, MD
Pete Panzica, MD
Beth Person (Co‐Leader)
Verna Rettagliati
Edward Rodriguez, MD
Dottie Sarno
Ross Simon (Facilitator)
Jason Wakakuwa, MD (Co‐leader)
Sponsor: Richard Whyte, MD
II. Current Condition
III. Analysis
For More Information Contact
Alok Gupta, MD agupta4@bidmc.harvard.edu
Beth Person, bperson@bidmc.harvard.edu
Jason Wakakuwa, MD jwakakuw@bidmc.harvard.edu
�
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Title
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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.
Jason Wakakuwa (<a href="mailto:jwakakuw@bidmc.harvard.edu">jwakakuw@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Anesthesia
Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mary Austin
Alok Gupta
Verna Rettagliati
Jason Wakakuwa
Seema Chowdhury
Stephanie Jones
Edward Rodriguez
Jane Cody Pete Panzica
Dottie Sarno
Jonathan Critchlow
Beth Person
Ross Simon
Richard Whyte
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Title
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Add-On Team
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2014
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pdf
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a1167cd06175d98dbb5f4c9cbba4ae95
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Text
Re-designing the Division of General Surgery’s General Appointment Line
The Problem
The Results/Progress to Date
The General Surgery Line (GSL), a resource intended to streamline the appointment
scheduling process for referring provider and non-directed referral patients, was not
meeting the intended need. Schedulers could not schedule appointment without
physician office approval, causing delays and frustration. Many of the patients
scheduled often missed appointments or arrived at the wrong time. Surgeons
questioned the appropriateness of the referrals and referring provider offices were
often frustrated with the length of time it took to obtain an appointment.
The creation of the GSL and Doc-to-Doc appointment types allowed us to track and
report results. In FY13 a total of 417 new patients entered the Division via GSL
(kept appointments). Of those patient, 45 outpatient procedures were performed
(11%), and 151 OR cases completed (41%).
Aim/Goal
To improve access and communication within the Division of General Surgery,
thereby, improving customer service.
The Team
Mark P. Callery, MD- Division Chief, General Surgery; Yaramalies Davila,
Administrative Manager, Divisions of Acute Care Surgery and General Surgery;
Ailicet Montilla, Program Administrator, Division of General Surgery; Jazmin Vega,
Administrative Assistant, Division of General Surgery; all Surgeons and administrative
staff within the Division of General Surgery.
The Interventions
Creation of The GSL Guidelines and Protocol, which outlined
expectations and provided guidance on dealing with different situations
and clinical resources.
Cross training administrative staff and establishing a coverage plan for
unexpected and expected staffing shortages.
Creation of appointment intake sheet for internal communication.
CCC template review and standardization.
Reserving slots for open booking.
Surgeon support and engagement.
Creation of GSL specific reports to track DNK, patient distribution,
booking diagnosis, and surgical and procedural intervention, allowing us
to track resource volume and effectiveness.
Lessons Learned
General Surgery clinics are held on the East and West campus along with
Chelsea, Lexington, Milton and Needham; given our scope, physician support and
engagement was very important to our success.
Training and physician engagement are on going. Administrative and Faculty
meetings, along with combined bi-annual meetings are forums by which we
communicate and re-enforce our commitment to access and service excellence.
Next Steps/What Should Happen Next:
Work towards open-access booking across more sites.
For More Information Contact
Yaramalies Davila, Administrative Manager
Divisions of Acute Care and General Surgery
ydavila@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.
Yaramalies Davila (<a href="mailto:ydavila@bidmc.harvard.edu">ydavila@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
General Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mark P. Callery
Yaramalies Davila
Ailicet Montilla
Jazmin Vega
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Title
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Re-designing the Division of General Surgery’s General Appointment Line
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e403b445d8f9689a876bb75d524e391d.pdf?Expires=1712793600&Signature=DSiRhkXdmi2BJqex2ACTd82oqjGmW4pF3eH5z7vnD8XRmcVgsFuGLACf2GX5SQddC8d85m9LHMCfpbPGjaZVilR1FHL9-RVoshHBJ3dRlVQml%7EjZsGu4TSSbbklSka-zg85b0eCUnSCxl0YuwZP12CvQgBP%7Es9SLHFTXz0ygkHZ-8yY0Rxi5vDxktO8sj1OMFzfLbSDIQC4HU4QSdgjFFeKqTW9jp-Rs6sxFD7OLhUpgW5h5G4e7Xkfe-icFmDLpS7g2JLarQdVDrmudAj-kw%7EvJKI-WCLnRWOsJGaMz59VGqWk1QeCIKWBeYhWIlsKNOBHJxRtRFNugn-d9FJEARQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ffd7c8a8b1cb6c32358140b53cfef35c
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Text
Advantages of Programming and Implementing an
Internally Developed NICU/Newborn Nursery cPOE
AIM
Beth Israel Deaconess Medical Center
Boston, Massachusetts
RESULTS: cPOE DEVELOPMENT
To develop a Computerized Provider Order Entry
(cPOE) program that mimics the order sets and
forms that were currently being used in the NICU
and Newborn Nurseries.
Original Paper PN Order Form
NICU Daily Orders Entry Screen
cPOE PN Order Form
SETTING
48 bed Level III NICU, Academic Medical Center
Approximately 5,000 deliveries per year
METHODS
IMPLEMENTATION
The team began meeting in June, 2008.
The neonatal formulary weight based dosages
were programmed into cPOE using the existing
renal dosing for adults.
Clinicians worked directly with our medical center
programmers to develop a user friendly cPOE
with good work flow.
The internally developed cPOE programming allowed customization
to include:
a scrolling view of all active orders
the ability for clinicians to make changes and enter new orders
while scrolling through active orders
a total fluid goal bar created by all parenteral and enteral orders
display of birth weight and weight from last 3 days
The cPOE went live in our NICU and Newborn
nurseries on November 29, 2011.
ASSESSMENT
To assess one measure of impact of the cPOE
implementation, we reviewed orders for
parenteral nutrition entry for 3-month periods
prior to and after cPOE launch. Parenteral
nutrition is the most complicated platform within
cPOE. Orders were reviewed for number
requiring revision after pharmacy review.
RESULTS: cPOE ASSESSMENT
Order Revisions Pre- and Post- cPOE
To assess staff satisfaction, a survey was sent to
NICU clinicians in September 2013.
TEAM
Chair: Susan Young CNS
LESSONS LEARNED
Survey of NICU Staff cPOE Users
• Following implementation of cPOE, more pharmacy interventions
were seen with PN orders than with paper order entry.
Babies on PN vs. PN orders with interventions
80.00%
• Developing a PN order for cPOE that could do calculations and
osmolarity checking proved to be a challenge. The paper form was
more time consuming, but communicated changes more clearly
than the cPOE PN order.
70.00%
60.00%
50.00%
Clinical Systems: Laura Ritter-Cox, Mary Biagiotti
40.00%
Dietitian: Claire Shoaie
% Babies on PN
30.00%
% PN orders with
interventions
10.00%
ry
br
ua
Fe
ar
y
nu
ec
e
D
Zinc
2
2
Selenium
Error Subtype
4
Fluids
2
5
• Keep paper orders updated with cPOE format in case there is a
computer downtime.
Potassium
2
L-cysteine
11
Total fluid goal
23
1
PTE
2
2
• Continue to update cPOE to maintain patient safety and reflect
clinical practice changes.
Protein adjustment
PN rate
8
0
• Add a feature to the cPOE PN order entry so that additives that are
held are highlighted rather than deleted.
Fat Emulsion
5
Enteral intake
10
15
n
CORRESPONDING AUTHOR:
Greg Dumas, RPh
gdumas@bidmc.harvard.edu
NEXT STEPS
1
Programmers: Kevin Afonso, Jeanne Hurley, Nan
Zullo
Respiratory Therapist: Nina Koyama
• It is important to retest all aspects of cPOE when it is launched to
insure that the functionality in Test is transferred to Live.
Overall Error Subtypes
Pathology: Gina McCormack
Pharmacy Interns: Jessica Baron, Lauren Escobar
Ja
m
m
ov
e
N
RNs: Radka Arnold, Janine Caruso, Jane
Smallcomb, Deirdre Wooley
Pharmacy Information Systems: Steve Maynard
be
r
er
ob
r
m
be
Se
pt
e
be
r
0.00%
NPs/PA: Aimee Madden, Mary Ann Ouellette,
Mary Quinn, Laura Tannenbaum
Pharmacists: May Adra, Holly Creveling, Greg
Dumas, Christine Huynh, Rena Lithotomos
• Additives held for clinical issues were crossed out on the paper
form making the change visible. With cPOE, the additive is deleted
from the printed form which resulted in ordering and
compounding errors.
20.00%
O
ct
MDs: Munish Gupta, Stephanie Hale, Camilia
Martin, DeWayne Pursley, Vincent Smith
• Internally developed cPOE programs allow clinicians to work
closely with programmers to reflect established clinical processes.
20
25
Dextrose
Calcium, Phoshate
Number of responding clinicians
110 clinicians responded to the survey and 81% felt satisfied with cPOE.
• Continue to evaluate cPOE to insure that it accommodates order
entry for infrequent clinical occurrences.
�
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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.
Greg Dumas (<a href="mailto:gdumas@bidmc.harvard.edu">gdumas@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Clinical Systems
Nutrition Services
Neonatology
Newborn Nursery
Nursing
Pathology
Pharmacy
Information Systems
Respiratory Therapy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Susan Young
Laura Ritter-Cox
Mary Biagiotti
Claire Shoaie
Munish Gupta
Stephanie Hale
CamiliaMartin
DeWayne Pursley
Vincent Smith
Aimee Madden
Mary Ann Ouellette
Mary Quinn
Laura Tannenbaum
Radka Arnold
Janine Caruso
Jane Smallcomb
Deirdre Wooley
Gina McCormack
May Adra
Holly Creveling
Greg Dumas
Christine Huynh
Rena Lithotomos
Steve Maynard
Jessica Baron
Lauren Escobar
Kevin Afonso
Jeanne Hurley
Nan Zullo
Nina Koyama
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Title
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Advantages of Programming and Implementing an Internally Developed NICU / Newborn Nursery cPOE
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e2bf631139624a9873da23e0632853a9.pdf?Expires=1712793600&Signature=AL-cNt0qZs-nlzCe2TSSKgQikLKtrxdqPYsCPSA-Sh0eI7rxGBKw-80k4izC3UcnlVnrNq1VJ6epJRNhxGt1Nqr2ZI5TUBdem9GyAJMMwhAW1i3f-E%7E4cp0P2KX9ZbP%7EWl23MiGu-t%7EHIkv57lpHmyELyExsygGPQOoym-xP2TCvuiSL6QrvHb1mcBTxsfvT1Vdb--Ed-H9yjZLS1gdYdaqclEoVjJKGq4it%7EY-qGu7J%7EYbg4OXfe07OI6I0bnS8u6Ol3Mn9HzNBoCBJZCjoYYAWzPRmb1vGdQCTBoBOsFXVta86nvH4H-0eqbQD22IpTGcfODTUs2b7MFUMKo3row__&Key-Pair-Id=K6UGZS9ZTDSZM
136cb5e4c1746321c55e11cddb65d5af
PDF Text
Text
Answering the Call….(Bell)
The Problem
During the 2013 TJC visit the access to nurse call systems for patients in the hallways
of the emergency department was seen as vulnerability. A patient in a hall bed may
have direct line of sight of the nursing station however there must be a mechanism for
the patient to summon help without the use of their voice.
Aim/Goal
To identify and deploy a reliable system to allow patients to summon help without the
need to install a high cost wired system or to deploy a low tech solution such as
physical bells which in an emergency department could be lost or used as a weapon.
The Team
Daniel Nadworny, RN BSN – ED
Shelley Calder RN, MSN – ED
Bernita Krueger LICSW - ED
Jane Dufresne , RN, BSN- ED
Pam Dicapua – Clinical Engineering
ED Staff ( Patient information, nurses and techs)
The Results/Progress to Date
The Interventions
The ED leadership team met to discuss options for corrective action:
Discontinue Hallway beds
o Would have negative impacts to flow of the unit with 20-25 hallway
spaces used each day
o High workload to assure compliance
Place small bell at each location
o Low cost for installation but high risk of loss
o May be hard to hear or determine location
o Audit process would be difficult
Wireless systems
o Higher cost but leverages current IT solution in place
o Audit process could be automated
o Required staff education on new system
The ED team working with Clinical Engineering, IT and our vendor we able to deploy
an adaption of our RFID tags to work as a call system. This was paired with a
desktop system at the main desk to alert staff of a patient need.
Lessons Learned
•
•
•
Staff had larger learning curve for use than expected
No patient notification that the alarm was recognized
Online log in issues occurred throughout the process
Next Steps/What Should Happen Next
Aeroscout and mobileview shown as proof of concept but hard wired
nurse call system preferred
System could be used as back for a nurse call system
Address challenges that may have impeded successful achievement of
the improvement goals.
For more information, contact:
Daniel Nadworny, RN BSN dnadworn@bidmc.harvard.edu
�
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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.
Daniel Nadwonry (<a href="mailto:dnadworn@bidmc.harvard.edu">dnadworn@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Emergency Department
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Daniel Nadworny
Shelley Calder
Bernita Krueger
Jane Dufresne
Pam Dicapua
ED Staff ( Patient information, nurses and techs)
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Title
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Answering the Call...(Bell)
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
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-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/cebdfa24a8d71f67f20c0d7b4969c127.pdf?Expires=1712793600&Signature=slo56EuJytNDMSC24kIgLR11K84bweiQi1z9ZMVGA9NFfETsdwO751P7ExX2m2vOIp12pNpucWzjFyjssCfYeGFrV1YDbRHNTexOXQzcS5M2uHV5aBSz6zB0p1uxiz3Vzx0bSvBSFbruVS%7EgIE7TR-Tgf0JNeh8KC3UgeNFbeDG1JQsb1fqnpF7E9rNL7ARSJjCtaIm6nH3B7tXTy2yc%7Eoc5%7E6j3efMkFgQcd8V-MclVG3Qs-f3p8eEeOXjdlk0pnLKr03vuXJDBJvc1M9YXJ17z7lzsIqSGspVgDhl4HQMCfnNEPqZCgqW5rUuVlb29XARxuIYdZwTGwh6n-Glfsg__&Key-Pair-Id=K6UGZS9ZTDSZM
cb6cab039a60ea38b08fedf2c429a54c
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Text
Beth Israel Deaconess Hospital-Milton
Antibiotic Stewardship: Applying Vancomycin Kinetics
The Results/Progress to Date
The Problem
Vancomycin has become one of the most commonly used antibiotics in US hospitals for
the treatment of gram-positive infections, especially those involving Methicillin-resistant
Staphylococcus aureus (MRSA). Necessary changes in Vancomycin dosing guidelines were
fueled by the increase of Vancomycin resistant Staphylococcus aureus and Vancomycin
resistant Enterococcus species (VRE). Patients were traditionally dosed with universal
dosing of 1 g every 12 hours with no regard to patient weight or renal function.
In 2009 Vancomycin therapeutic monitoring guidelines were developed by the Infectious
Diseases Society of America and the American Society of Health-System Pharmacists
(ASHP).
In review of Vancomycin ordering, dosing and monitoring practices at BID-Milton,
significant variation relative to these published guidelines was identified.
Aim/Goal
Provide optimal management of Vancomycin to inpatients relative to dose, frequency and
monitoring as a means of optimizing therapeutic effect, mitigating potential harm from
drug toxicity, reducing the number of vancomycin peak/trough levels drawn and
decreasing drug resistance.
The Team
Rachel Kleiman–Wexler: Pharm. D, Msc., R.Ph, Director, Pharmacy Services
Jorge Barinaga: MD, Infectious Disease
Maria Pia Sanchez: RN, MSc, MPH, Manager, Infection Prevention
The Interventions (Select Actions Taken)
Program presented and approved by Medical Executive Committee (April 2012)
Roll out of program began in May 2012: Pharmacy Director reviewed 100% of
all Vancomycin orders, evaluated dosage, frequency, drug levels, monitoring
parameters (including weight and creatinine clearance), and trough levels
Pharmacy ordering of trough levels
As necessary, recommendations made to ordering physician re. Dose/frequency
changes, monitoring etc. Order revised based upon physician approval.
2012-2013, additional pharmacists trained on the process of Vancomycin order
review and clinical decision support
Outcomes shared quarterly at Pharmacy & Therapeutics, Clinical Oversight and
Medical Executive Committees
Lessons Learned
Despite protocol-driven recommendations and physicians education, % of recommendations
is
unchanged
since
start
of
program,
reflecting
that
clinicians
have
not adopted weight-based ordering of Vancomycin
Positive response from Medical Staff. Majority of recommendations made by pharmacy (>
90%) are implemented
Pharmacy recommendations that are not accepted by provider are reviewed for patient
impact/potential harm by the Antibiotic Stewardship Team and communicated to the
Department Chief as necessary for review and follow up
Next Steps/What Should Happen Next
Identify feasibility of Vancomycin dosing etc under the full direction of pharmacy. Physicians
would order first dose and then adjustments and monitoring would be performed by
pharmacy. Changes/findings would be communicated to the attending physician.
Currently working on a similar program model for aminoglycoside drugs
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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Silverman Symposium
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An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
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Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
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Pharmacy
Infectious Diseases
Infection Prevention
BIDMC Location
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BID-Milton
Project Team
Rachel Kleiman–Wexler
Jorge Barinaga
Maria Pia Sanchez
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Antibiotic Stewardship: Applying Vancomycin Kinetics
Date
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2014
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b950c7287e882aa4ea58bb16aea20f3b
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Anticoagulation for Patients with Known or Suspected Heparin
Induced Thrombocytopenia During Cardiac Surgery
The Problem
The Results/Progress to Date
Completion of literature review
Multi-disciplinary meeting between cardiac anesthesia and perfusion completed
Institutional standard for bivalirudin concentrations obtained
Preliminary protocols established as follows:
On-Pump Cases
1. Bolus of 1 mg/kg bivalirudin
2. Start infusion at 2.5 mg/kg/hr
3. 50 mg added to pump prime
4. Check ACT 5 minutes after bolus and every 30 minutes after
5. 0.1 to 0.5 mg/kg boluses as necessary
6. ACT target – 400 s vs. 450 s vs. 2.5 x baseline ACT
7. Shut off infusion 15 to 30 minutes before coming off
8. Infuse venous line blood to patient and fill circuit with saline
9. Once off, add 50 mg to pump, start infusion of 50 mg/hour, and recirculate
10. Once CPB definitely not needed, run pump contents through cell saver (cell
saver removes bivalirudin)
Surgical Issues
1. Flushing of grafts and testing of flows should be performed with saline or, if
blood with bivalirudin is used, should be flushed out with saline and bull-dogged
while there is pressure on syringe.
2. IMAs should be transected only just before grafting is performed to avoid stasis
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated, adverse drug
reaction that can lead to life threatening complications. It occurs when patients
develop antibodies to a complex of heparin and platelet factor 4 that has platelet
activating properties. This platelet activation can lead to devastating thromboembolic
complications. The avoidance of heparin exposure is critical during the time that
these antibodies persist. However, during cardiac surgery, the avoidance of heparin
is extremely problematic and risky. This stems from the fact that no other clinically
available anticoagulant can be so quickly and easily monitored at the point-of-care
and have its activity so quickly reversed. Our current protocol for anticoagulation in
cardiac surgical patients with known or suspected HIT calls for the use of heparin with
a potent anti-platelet medication known as alprostadil. Unfortunately, the safety of
this protocol has never been well established. Bivalirudin, is a direct thrombin
inhibitor with a relatively short half-life has been suggested as a possible alternative.
Aim/Goal
To develop a new heparin-free anticoagulation protocol in cardiac surgery for patients
with known or suspected HIT.
The Team
Lessons Learned
Anesthesia: Jacob Clark, MD; Adam B. Lerner, MD
Perfusion: Kyle Spear CCP, Christopher Dacey CCP, Ralph Deyo CCP, Lauren
Finkelstein CCP, Robert Marquis CCP
CT Surgery: Kamal Khabbaz, MD; David Liu, MD; Senthil Nathan, MD
CVI Nursing – Verna Rettagliati, Mary Francis Cedorchuk
The Interventions
Multi-disciplinary meetings reveal issues not even considered by individual
disciplines
Regular reevaluation of protocols for relatively infrequent circumstances is
difficult but important
Finding scientific support for developing protocols related to rare clinical
conditions can be an enormously unfulfilling exercise
➢
Reviewing current literature and other institutional protocols regarding
anticoagulation for HIT patients in cardiac surgery
➢
Soliciting input from anesthesiologists, surgeons, perfusionists, and
pharmacists at multidisciplinary meetings
➢
Review preliminary protocol at multidisciplinary meeting with entire cardiac
anesthesia and cardiac surgical teams
➢
➢
➢
➢
➢
Develop a preliminary protocol for review and modification
Modify protocol as necessary and finalize
➢
➢
➢
➢
➢
➢
On-going performance measurement and safety monitoring
Next Steps/What Should Happen Next
Finalize protocol via multidisciplinary meetings
Purchase necessary equipment (heparin free bypass circuitry)
Program infusion pumps with institutional standards
Educate residents, fellows, and staff through information sessions, internal
communications, and publication to the institution’s PPGD
Program infusion pumps
Educate anesthesia staff and residents as to new protocol
Publish protocol to PPGD and anesthesia intranet
Monitor effectiveness and safety of protocol
For more information, contact:
Jacob Clark, MD,Fellow Cardiothoracic
Anesthesia,jclark4@bidmc.harvard.edu
�
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Silverman Symposium
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An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
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Adam Lerner (<a href="mailto:alerner@bidmc.harvard.edu">alerner@bidmc.harvard.edu</a>)
Department
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Anesthesiology
Perfusion
Cardiac Surger
Cardiovascular Institute Nursing
BIDMC Location
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BIDMC
Project Team
Jacob Clark
Adam B. Lerner
Kyle Spear
Christopher Dacey
Ralph Deyo
Lauren Finkelstein
Robert Marquis
Kamal Khabbaz
David Liu
Senthil Nathan
Verna Rettagliati
Mary Francis Cedorchuk
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Title
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Anticoagulation for Patients with Known or Suspected Heparin Induced Thrombocytopenia During Cardiac Surgery
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/792546f61bd1fdf14d91d3236daa201e.pdf?Expires=1712793600&Signature=qh2hUcPVSliYXTs%7EWWia0C7MS2McFi7R1e3KshAhHOQsDK%7EvuvKuNUwUi0H3r9UKUv6I5V7nXo-KOwqvKAC-pnDJS%7EKIk-4ZSLbvkDFiaah4AGLTZ3ShJ7Nt1YJLBw9ht-XWiAezxKuLjiCrHGwQV9131fV6dxyhXBj95qAiqyR6RLQV31D2-joD2hEEnUDMkIquwlBJ%7EIZEMxOZRdU-rCEb-%7Ekic2rRqOVDRWMwnA4s61PkIeDkWJKEI0WTZZW1RSzYwjX2vqgbNBu1TLgvCKXc1GYakTiB2VfjGxgij2CT%7EQ4lCvngGhKz1mqiVqannd5rM4texqH1KmHnh-WSPw__&Key-Pair-Id=K6UGZS9ZTDSZM
f80ec779c828c62dab27772c681cedb2
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ASA Classification: What does it mean for your patient?
The Problem
*
ASA Classification
ACS NSQIP (American College of Surgeons National Surgical Quality Improvement
Program) is recognized for as nationally validated risk-adjusted, outcomes based
program to measure and improve quality of surgical care. The American Society of
Anesthesiologists Physical Status Classification System (ASA classification) is just
one variable that NSQIP utilizes in case severity and has an impact in the SemiAnnual Report, once risk adjusted. During data abstraction of lower extremity
endovascular variables, the nurse reviewers observed a discrepancy in the ASA
classification assignment between patients receiving nurse administered moderate
sedation and Monitored Anesthesia Care. These inconsistencies exposed
vulnerabilities associated with the reporting of ASA classification. Accurate
documentation is essential to comply with hospital quality standards and policies.
Aim/Goal
The goal of this quality initiative was to elucidate the methodology of ASA
classification and educate the procedure nurses and Vascular physicians on the
implications and importance of accurate ASA classification.
The Team
Sheila Barnett, M.D. Department of Anesthesia
Mary Beth Cotter, R.N, NSQIP Program Manager
Marc Schermerhorn, M.D., Division Chief Vascular Surgery
Mary Ward, R.N., NSQIP
Richard Whyte, M.D., Vice Chair for Clinical Affairs, Quality and Safety
The Interventions
The Department of Anesthesia provided education of ASA definitions to
Vascular surgeons and procedure nurses.
Education was provided to Interventional Procedure areas where conscious
sedation is utilized include the Cardiac catheterization laboratory and the
Endovascular suite.
The electronic medical record was modified to require documentation of ASA
classification by the operative physician.
The Interventional Procedures intranet page has been updated to include
ASA classification definitions.
The Results/Progress to Date
The baseline ASA class distribution for the initial six week period was ASA
classification= 2.0 +/- 0 (N=19). Following the intervention, the ASA
classification distribution was 2.90 +/- 0.55 (N=39). Average ASA classification
and distribution were significantly increased (p < 0.01) after the intervention.
Lessons Learned
ACS NSQIP is just one tool for data abstraction of surgical outcomes. Assigning the correct
ASA classification impacts the NSQIP data for case severity and impacts the O/E ratio in the
Semi-Annual Report. Working with Anesthesia to address this issue allowed for education to be
provided to staff in Interventional Procedures areas in addition to the Operating Room.
Key Lessons:
What does the data mean?: Significance and implication of documented information
Where does it go?: Importance of a standard location of electronic documentation
Why does it matter?: Compliance with quality standards of hospital documentation, as
well as awareness of policies and procedures regarding moderate sedation.
Next Steps
Ongoing education to Vascular surgeons and procedure nurses.
Audits of Medical Records to ensure that the ASA classification is
correctly assigned by NSQIP nurse reviewers.
Biannual feedback regarding audit compliance to Interventional
Procedures Committee.
Review results of the next NSQIP semi-annual report.
For more information, contact:
Mary Beth Cotter, R.N. NSQIP Program Manager
mbcotter@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.
Mary Beth Cotter (<a href="mailto:mbcotter@bidmc.harvard.edu">mbcotter@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
HMFP Department of Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Sheila Barnett
Mary Beth Cotter
Marc Schermerhorn
Mary Ward
Richard Whyte
Dublin Core
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Title
A name given to the resource
ASA Classification: What does it mean for your patient?
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d33c1dde18a5b0ae4078df94444ba5bf.pdf?Expires=1712793600&Signature=FQ2uLiUXm3dktZjub7W5-OrAcjRWa%7EGX4X7L8ur4PAVYm3fWbDihYmBjGmKSUwePwM0daLdkYicgmLbfSSbPMQvq2pN9fhi2JetxpYhwWBb9RKm6pLcUii0NV1FxzTfkgotMosyVuP4iOgaIEeBSRUh4GRbk54lDtIfI6TFDSmFdtL1oTNUVI9AqgyHnAm5dwlpXV%7E1slyFUwTIdxFRRnoJkDjWmGIlBBVu7kIE%7EhS5WPLO18fZ2c5NeAFlXO7aaWvyu-ONja0bAu1AFpM%7E1I8l7P0mf1IVHw7HzPXEf2dZNRf-1jNhpxAy6N%7ELv3tIz8Iczo5AO2YgStoRUPu7Jhw__&Key-Pair-Id=K6UGZS9ZTDSZM
d4abe17afbbf91e7e5482e7419fecb64
PDF Text
Text
Assessing a Multimodal Curriculum to Develop Resident Professionalism
and Communication Skills – A Pilot Study
The Problem
The Results/Progress to Date (Figure 2, Table 1)
Though critical, professionalism and communication skills are rarely taught.1
A curriculum in professionalism and communication for anesthesia residents,
assessed by a patient survey, may improve patient satisfaction.
Pre-intervention response rate: 233/920 (25.3%)
Post-intervention response rate: 236/689 (34.3%)
Figure 2: Chi-squared test results
Aim/Goal
Design and implement a simulation and web-based resident curriculum to improve
patient satisfaction with these aspects of resident performance as measured by a
survey tool based on the validated Four Habits Coding Scheme (4HCS).2
The Team
John D. Mitchell MD*
Cindy Ku MD*
Vanessa Wong, BS*
Lauren Fisher DO*
Sharon Muret-Wagstaff PhD*
Qi Ott MD*
Sajid Shahul MD*
Ruma Bose MD*
Stephen Cohen MD, MBA*
Carrie Tibbles MD+
Stephanie B. Jones MD*
*Department of Anesthesia, Critical Care
and Pain Medicine
+Department of Emergency Medicine
Table 1: Averages and t-test results
Question
6
9
10
The Interventions
Modified 4HCS into an ambulatory surgical
patient survey (Figure 1)
Sep 2012-Jan 2013: Pre-intervention survey
Jan 2013-Mar 2013: Curriculum roll out
o Simulated scenarios (3) focused on
patients’ emotions, setting expectations,
and shared decision-making
o Residents completed live sessions, an
online module, or both
Post-intervention
(n = 38 residents)
3.69
3.49
3.51
Paired
p-value
0.06
0.18
0.14
Unpaired
p-value
0.07
0.24
0.19
Lessons Learned
A patient survey to assess residents’ professionalism and communication skills
may be able to assess a targeted curriculum
Responses to the questions corresponding to the curricular focus improved
Analysis on a per-resident basis may be more accurate in assessing efficacy
Next Steps
Apr 2013-Jun 2013: Post-intervention
survey
Figure 1: Patient survey
Pre-intervention
(n = 38 residents)
3.51
3.33
3.32
Compared pre- and post-intervention data
o Chi-squared test for each question
o To control for individual residents:
Student’s t-tests on average ratings for
questions showing statistical
significance in chi-squared analysis
Further statistical analysis to evaluate impact
Adapt data collection process to improve statistical power
Adapt the survey to address the needs of other specialties
1. Gaiser RR. The Teaching of Professionalism During Residency: Why It Is Failing
and a Suggestion to Improve Its Success. Anesth Analg 2009;108:948–54.
2. Krupat E, Frankel R, Stein T, Irish J. The Four Habits Coding Scheme: Validation
of an instrument to assess clinicians’ communication behavior. Patient Educ Couns
2006;62:38–45.
For more information, contact:
John Mitchell, MD, jdmitche@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.
John Mitchell (jdmitche@bidmc.harvard.edu)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
John D. Mitchell
Cindy Ku
Vanessa Wong
Lauren Fisher
Sharon Muret-Wagstaff
Qi Ott
Sajid Shahul
Ruma Bose
Stephen Cohen
Carrie Tibbles
Stephanie B. Jones
Dublin Core
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Title
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Assessing a Multimodal Curriculum to Develop Resident Professionalism and Communication Skills - A Pilot Study
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/a4a27692ef6effae12d54d8f73079cc0.pdf?Expires=1712793600&Signature=T%7EYTnT3%7E3FciIENbn9cwRgDfY6NrQcveLXFCxbOs0p5A6yO407H6VcqbfYTZPF4deQ7JzyHQrE7QQ1EHTrYaVZLbUFq2KwV-8q3BFdebh7row7usAGDRCP6FWB7IbrHevWhMh2pvjjpcAw8sKXBi8eH6Arx3mBwHGLPk%7ETvzv0%7EUOF4kFTXxmPaTlg27QIJIuzD8Zl0BpJnmnxTzVKGFdR9%7EmBg2vioxM1KG7lfhgK9kaJSY0ai6PAT%7EV0OOTzN3HlJOAhjvYs0fhNrJCOWZcM5bXR%7EsKBLTy899V6U9MdA91ukhm1HRrgFwDr7pYcSPyOP8b71bY8VBx5L0B2A%7EEg__&Key-Pair-Id=K6UGZS9ZTDSZM
0c880f8c8e480c8cb1c488fdacc9ce83
PDF Text
Text
Benzodiazepines and opiates for admitted patients
with cirrhosis: Can we do better?
The Problem
Patients with cirrhosis are at high risk for hepatic encephalopathy.
Acute exacerbations of hepatic encephalopathy are associated with high
mortality and can be triggered with medications, such as benzodiazepines or
opiates.
Despite this fact, patients with cirrhosis are commonly prescribed these
medications during their hospital admissions, with unclear consequences.
Progress to Date
70.0%
Ammonia <60 umol/L on admission
60.1%
60.0%
50.0%
Ammonia >60 umol/L on admission
39.3%
39.2%
40.0%
26.8%
30.0%
25.5%
16.2%
20.0%
Aim/Goal
Our team sought to investigate the prescribing habits of BIDMC physicians of
10.0%
0.0%
benzodiazepines and opioids to cirrhotic patients admitted to our hospital with an
ammonia level checked on admission.
We also looked at how being prescribed a benzodiazepine or opiate affected
length of stay or in-hospital mortality for these patients.
Our longer-term goal is to decrease the frequency with which cirrhotic patients
Rx'd Benzodiazepines
Yesenia Risech-Neyman, MD (Internal Medicine)
Vilas R. Patwardhan, MD (Gastroenterology)
Zhenghui G. Jiang, MD PhD (Gastroenterology)
Gail Piatkowski (Decision Support)
Elliot B. Tapper, MD (Gastroenterology, Internal Medicine)
Ammonia level is associated with changes in management: Analysis revealed
significantly lower prescribing rates for patients with admission ammonia of >60
umol/L for benzodiazepines, opiates or both.
We are putting our patients at risk: We found increased odds of longer than
median length of stay (5 days) for patients prescribed benzodiazepines (OR
2.31) or opiates (OR 3.88) Patients with an admission ammonia >60 umol/L
were also more likely to die during their admission after prescription of a
benzodiazepine (OR 3.31) or an opiate (OR 4.68)
Room for improvement: About 1 in 4 cirrhotic patients with ammonia level >60
umol/L were prescribed a benzodiazepine during their admission, and about 2 in
5 were prescribed an opiate. Many were prescribed both (see bar graph above)..
The Intervention
Defining the problem: We analyzed the admissions of 492 cirrhotic patients to any
service at BIDMC between April 25, 2007 and September 24, 2012 who had an
ammonia level checked on admission.
Prescribing rates were compared between patients with high (>60umol/L) and
low (<60umol/L) ammonia levels on admission for benzodiazepines, opiates,
non-benzodiazepine sleep aids and antipsychotics.
Examined length of stay and risk of dying during the admission after
adjusting for age, MELD, sodium, lactate, infection, acute kidney injury,
variceal bleeding, DNR/DNI status or palliative care consult.
Rx'd Both Opiates and
Benzodiazepines
Lessons Learned
are prescribed these medications when admitted to our hospital to decrease the
adverse outcomes identified in our investigation.
The Team
Rx'd Opiates
Next Steps
Education: Present to hepatology faculty, housestaff and nursing.
Prompts: Similar to the decision support alerts for our GRACE protocol patients,
we are in the process of creating a proposal for our Provider Order Entry system
to include new prompts to help inform or remind clinicians of the potential for
harm when prescribing opiates and benzodiazepines to patients with a diagnosis
of cirrhosis or hepatic encephalopathy
For more information, contact:
Yesenia Risech-Neyman, MD PGY-2 Internal Medicine
yrisech@bidmc.harvard.edu
�
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Title
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.
Yesenia Risech-Neyman (<a href="mailto:yrisech@bidmc.harvard.edu">yrisech@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Internal Medicine
Gastroenterology
Decision Support
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Yesenia Risech-Neyman
Vilas R. Patwardhan
Zhenghui G. Jiang
Gail Piatkowski
Elliot B. Tapper
Dublin Core
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Title
A name given to the resource
Benzodiazepines and Opiates for Admitted Patients with Cirrhosis: Can We Do Better?
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/31021d2f3cb0fd12d7118812318448e3.pdf?Expires=1712793600&Signature=YyUdCF15RHS7C2JmnOHIT%7EjZpLj0zkZZveAZ0Et3R19CUjvG4XK-k5GtrGIyiJjlfaU1fXEZOGl-JQ4nKWY7XTePZ4kTmfxUwdpEVjr%7E-XlYhHDWb%7EZN-CqLQHsx%7EzT4sHuce8M429fVV4SKIQkLIKzVkS744yNcshw6TiXCy5B-cLC5NBtoUmrdn%7E6sDkswDhW4Kx6x7JBcFWMCeyubdmRfGGFnRes15VrdMFIAmpD%7E3S7ecYhj%7EUIf4myrEV-E5aAOwyRMCtcBaxue43MeG1XPmCIqnfoPC7gk4pYdU9kyrNbaXWH0XPU8DHLUOdrsf81VjM9x6RMHpofiRCBkgA__&Key-Pair-Id=K6UGZS9ZTDSZM
436eadcd96460b9c75a6c3c593dc2331
PDF Text
Text
Best Practice: Thoraco-Abdominal Aneurysms
The Problem
The Results/Progress to Date
The operative treatment for Thoraco-abdominal aneurysm requires meticulous application
of best practices to decrease risk of complications such as myocardial infarction,
respiratory events, excessive blood loss, or visceral and spinal cord ischemia. This team
reviewed current evidence and designed a process to ensure consistent implementation of
state-of-the-art best practices.
The following Thoraco-abdominal CSF drainage protocol was established and is used
by multidiciplinary team members:
ICP
Drainage (per hour)
< 10
No Drainage
10-15
10cc
15-20
15cc
>20
Call HO
Call HO for:
New onset ICP > 15 mmHg that does not respond to
drainage
Change in neurological exam
Aim/Goal
The goal of this team was to identify best practices in the approach to elective thoracoabdominal aneurysm repairs and construct systems that ensured these practices were
consistently applied.
The Team
Feroze Mahmood, MBBS, Co-Leader (Anesthesia)
Marc L. Schermerhorn, MD, Co-Leader (Vascular Surgery)
John Whitlock, RN, MS, Co-leader (CVICU Clinical Nurse Specialist)
Matthew Alef, MD (Vascular Surgery Fellow)
Mary Cedorchuk, RN (Cardiac, Vascular & Endovascular ORs)
Mark Courtney, NP (CVICU)
Senthil Nathan, MD (Cardiac Surgery)
Shahzad (Shaz) Shaefi, MD (Anesthesia)
Kamal Khabbaz, MD, Advisor (Cardiac Surgery)
Marjorie (Margie) Serrano, RN, MS, Advisor (CVICU Nurse Manager)
Richard Whyte, MD, MBA, Advisor (Surgery)
John Tumolo, MBA, Facilitator (Surgery)
All documented protocols were used to design a Post‐Op Order Set in POE
to standardize practice for each Thoraco‐abdominal aneurysm:
Lessons Learned
The Interventions
The following interventions were identified thorough literature review and best practices of
high-volume centers across the country:
Consistent scheduling communication to appropriate departments two weeks
prior to surgery and use of distribution list
Multidiscipline joint “huddle” prior to case start
Consistent line and drain placement in the OR holding area
Implementation of intraoperative neuro-monitoring for all cases
Development of Cerebral Spinal Fluid (CSF) drainage protocol with “rescue”
protocol for patients with altered neurological exam
Development of standardized postoperative order set
Implementation of hands-on training program as part of annual ICU nursing
competencies
Commitment to daily multidisciplinary rounding
Next Steps/What Should Happen Next
It is unclear if these efforts have had a measureable impact on patient outcomes.
The following next steps will need to be implemented to measure a consistent,
coordinated approach to managing thoraco-abdominal repair patients:
Measure utilization of standardized order set
Measure compliance/appropriateness of CSF Drainage Protocol
Measure patient outcomes and complications: Review on
Education & Reinforcement: Service level review of protocols
Joint Rounds are difficult to coordinate with multiple services
Measuring goals with such a small cohort presents unique challenges; Ongoing
measureable goals were difficult to establish in evaluating success given low
numbers of cases done each year
Staff are able to articulate a perceived consistency in their approach to patient
management and a clearer understanding of what is expected of them
The body of evidence is relatively small for TAA management; the team learned
from shared experience of other major academic medical centers
For more information, contact:
John Whitlock, RN, MS, CVICU Clinical Nurse Specialist
jwhitlo@bidmc.harvard.edu
�
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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.
John Whitlock (<a href="mailto:jwhitlo@bidmc.harvard.edu">jwhitlo@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
Anesthesia
Nursing
Intensive Care Unit
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Feroze Mahmood
Marc L. Schermerhorn
John Whitlock
Matthew Alef
Mary Cedorchuk
Mark Courtney
Senthil Nathan
Shahzad (Shaz) Shaefi
Kamal Khabbaz
Marjorie (Margie) Serrano
Richard Whyte
John Tumolo
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Title
A name given to the resource
Best Practice: Thoraco-Abdominal Aneurysms
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5fc1533e4b00ef8cccc05e2e2290e59b.pdf?Expires=1712793600&Signature=cJvaYqxOir5JjeRFBIw7ddcoBagbzW-XHz2iBw7FQOoAYFIt21lJVlLtzm-lC3vePma6qAfRni9Abr2sa8CdxuEM9w23EcDGqmFrUfV91-hsdWniVBQnz36KA9kQmpInOY0OVy8Ut2nGXD5Ey8BOBKH4VbR0Hm512kTZpP9ltZW-ckitneel-eKBSRyO9khhJO7w54lpt5UPpN52Wc07d-idL%7E3mK4SpROmbQUvlsrNnIvvEt3%7E58cmXLkxtMv1uIBHVMlIQKM5O9-7tTWfU381SpGGig0s0mlBWbJY08oB3rD340ZmRCdaAyZPlEgtoSyUUdx5loOvP1i97Jbg%7EAA__&Key-Pair-Id=K6UGZS9ZTDSZM
cb6e0700faad7db7955c2c9b71c9620a
PDF Text
Text
BID-Plymouth Low Back Pain Clinical Pathway
The Problem
Due to a lack of adherence to low back pain best practice guideline, there is significant geographic
variation in quality and utilization of surgical, interventional procedures, imaging, opioids and
psychosocial intervention related to low back pain.
This variation leads to:
•
Significant rise in costs of evaluating and treating LBP - IOM dimension of quality: inefficient
care
•
Significant rise in costs associated with LBP impairment/disability - IOM dimension of quality:
ineffective care
•
Compliance concerns associated with the constraints of new payment models on hospital
admissions which are deemed inappropriate for admission - IOM dimension of quality:
appropriate care
In most communities, there is no established or quantatively defined standard for evaluation and
management of the psychosocial components of a low back pain patients presentation.
Aim/Goal
•
•
•
•
•
•
•
Define, develop and implement a comprehensive, patient centered and evidence based Low
Back Pain Clinical Pathway that is the standard of care for the BID – Plymouth community.
Encourage physician behavior to utilize this pathway
To effectively manage the psychosocial concern in our communities LBP patient population.
Achieve 95% compliance for BIDP-ED back pain patients completing STarTBack questionnaire
o
STarT Back tool is validated to assess a LBP patients psychosocial risk factors.
To increase the number for patients seen in spine center with >3 score on STarTBack
To reduce by 50% the number of return visits to BIDP ED for LBP.
To reduce hospital admissions for Medical back pain (MS DRG 552)
The Results/Progress to Date
Aug 27, 12-Oct 5, 13 N-793 – Seen in ED/Referrals Sent to BID-Plymouth Spine Center
>1000 Visits assessed in ED – StartBack Score >3-100% offered appointment within 48 hr
ED Questionnaire Completion Nov 7 -Dec 31 12 Compliance: 65% (96/148)
Jan 2 – Nov 12,13 Compliance: 93% (963/1033)
42% (340/793) seen in BID-Plymouth Spine Center
60% (204/340) Returned Pt Satisfaction Survey – 91%Rated Care (Excellent)
Note: Primary Negative Comment-will not refill opioid prescriptions
6% (21/340) of pts seen in BID-Plymouth Spine Center returned to ED for additional visits
26% (118/453) not seen on referral at BID-Plymouth Spine Center
Returned to ED for additional visits-Avg 2.6 visits/pt (118 pts with 313 visits)
BID-Pymouth Admissions
MS DRG 552 Medical Back Pain w/o MCC
2009-132 2010-125 2011-90 2012-59 2013-31
MS DRG 551 Medical Back Pain with MCC
2009-10 2010-12 2011-5 2012-5 2013-12
Spine Center (SC) Referrals: N-150
50% treated >1x SC 35% Physical Therapy 25% CT/MRI 22% Pain Management 18%Neurosurgery
The Team
Ian Paskowski, DC Medical Director, BIDP Spine Center
Christine Healey, RN, Office Manager BIDP Spine Center
Mark DeMatteo, MD, Chief, BIDP Emergency Services
Jessica Nichols, RN, Nursing Director, BIDP Emergency Department
Judy VanTilburg, RN,BSN,MHM,CPHQ, BIDP Senior Director of Quality and Safety
James A. Berghelli, RPh, MS, BIDP/JCACO Director of Clinical Integration
BID-Plymouth Clinical Pathway Team
The Interventions
•
Implemented hospital wide LBP Continuum of Care Clinical Pathway in 2011 with
training/education of all key stakeholders throughout the community.
•
Gathered data:
1. Within ED for administration of STarTBack questionnaire to those patients with
LBP
2. Patients seen at BIDP ED for LBP and percentage of return visits to ED for those
groups who did follow through with referral to Spine Center and those patients
who did not follow through with their referral to Spine Center
3. Data for patient satisfaction and appointment offered within 48 hours of ED visit.
4. # of admissions for past 3 years with diagnosis of MS DRG 551 and 552
•
Track changes in measures defined above.
Lessons Learned
•
When appropriate resources are established, physicians will employ patient centered,
evidence based care for low back pain patients.
•
Involving key stakeholders at the initiation of the project ensures ‘buy in’ and greater ease
during implementation and increasing physician behavior changes
•
Utilization of a Primary Spine Practitioner model facilitates quality care for patients and
enhances “Patient-Centered Care” for LBP patients within the BID – Plymouth system
Next Steps/What Should Happen Next
•
Continue to monitor the above data sets to ensure sustainability of the model and make
modifications if trending changes to ensure patient centeredness and quality.
•
Expand the BIDP LBP Continuum of Care Clinical Pathway to other facilities within the Atrius /
BID health care system
For more information, contact:
James A. Berghelli, R.Ph.,MS
Director of Clinical Integration/JBerghelli@BIDPlymouth.org)
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Ian Paskowski (<a href="mailto:ipaskowski@jordanhospital.org">ipaskowski@jordanhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Spine Care
Emergency Department
Quality and Safety
Clinical Integration
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Plymouth
Project Team
Ian Paskowski
Christine Healey
Mark DeMatteo
Jessica Nichols
Judy VanTilburg
James A. Berghelli
BID-Plymouth Clinical Pathway Team
Dublin Core
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Title
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BID - Plymouth Low Back Pain Clinical Pathway
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
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BIDMC: BECOMING A NETWORK
by Integrating the Supply Chain at Affiliate Hospitals
The Problem
BIDMC is a fast growing network of hospitals. To achieve the benefits of an affiliation,
the supply chain at the Boston campus must work closely with the affiliates to align
products, purchases and processes. Some of the problems encountered were:
Different material management information systems not permitting access to
item file information which made standardization opportunities difficult.
Various processes for approving new products and initiating saving initiatives.
Different supply distributors for medical surgical supplies.
Lack of standard supply chain communication processes between facilities.
The Goal
The goal was to streamline communication and processes throughout the supply
chain network to include contracting/purchasing, materials management, the Group
Purchasing Organization (GPO) and Clinical Quality Value Analysis (CQVA).
The Interventions
The “Team” traveled to Needham and Milton hospitals monthly having
meetings to include key leadership within supply chain and administration.
Purchasing and contracting personnel were incorporated in weekly roundtable
contracting meetings in Boston.
Needham converted to a “Just In Time” distribution model with our Med Surg
Distributor with close oversight and assistance from Bill Pyne
Milton also converted to the same Med Surg Distributor to provide continuity at
all three campuses.
Novation reviewed potential contracts, conversion opportunities, monitored
pricing, and tracked results.
CQVA is an embedded process at each facilities product committees, to guide
initiatives and monitor savings.
The Results and Progress to Date
The Team
Bob Cherry, SVP Support Services
Steve Cashton, Director of Contracting and Purchasing
Shane Egan, Director of Finance for Support Services
Chip McIntosh, Director of CQVA
Nancy Miller, Sales Executive On-site for VHA/Novation GPO
Bill Pyne, Director of Materials Mgmt.
In FY’13, $643,402 in supply costs were attained for Needham and Milton
hospitals. BIDMC is on track to save $1.6 million in FY’14 for all three of our
affiliates.
Needham and Milton experienced a successful implementation of a “Just In
Time” (JIT) program for delivery of medical surgical supplies reducing
warehouse space.
Purchasing silos were reduced as each facility now has access to the same
contracts and pricing.
Collaborative relationships were built to foster trust and further engage in
streamlining processes which further integrated all three facilities.
The Lessons Learned
Executive support at each facility is paramount.
Community hospitals have unique needs, they are quicker to redesign
processes, but they may not have the resources to make those changes
happen without support from the Boston campus.
Next Steps
Review a process to integrate the affiliates master item file and purchasing
history with the Boston campus
Implement a process to track initiative conversions at affiliate sites.
Review the supply chain and purchasing structure with affiliates to be
consistent with Boston campus leadership
Continue same process with new affiliates
Request further standardization and price reduction from vendors as our
physicians from BIDMC practice at our affiliates
Focus on moving outsourced purchased services at affiliates to an in-sourced
BIDMC model.
For more information, contact:
Chip McIntosh, NP, PhD
Director Clinical Quality Value Analysis (CQVA)
amcintos@bidmc.harvard.edu
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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.
Chip McIntosh (<a href="mailto:amcintos@bidmc.harvard.edu">amcintos@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Support Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Bob Cherry
Steve Cashton
Shane Egan
Chip McIntosh
Nancy Miller
Bill Pyne
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
BIDMC : BECOMING A NETWORK by Integrating the Supply Chain at Affiliate Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
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