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Text
"I Got the Shot: The Story of COVID Vaccine Clinics in the Community"
Ellen Volpe, Kristin O’Reilly, Katelyn Rick, Jordan Ellis, Jaime Levash, Jasmine Cline-Bailey
BIDMC
Results/Progress to Date
Introduction/Problem
Total Doses given by BIDMC
47672
Axis Title
In December of 2020, nearly one year into a global pandemic that had killed over
300,000 Americans the world was looking for something to be hopeful about. On
December 13, 2020 Pfizer Biotech received the initial EUA approval for a two
dose COVID-19 Vaccine that had promising results in clinical trials. Shortly
thereafter Moderna and J&J were also approved and BIDMC’s mission shifted to a
widespread vaccination campaign.
31109
Aim/Goal
The goal of this work was to provide access to life saving vaccines to as many
patients as possible and focus our efforts on the communities where our patients
were disproportionately impacted by the pandemic.
14926
The Interventions
Reviewed data that showed where the highest concentration of COVID cases were by zip
code
Worked with facilities to identify potential clinic locations in those areas: Dorchester, Chelsea,
Boston
Our IT team developed a worklist of our patients based on eligibility criteria
We used that email/ text patients directly to schedule their appointment
Outlined a process for how the clinic would flow: outreach, scheduling, perform check in,
documentation, and future scheduling
Outlined safety protocols for vaccine sites with multiple vaccine types
Created staffing and throughput models to maximize capacity
Recruit, train, and staff each location
Strategized to ensure we used an equitable approach to outreach, scheduling, booking, and
administering of vaccines
Engaged with Interpreter Services to ensure we were adequately serving our LEP patients
CHELSEA
DORCHESTER
TEMPLE ISRAEL
Total Doses
In total, BIDMC’s site administered 93,707 doses of COVID-19 Vaccine. This accounts for 28% of all doses
administered through BILH. BILH administered 338,457 doses.
We collected data on patient experience throughout the clinics being open which helped us to gain
some good insight into what could have improved the experience for patients.
Vaccine Site
Chelsea
Chelsea
Dorchester
Dorchester
Chelsea
Patient Response to what could have been better
This was so easy, clean, and well organized. So much better than I
expected.
Your Chelsea Team deserves a patient care award.
Could not have been any easier or better than what I experienced
to today all was 100%
3-Mar-21
3-Mar-21
2-Mar-21
Someone playing the piano in the fellowship room would be lovely 3-Mar-21
The directions to the location should of been more clear because
the whole plaza is 1100 revere Beach parkway in Chelsea and it
For
more
brings you to a buffet when put
in the
gps information, contact:
2-Mar-21
Katelyn Rick, MSN, RN Manager, Improvement and Innovation krick@bidmc.Harvard.edu
�“I Got the Shot: The Story of COVID Vaccine Clinics in the Community"
Ellen Volpe, Kristin O’Reilly, Katelyn Rick, Jordan Ellis, Jaime Levash, Jasmine Cline-Bailey
BIDMC
More Results/Progress to Date
The Team
Ellen Volpe, Vice President - Ambulatory Services
Mary LaSalvia, Associate CMO, Infectious Diseases MD
Peggy Stephen, Chief Pharmacy Officer
Jarrod Dore, Director of Capital Facilities
Mo Ortega, Project Manager, Emergency Management
Sherry Calderon, Director, Ambulatory Services
Shari Gold-Gomez, Director, Interpreter Services
John Casavant, Manager, Telecommunications
Katelyn Rick, Project Manager for Chelsea
Kristin O’Reilly, Director Improvement and Innovation
Bridgid Joseph, Program Director ECC & Training Center Coordinator
Barbra Blair, Infectious Disease MD, Medical Director of Vaccines
Kyle Franko, Internal Communications Manager
Elise Porter, Site Director for Chelsea
Kerry Falvey, Site Director for Dorchester
Sandi Leitao, Site Director for Temple Israel
Larry Markson, Vice President of Information Systems
Divya Narayan, Project Manager IS
Jordan Ellis, Project Manager for Temple Israel
Jaime Levash, Project Manager for Dorchester
Jasmine Cline-Bailey, Project Manager
Sarah Moravick, Vice President- Organizational Planning
Julie Lanza, Pharmacy Compliance Specialist
Katie Scalzulli, Project Manager, Vaccine Staffing
Kerry Carnavale, CNS Nursing Educations for Vaccine Clinics
Kate Willetts, Nursing Educator
Paula Sterling, APP for Vaccine
Lessons Learned
The team learned to be flexible and pivot quickly when vaccine supply changed or was reallocated.
Leveraging relationships the clinics (Bowdoin, Chelsea internal medicine) have with their patients
proved to be an effective strategy to broaden our outreach and work through vaccine hesitancy.
We worked with IT to include patient language data and message a second time to all patients in their
primary language.
The BIDMC team created a “playbook” for how to open a vaccine site that was given to the BILH
system for the future.
Next Steps
The team is working towards rolling out a booster clinic for 3rd dose Moderna and 2nd dose J&J
For more information, contact:
Katelyn Rick, MSN, RN Manager, Improvement and Innovation krick@bidmc.Harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Katelyn Rick (<a href="mailto:krick@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">krick@bidmc.harvard.edu</a>)
Project Team
Ellen Volpe
Mary LaSalvia
Peggy Stephen
Jarrod Dore
Mo Ortega
Sherry Calderon
Shari Gold-Gomez
John Casavant
Katelyn Rick
Kristin O’Reilly
Bridgid Joseph
Barbra Blair
Kyle Franko
Elise Porter
Kerry Falvey
Sandi Leitao
Larry Markson
Divya Narayan
Jordan Ellis
Jaime Levash
Jasmine Cline-Bailey
Sarah Moravick
Julie Lanza
Katie Scalzulli
Kerry Carnavale
Kate Willetts
Paula Sterling
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID Healthcare - Chelsea
Community Health Center
Department
Any departments listed on the poster or identified in the spreadsheet.
Improvement and Innovation
Infectious Diseases
Ambulatory Services
Pharmacy
Information Systems
Organizational Planning
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Title
A name given to the resource
"I Got the Shot": The Story of COVID Vaccine Clinics in the Community
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d78a817d3fa2ab655d224bd6d88d3a21.pdf?Expires=1712793600&Signature=BanHKF6jueHsKIkr7sTL%7ExlRz5KsGweZmLQu0HN5vvKi13kV-lA1dHxZCXOZCXW3nhLkZXwoEEg9ObTbNzr7fh8XSvoio7VMxm1MgSvLJcyI-upV3HG4cOSeUEaVppjSL9uyRuqTgK6cHIAOYAny8JcwQdSljJdZCUwm1rKx3510S8LRXY2MqWUgqeIjvsicu6n%7E-biq62oQtHhUvEml7Gwm5TYWnuIJGzk5kUR3kijPQV232l1ed7JPyb46POm8xlTB2%7EYlybWrzw0T1WHf3fm1taVZfUQdNrpoCftRW2vsk2WVXLhVaI0%7EuNOC1Qo3ZqBHIySJyUh29Nk-OFT%7E4A__&Key-Pair-Id=K6UGZS9ZTDSZM
46f0641a588ecf21337feda91678e3d7
PDF Text
Text
“We Promise…” Patient Care through Hourly Rounding
Ensuring patient safety and satisfaction are essential goals of our work at BIDMC.
Research has shown that hourly rounding by nursing staff can decrease fall rate
(improving patient safety) and improve how well patients feel we respond to their
basic needs (increasing patient satisfaction). After an early roll-out of hourly rounding
in 2008-2009 showed initial success, we wanted to roll the practice out in a
sustainable way; involving staff and making patients aware of our commitment.
Aim/Goal
Our goal is to roll out hourly rounding on the medicine and surgical units in order to
improve nurse workflow, decrease the fall rate, and increase patient satisfaction (as
measured through HCAHPS survey questions). We use LEAN methodology as a
framework to guide the work and emphasize two components to hourly rounding:
1. Proactive, standardized approach to anticipating patient needs and
improving nursing workflow
2. Patient-centered approach to communicating with our patients and families.
Our aim is also to make the hourly rounding commitment visible to the patients,
establishing a culture of transparency and accountability.
The Team
Jane Foley, RNC, BSN, MA, Associate Chief Nurse, Critical Care & Med/Surg
John Ryan, RN, Nurse Manager Farr 9
Denise Corbett-Carbonneau, RN, Nurse Manager Farr 2
Linda Denekamp, RN, Nurse Manager Farr 5/VICU
Christine Kristeller, RN, Clinical Nurse Specialist
Margie Serrano, RN, Nurse Manager Farr 6 and CVICU
Anissa Bernardo, LCSW, Patient Satisfaction Improvement Coordinator
The Interventions
The Results/Progress to Date
Fall Rate: FY09 vs. FY10
Medicine and Med Surg Units
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
FY09
FY10
3.77
3.21
2.96
2.93
Patient Experience (by Recieved Date)
Jan 2010-present
90%
80%
70%
60%
50%
40%
30%
20%
RN Communication
Responsiveness
Likelihood to Recommend
10%
Fall Rate: Medicine
Fall Rate: Med/Surg
Ja
0 10 10
10 -10 t -10 -10 -10
10 10 r-10 r-10 y-1
lp
gn- ebc
a Ap
a Jun Ju
ov ec
O
M
D
N
Au Se
M
F
Lessons Learned
1.
2.
3.
4.
Staff involvement critical to promoting ownership and accountability to practice.
Leadership involvement is essential to successful change.
High volume/operating at 100% capacity can impact progress; sustaining safety
and satisfaction metrics in such situations can be viewed as a success.
Ongoing sustainment measures are essential.
Sustainment Measures and Next Steps
Continued staff engagement
Planned program using a LEAN approach
o Observed nursing workflow
o Involved front line staff in focus groups and as Champions
o Developed a checklist to anticipate patient needs, standardize workflow
o Created “We Promise…” to emphasize importance of the practice
Educated staff
o Created a video demonstrating best practices
o Held mandatory in-services for all nursing staff
o Observed staff through audits by unit leadership
Informed patients to promote transparency
Involved Media Services to create a “We Promise…” brand, posters, table top
cards and buttons
Created systems to communicate results at a unit and PCS level
o Use monthly “unit dashboards” and “Voice of the Patient” posters to
communicate patient satisfaction data
o Distribute monthly “We Promise” newsletter to share results, stories and news
o
The Opportunity
o Involve staff in problem-solving on units (fishbone exercises)
o Promote We Promise newsletter
o Partner with other disciplines (environmental services, social work, etc)
Continued leadership focus
o Staff observations
o Leadership rounding on patients
o Reward and recognize high performing staff
For More Information Contact
Jane Foley, RNC, BSN, MA, Associate Chief Nurse
jfoley@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.
Jane Foley (<a href="mailto:jfoley@bidmc.harvard.edu">jfoley@bidmc.harvard.edu</a>)<br /> Anissa Bernardo (<a href="mailto:abernard@bidmc.harvard.edu">abernard@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
PCS
Patient Satisfaction
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jane Foley<br />John Ryan<br />Denise Corbett-Carbonneau<br />Linda Denekamp<br />Christine Kristeller<br />Margie Serrano<br />Anissa Bernardo
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
"We Promise..." Patient Care through Hourly Rounding
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Format
The file format, physical medium, or dimensions of the resource
pdf
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/99ee33021bcda5f53e78cfb7dfbb0b8a.pdf?Expires=1712793600&Signature=eISGmPGCecNicSKbC3ETvzyTLjh%7Ex3P6kOb%7EbezmriQ5Xj5yB1L3TRv0O-H10VqpSJE2c9eyVZ-I2EBq0osSMi2uxm4X30U%7ECNUZi0bPYROsP1KNS4-5s1XdpqE399aD4HVmHhCKTU8bf8kQmF3it9ImaQn3S61l%7EVX9g%7Ec6eWbuSmMwZdOvlpTALNicBw%7EZUtTKz3lG1oFi9cQ-5pEA4F-IZ22AjJJ%7E9K9stodgzAIyyn0AUpOodo77F3V5WOPy8VF2-o-9Mjeu6pibp1j72Qc39UPMO-QAMT5QdeEpXIhh53rWLzHkVnPCipA2DIbJnU%7EOaGP4283kT5XoFM3Xmg__&Key-Pair-Id=K6UGZS9ZTDSZM
a924ef375e392d6038b8bb23f8eb417e
PDF Text
Text
Teamwork
Award
Decreasing the Fall Rate on the Oncology Units
The Problem
The Results/Progress to Date
the fall
While the fall rate in the Med/Surg population was decreasing hospital-wide,
rate
in on the Oncology Units continued to rise.
The Morse Fall Score was not capturing our patients that were most at risk to fall.
Chemotherapy treatments, supportive medications increased patients risk to fall.
Patients were not educated on their heightened risk to fall
IHI Bundle Start
# Patient Falls on 7 Feldberg Oncology Unit
M ay - September 2011
4
3
2
1
0
Pre-pilot (May- July
19 )
IHI Bundle Implemented (July 20 )
Aim/Goal
To decrease the fall risk in this specific patient population.
Evidence illustrated that the Institute for Healthcare Improvement’s (IHI) Falls
bundle could do a better job of capturing patients who are at a true risk to fall. By
focusing on these patients, we could concentrate our fall prevention efforts more
efficiently and potentially reduce chair and bed alarm fatigue.
The Team
Kathy Baker, RN, CNS
Pat Folcarelli, RN, PhD
Meggie Galligan, RN, UBE
The Interventions
May
32
August
September
th
Lessons Learned
Patients should be an active part of their care team. By educating patients about their
risks to fall, we can decrease the potential for falling and falls with injury.
Next Steps/What Should Happen Next
Continue to assess the fall rate on the Oncology Units
Spread the IHI fall bundle hospital-wide
Continue to have patients be a part of their care and work with the interdisciplinary
team to decrease their risk to fall
Look at medications contributing to the fall risk and evaluate dosing and the patient’s
need for these medications
In addition, a former oncology patient wrote a letter to current patients describing
her personal experience with a fall as a patient, and how she thought it would
never happen to her. She then shares practices that patients should take to help
protect themselves from a fall. This letter and list of interventions was given to
each patient upon admission.
July 20th-31st
Chris Kristeller, RN, CNS
Kim Sulmonte, RN, MHA
RN, UBE
Erin Tardanico,
July 1-19th
th
We hypothesized that we had an improvement opportunity to more accurately
identify patients at high risk to fall by using criteria from the IHI Fall Bundle for
evaluating ALL patients.
1. ensuring that the bed is in the lowest, locked position
2.
the nurse call light is in reach
3. the IV pole is on the side of the bed where the patient would exit
Upon completion of the above, the nurse must answer the following question:
“Is the patient able and willing to reliably and consistently use the call light to
ask
for help?” If the answer to that question is ‘No’, fall interventions will be
implemented, such as bed and chair alarms, low beds, room close to the nurses
station, etc.
June
For
More Information Contact
Chris Kristeller, RN, CNS
ckriste1@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.
Matt Rabesa (<a href="mailto:mrabesa@bidmc.harvard.edu">mrabesa@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Quality
Employee Occupational Health (EOHS)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Ambulatory Clinics / Leadership
BIDMC Senior Leadership Members
Communications
Employee Occupational Health (EOHS)
Human Resources
Infection Control
Information Systems
Inpatient Clinics/Leadership
Dublin Core
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Title
A name given to the resource
100% Flu Vaccination Rate for Employees with Patient Contact
Date
A point or period of time associated with an event in the lifecycle of the resource
2012
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/fde918d0039839f58a79eba5be6e1f6c.pdf?Expires=1712793600&Signature=RY2RFsDZNN76FdAtc6NRmYqhs-vwzbIsNPrwjFVz0OBYciYLtt0ccmKoJpdLG5VuhXeK1BWRFhMvLDREBxgLaFBubcLZ68ImqQROrmRx09pAHljTNb2R7wUJlTvT69IkyFhWQAii3zUPqCW-TE2H68rTxFAzTb33861IT2qFKsy0ZjiLl0-5M4bJLAg7Mfpu%7E7YFi3cj%7ETUiiHtG8EzgvIJU1Xj82IgfLNka-893HmboPdYM%7Ezj6nB%7EWaqQZe1RxhPkpkQ-cNf-2tqk7EC1ez7-r2lx0xkXL5tz7KxZcp9QkpU7uJz8ZW12ofAIILMCQimV-9beqQqE5IztvDSHojQ__&Key-Pair-Id=K6UGZS9ZTDSZM
f0f91a34a3c577d29ce78cd3a735c2f4
PDF Text
Text
11 Reisman Day to Day Productivity
Moved Zettler paging system so all staff could use, which reduced
Unit Coordinator interruptions
Created signal cards to indicate when a patient and their chart are off
the floor, which reduced searching by clinicians for charts
Located MD and RN forms where they are used, versus a central
location, to reduce fetching
The Problem
Clinical staff on inpatient units spend significant time on non-clinical tasks
impacting efficiency, productivity, and patient satisfaction. Patients want safe,
timely, and coordinated care from their caregiver team. The11 Reisman staff
noted many barriers to providing quality care, including:
Not well coordinated communication between MDs, RNs and PCTs.
Workplace organization resulting in inefficient workflow.
Missing standard procedures for continuous and level admits and
discharges.
Aim/Goal
The team applied Lean, or principles of Toyota Production System (TPS), on 11
Reisman to identify and eliminate non-value added tasks in 11 Reisman’s
workflow. The team’s goal was to improve efficiency and patient satisfaction by
targeting wastes in their workflow. The goals were:
Implement standard work.
Identify and eliminate barriers to providing safe, efficient care on 11
Reisman
Increase involvement of patients in their care.
The Team
Team Leaders: Sucharita Kher, MD and Mary O’Connell, RN Manager
RNs: Anne Brown, John Deckro Kristen Kilduff, Alyssa Montouri, Joanne
Passcucci, Danielle Pero, Marlena Pettit, Christine Saba, Katie
Whetstone
PCTs: Sonia Barros, Martha Clinton, Mydrie Douyon
Unit Coordinators and Assistants: Kenila Barros, Gino Cammosse,
Zobeida Colon
Lean Program Team
The Interventions
5S Workplace Design for flow:
Created satellite linen carts to reduce walking
Co-located items by function to increase efficiency
Moved precaution signs to point of use on every patient door to reduce
searching
Designated homes for clinical equipment so staff can reliably locate and
return after use
Labeled workstations and printers to eliminate guesswork for
finding print-outs
Clean Utility Supply Chain:
Clearly labeled items to reduce searching and errors
Adjusted par levels so there is not too much, not too little, but just
enough supplies
Discharge:
Piloting admit RN role to balance RN daily workload
Piloting discharge facilitator role to assist with administrative tasks to
expedite discharge
Created coordinated patient assignments to MD and RN micro teams
The Results
Baseline
(Oct ’07)
Metrics
Minutes to gather and
administer a new IV
Minimum minutes spent per
shift by PCTs to get linen
Minutes spent finding supplies
in clean utility room by RN (no
training, no publicizing, one
instance)
Minutes spent in daily
multidisciplinary rounds by
RN
Target
Results
(as of
Feb ’08)
%
Change
5:30 min
2:45 min
3:03 min
45%
14:00 min
<7 min
6:20 min
55%
3:17 min
1:38 min
1:22 min
58%
45:00 min
15:00 min
11:40 min
74%
Lessons Learned
Using Lean, significant staff time was saved in the inpatient setting. This was
achieved by many simple, small changes that produced significant, measurable
results. As a result more time is now available to provide direct patient care.
Next Steps/What Should Happen Next:
11 Reisman’s next Rapid Improvement Event (RIE) is focused on day-to-day
processes. The work will focus on further standardizing daily tasks for RNs and
PCTs to reduce wastes and increase value-added time for patient care.
Alice Lee, Office of the President
Mary O’Connell,11 Reisman RN Manager
Sucharita Kher, Hospitalist
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mary O’Connell (<a href="mailto:moconne2@bidmc.harvard.edu">moconne2@bidmc.harvard.edu</a>)<br /><br />
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Sucharita Kher<br />Mary O’Connell<br />Anne Brown<br />John Deckro<br /> Kristen Kilduff<br />Alyssa Montouri<br />Joanne Passcucci<br />Danielle Pero<br />Marlena Pettit<br />Christine Saba<br />Katie Whetstone<br />Sonia Barros<br />Martha Clinton<br />Mydrie Douyon<br />Kenila Barros<br />Gino Cammosse<br />Zobeida Colon<br />Lean Program Team
Dublin Core
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Title
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11 Reisman Day to Day Productivity
Date
A point or period of time associated with an event in the lifecycle of the resource
2008
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/631be6e45020e67e9719a665b28544e5.pdf?Expires=1712793600&Signature=DzNsdGd15t3AedRRL7qzsdnAtOCTW1TfecKu34M7RIvX1fG-GLRolggEIKPTUQ0xBdpDtip%7E1CfQtdPP1cveAENTafZZm4XB2wkJx4uWZ6XiBh8KOHUpIR685IvSN3bKaF9rUvSuAdlUGiUTPGohPWIQDUe4uJAF4NwLjyMYlgd03OvP4%7Ebt%7EiVTANxhKqX6A2Z%7EriH7jxKz7QrOXG055zKCqBDnMoW27LlGbOq8MV3BHrrXcORlrKHXg7U-SWpTsVhLfe2LMg5zL-Et0-AmRX%7ERXZtpvgwmF-18%7ENykc-IekW-aIkof6EaJSH-G5s7%7EMPYQga4oyqjl59hUa3fZIg__&Key-Pair-Id=K6UGZS9ZTDSZM
5af88db76720ec0a0027d69c58d530cc
PDF Text
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11 Reisman Palliative Care / Oncology Integration Model
Mary Buss, MD, MPH; Ben Schlechter, MD; Kathryn Zieja
Introduction/Problem
Palliative Care at BIDMC is provided in both the inpatient and outpatient settings by a multi-disciplinary
team of physicians, nurse practitioners, social workers, and interfaith chaplains. This multi-disciplinary
team works collaboratively with primary care providers, specialists, home-based clinicians, hospice
providers, and community health workers to smoothly facilitate care. Palliative care consistently
demonstrates improvements in patients’ physical and psychosocial symptoms, family/caregiver wellbeing
and satisfaction, and outcomes of care. Currently at BIDMC, the demand for palliative care outstrips the
supply and there is variation in how and when palliative care is consulted. Hospital leadership has
approved a new palliative care and oncology integration model with additional MD/NP and Social
Work//Spiritual Care support starting in FY2020. This new model on 11 Reisman will use criteria to
determine palliative care needs for every hospitalized patients with cancer.
Aim/Goal
The Interventions
Design and implement an alternative model for partnership between Palliative Care and the Oncology
services, with an initial focus on 11 Reisman, aimed at improving the quality of care hospitalized patients
with cancer receive at BIDMC as well as reducing inpatient length of stay and cost.
The Team
Leadership and staff from the following departments:
Social Work
Palliative Care
Spiritual Care
Oncology
Case Management
11 Reisman Nursing
Office of Improvement & Innovation
Medicine
Project Sponsor: Sam Skura, Sr. Vice President, Ambulatory and Clinical Services
Lessons Learned
• In order for this program to be successful , everyone on the team has had to dedicate many hours to
figuring out all the logistics and details.
Develop and pilot screening criteria
Implement IT solutions to support the new model
Obtain buy-in from all staff impacted by this change and create collaborative care standards
Define the “two” interventions (MD/NP & SW/Chaplain) in order to create expectations of care
throughout patient journey
Create patient and family educational materials
Create standard staff communication to introduce program to patient/family
Plan how the new MD/NP & SW/Chaplain staff will integrate into existing department operations,
including new models for weekend coverage
Support discharge planning and optimization of General Inpatient Care (GIP)/hospice disposition
education
Recruit new faculty, Social Worker, and Chaplain
Results/Progress to Date
•
•
•
•
•
•
•
Established multi-disciplinary workgroup and steering oversight committee
Obtained buy-in from all departments to support this new model
Recruited new MD/NP
Identified metrics to measure program success
Supported the optimization of GIP
Developed and continuing to pilot screening criteria
Multiple subgroups have been created to focus attention on IT solutions, staffing models, standard
staff communication, and care pathways
Next Steps
Over the next five months, we will be finalizing all aspects of the new model so it is ready to be rolled out
on October 1, 2019
For more information, contact:
Mary Buss, MD, MPH, Chief, Section of Palliative Care; mbuss@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 Buss (<a href="mailto:mbuss@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mbuss@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Palliative Care
Oncology
Medicine
11 Reisman Nursing
Social Work
Spiritual Care
Case Management
Office of Improvement and Innovation
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mary Buss
Ben Schlechter
Kathryn Zieja
Sam Skura
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Title
A name given to the resource
11 Reisman Palliative Care / Oncology Integration Model
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f0b5cf9a139ddf2742631f0c565a9d89.pdf?Expires=1712793600&Signature=OwOmAYW8Jn4kJIxHPfphGMEr1WHpRc9YO81V2borT5Yq3gxu7D-isR3cue3uOpP3royRx81JrvLia9zLUj4YlSYqGbgMlCGzcJfcKJCfVo2D57-CCeNlR9jsrjWIFpobS5a12ZUIioWNDwUagvhGnFIM8B4lYi-a0leniNI4RYTC9kuOx9Wgr3euleZGiE71au2WKgp1aa7TG2DHai0LpcMn6YOP9ns82kkacfitA20rvwNszufYxhE2KuxDww3Kl3khohxiL-Xry6edl%7EkLjuj51%7EPCmbIidg8g-9ReS8K6WMtyRkD0vM5tFMlf%7EuG7X02Z23MdRaJobTh6M3hAew__&Key-Pair-Id=K6UGZS9ZTDSZM
754cd9fd77ce9ddde503b54184f17f65
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Text
11 Reisman Supply Chain
The Problem
The Clean Utility Room on Reisman 11 was in disarray with no clear organization
as to where the 365 stocked items were on the carts. This made it difficult and
very time consuming for staff to locate necessary items needed to provide the
best care to patients. In addition, many items were either under or overstocked,
creating safety concerns for patients. Under stocked items require a call to
distribution, while overstocked items would accumulate, and eventually expire.
Staff all agreed, it was important and a priority to have what they needed, when
they needed it, so more time could be spent at the patient bedside and less
wasted time searching for equipment and supplies.
Aim/Goal
Organize the Clean Utility Room to:
o Reduce searching for items
o Increase pick efficiency by co-locating similar items
Adjust par levels based on usage to:
o Reduced cost of overstocked items
o Reduce likelihood of items expiring
The Team
Kervin Burrell, Par Stocker, Distribution
Martha Clinton, PCT, 11 Reisman
Mary O’Connell, Nurse Manager, 11 Reisman
Kerri Petraitis, Operations Coordinator
Marlena Pettit, RN, 11 Reisman
Bill Pyne, Manager, Material Logistics
Lean Program Team
The Interventions (7/07 - present)
Mistake-proofed respiratory cabinet and IV Cart
Gravity fed carts
o Reduce likelihood that items expire before use
o Easy reach for nurses, easy fill for par stockers
o Better visibility of items
o Impossible to overstock
The Results
Baseline
(Nov ’07)
Target
Results
(as of Mar ’08)
%
Change
Time to find supplies
in clean utility room
(min) (no training, no
publicizing, one
instance)
3:17 min
1:38 min
1:22 min
58%
Cost of overstocked
items
$10,193+
$0
$77
99%
% of stocked items
154%
0%
101%
53%
Metrics
Lessons Learned
Staff who do the work should be a part of the decision making process, as
they are the ones who know the process best.
Well meaning distribution staff wanted to ensure that the RNs had what
they needed, but the result was an overstocked supply room, caused
because it was not clear how much was needed.
Used actual usage data to determine right-sized par levels
By using visuals and logical set-ups, per diem RNs and consulting MDs
could locate needed items immediately
Next Steps/What Should Happen Next:
Created functional carts with correct par levels
Wound Care
Gloves & Masks
Respiratory
GU/GI
ADL
IV
MD Cart
Housekeeping
Syringes
Labeled items with common clinical terms
Put process in place for maintaining par levels
Used color-coded right-sized bins to insure correct par level
Continue to monitor progress and tweak par levels based on data.
Expand redesign into Medication Room on 11Reisman.
Create a roll-out plan to extend improvement hospital-wide.
Alice Lee, Office of the President
Mary O’Connell,11 Reisman RN Manager
Sucharita Kher, Hospitalist
�
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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.
Mary O’Connell (<a href="mailto:moconne2@bidmc.harvard.edu">moconne2@bidmc.harvard.edu</a>)<br /><br />
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kervin Burrell<br />Martha Clinton<br />Mary O’Connell<br />Kerri Petraitis<br />Marlena Pettit<br />Bill Pyne<br />Lean Program Team
Department
Any departments listed on the poster or identified in the spreadsheet.
Distribution
Material Logistics
11 Reisman Nursing
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11 Reisman Supply Chain
Date
A point or period of time associated with an event in the lifecycle of the resource
2008
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The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ff88556cc50deef35f3c16ea4515d8b6.pdf?Expires=1712793600&Signature=WqKqgWvGzP6H0Y6k3wgplYukedqi%7EgBEj3LWJ4YNoInnVQSGPGrNn7R5-erGZ2SzD8ySiZfkevovEHl6t84GOpgwaj6IAkK%7EWu23RJzqwNbE1l4nBoiy7dmictkrKk4vxmMXp8a37OkAyZRPDKj0h8emu0gSPnmCfG8gYsob9YFGPATq1S4ldXJFJHVWIGgXVuBJjiBc9jSzENxu-iIozkX5lD4rMe8Qz9PKEZ2z1wZqbsGqMbkvaVX7hZj3EwNqrVnVvD4oIGCv9g%7EYN-keJLPcAn6XdwPMXIxHzJi7Rd8GV0Jq1llN6bnXRhm6CAjsl45rb5HhNV1zZjmk3peS1Q__&Key-Pair-Id=K6UGZS9ZTDSZM
38362e501df948ff0f277ffb7125886d
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Text
1st Case Starts East Campus Team
A Faculty Hour Team
IV. Analysis (cont.)
I. Background
An on-time start for the first case of the day in each operating room with a standardized process improves patient
safety, minimizes delays throughout the remainder of the day and improves OR utilization. Interdisciplinary
communication, collaboration, teamwork and accountability are critical in achieving these goals. Building on learning
from the Optimize First Case Starts Team (West Campus), this team will improve the percentage of first case on-time
starts.
Project Team
Jane Cody (Systems Analyst)
Naven Duggal, MD (Ortho)
Mary Ellis (CA-PACU East)
Lauren Fisher, DO (Anesthesia)
Phil Hess, MD (Co- Leader)
Hey-Chun Hur, MD (OB/GYN)
Katie Kilroy (CA FD Holding)
Vitaliy Poylin, MD (Co- Leader)
Advisor: Pete Panzica, MD
Patty Paisner (Circulator RN)
Kristen Telischak, MD
Katie Sullivan (NP, Anesthesia)
Ross Simon (Facilitator)
Barbara Sweeney (CA, Co- Leader)
Sponsor: Elena Canacari
1.
2.
3.
4.
5.
6.
7.
Analyzed on-time starts by division and surgeon
Analyzed OR and HA delays by service, by HMFP, non-HMFP and Atrius
Analyzed late Pt arrivals by Surgeon
Reviewed a Pareto Analysis of OR delays by service for Colorectal, Ortho, ENT and Plastic.
Reviewed HA delays by category/day of the week for Jan-Mar 2012.
Analyzed blocks by type and day of the week
Analyzed line & epidurals [blocks] by type & day of the week: Dominated by 2 types - femoral block for total knee
and shoulder. Mon & Wed are busiest days.
8. Used factor of percent on-time starts delayed x average delay time to prioritize which services to focus on for
improvement
9. Audited performance of services having consents and H+Ps in Holding Area on the day before and DOS
V. Countermeasures
II. Goals
Process Improvement
1. Developed a “Preferred Holding Area Workflow” defining and modifying roles & responsibilities for surgery,
anesthesia and nursing from the pt’s visit with the surgeon through DOS
1. Achieve 90% 1st case start times as follows.
• 0740 on Monday, Thursday & Friday
• 0810 on Tues
• 0940 on Wed
III. Current Condition
21. Mark pt
24. Pt comes back
to room
IV. Analysis
Impact/Difficulty Analysis
2. Enforced use of PAT Faxing to send consents/H+Ps to PAT prior to DOS with education of all staff & non-HMFP
3. Developed process to identify and bring-up earliest priority pts and what needs to be available at 0645 [so new
residents know what to draw-up.]
4. Standardized workflow such that surgical team checks charts night before to identify problems
5. Developed an implemented virtual whiteboard to enhance communication between services and highlight which
cases are missing H+Ps and consents
Holding the Gains
To maintain the gains:
• Auditing on an ongoing basis what’s missing in Holding Area night before & DOS at 0705 hrs
VI. Accomplishments
1. Collaborated interdepartmentally and with an interdisciplinary approach to develop practical solutions to a
complex problem.
2. Implemented the “Preferred Holding Area Workflow” defining and modifying roles & responsibilities for surgery,
anesthesia and nursing from the pt’s visit with the surgeon through DOS
3. Increased percent of cases where pt is in room within 10’ of start time from an average of 85.7% for the previous
quarter to 89% for two consecutive months since starting the project in April 2012.
For More Information Contact Philip Hess, MD, Associate Clinical Director, Department of Anesthesiology phess@bidmc.harvard.edu,
Vitaliy Poylin, MD, Surgeon, Section Colon and Rectal Surgery, vpoylin@bidmc.harvard.edu; Barbara Sweeney, RN, Clinical Advisor,
Patient Care Services, 3bsweeney@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.
Philip Hess (<a href="mailto:phess@bidmc.harvard.edu">phess@bidmc.harvard.edu</a>)<br />Vitaliy Poylin (<a href="mailto:vpoylin@bidmc.harvard.edu">vpoylin@bidmc.harvard.edu</a>)<br />Barbara Sweeney (<a href="mailto:bsweeney@bidmc.harvard.edu">bsweeney@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
Jane Cody
Phil Hess
Patty Paisner
Kristen Telischak
Naven Duggal
Hey-Chun Hur
Katie Sullivan
Mary Ellis
Katie Kilroy
Ross Simon
Lauren Fisher
Vitaliy Poylin
Barbara Sweeney
Pete Panzica
Elena Canacari
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1st Case Starts East Campus Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/efde6aa7c3f735f58fcb2857ba494a2e.pdf?Expires=1712793600&Signature=AhfYWvA36o5PbDEfVxVYNjsWWgvYIZ85nemw%7EkKtTY-HkgC0ul3xYZtR693Px7FkG0JpU4roMjTnvoiFcW%7EgZyMHa29eyznGg6VX7nzkeO4M61FqknaSR9TBdg1lYPKo9soej52289VbZDp8AH6NJlYP6XkCy89JnGbY8xnVc1i4OPeL9akheUaasVQlXZgLYRicCJoiMXLAXNnxSOPgvU0X%7EEUctgcjDmkq4I7zZlZEkv0q01C7VpW0Tt3bB0vBFz2HRBezsSHx8WU0HHxkec25yiaZpb%7ENWLCs8aauhnHwG5W-W2TMIIFXWxIfVzmwatGWXwmIgubsD4QWEwJnmA__&Key-Pair-Id=K6UGZS9ZTDSZM
c2dda2d7d133898d44416be3c60d64aa
PDF Text
Text
1st Case Starts West Campus Team
I. Background
IV. Goals
The Holding Area is an important element of patient throughput. All three (3) perioperative disciplines (nursing,
surgery and anesthesia) have responsibilities for patient preparation and throughput. There are opportunities to
improve the coordination of this activity to minimize delays and improve patient safety. Starting the first case late
decreases the overall OR process efficiency which impacts add-ons and staffing. Once we have a stable and structured
process in place, potential regulatory changes will be much easier to implement. Communication, collaboration,
teamwork and accountability are critical in achieving our goals. This team will improve 1st case starts in the West OR.
Project Team
Paul Appleton, MD
Ann Bonner
Mary Francis Cedorchuk (
i
d h k (Co- Leader)
d )
Jane Cody
Marylou Conant
1. Achieve 90% 1st case start times as follows.
• 0740 on Monday, Thursday & Friday
• 0810 on Tues
2. Create a smoothly operating system where the above goal is achieved without providers scrambling to implement workarounds.
V. Countermeasures
Laura Esnaola (MIT)
Scott Johnson, MD
Kailash Swarna (MIT)
Peter Germond
Pete Panzica, MD (Co- Leader)
Jason Wakakuwa, MD
Mary Grzybinski
bi ki
Sue Pobywajlo
b
jl
Allen Hamdan, MD (Co- Leader)
Ross Simon (Facilitator)
Mark Heuther
David Stryker (MIT)
Sponsors: Elena Canacari; M. Callery, MD; B. Simon, MD
II. Current Condition
9. Anes
provider
arrives & does
anes consent
(if nec) and
blocks, IVs
10. Surgical
team member
arrives:
Completes
paperwork if
k
not done.
Writes med
orders
12. Holding
Area nurse
completes
documentation
and pt leaves
for OR
VI. Accomplishments
III. Analysis
Impact/Difficulty Analysis
X
Analysis
1. Calculated on-time starts by service
2. Identified barriers by service
3. Developed and applied a factor to determine ranking of performance of services towards on-time starts
4. Audited performance of services having consents and H+Ps in Holding Area on the day before and DOS
Process Improvement
5. Developed a “Preferred Holding Area Workflow” defining and modifying roles & responsibilities for surgery,
anesthesia and nursing from the pt’s visit with the surgeon through DOS
6. Expedited use of PAT Faxing to send consents/H+Ps to PAT prior to DOS with education of all staff & non-HMFP
7. Created rolodex of cell phones to facilitate contacting attendings
8.
8 Standardized workflow such that surgical team checks charts night before to identify problems
9. Standardized workflow such that surgical resident/Midlevel arrives back in holding area at 0725 to roll patient
back to OR and stays in OR for pre-induction sign in
10. Modified whiteboard in West Holding Area to enhance communication between services and highlight which
cases are missing H+Ps and consents
Holding the Gains
11. To maintain the gains:
• Auditing on an ongoing basis what’s missing in Holding Area night before & DOS at 0705 hrs
• Formed continuous improvement team that meets on ongoing basis to address problems
Spreading the Learning
12. We’ll implement this process improvement on the East Campus; this will be launched in Q1 2012
For More Information Contact Mary Francis Cedorchuk, Nurse Manager of Cardiac, Vascular/Endovascular, Thoracic Surgery and
Interventional Pulmonology, mcedorch@bidmc.harvard.edu; Allen Hamdan, MD, Vice Chairman, Department of Surgery,
ahamdan@bidmc.harvard.edu; Pete Panzica, MD, Vice Chairman, Department of Anesthesiogy, ppanzica@bidmc.harvard.edu
�
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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.
Ross Simon
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
Paul Appleton
Laura Esnaola
Scott Johnson
Kailash Swarna
Ann Bonner
Peter Germond
Pete Panzica
Jason Wakakuwa
Mary Francis Cedorchuk
Mary Grzybinski
Sue Pobywajlo
Jane Cody
Allen Hamdan
Ross Simon
Marylou Conant
Mark Heuther
David Stryker
Elena Canacari
M. Callery
B. Simon
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Title
A name given to the resource
1st Case Starts West Campus Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2012
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e4595d1726512fb8b8f9ae05f0ed6fa4.pdf?Expires=1712793600&Signature=U6woZdX%7EF216bPhyvNbTyZ8TAhtOtiC9diVYM516vitGneI%7EC006hXI6ZbUDMk6CmG3IScObcsaVSWriJe%7E6souhFPp41EHiaKYUkzJVpq7FZR%7EAkJ5pEkV4vPs6sS4tU5ZQojQdibLmKJr93L0FII4Epc5OrZ4EriY8ZVWX4tUe573CKtRGpZpD66n7bC0sCK2YbotNtn%7EQnrHRLTDQyDJXD3pB9XbLKGG73putbRKNizHtJHMeigJdQtr-uS10n267SdTFYzmDCzEU2sWnrX-DG9lQTV3VhdPf2pjlxOEPWQ9ImYhLbTbS0LNLzm3-SdY-l48LnNvU5W7691ixwA__&Key-Pair-Id=K6UGZS9ZTDSZM
4ae6a5c55a11871fe390c6c48b0458cb
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Text
3D Printed Nasopharyngeal Swabs for
†
COVID-19: Innovations and Lessons Learned
Development of Four New 3D-Printed Swabs
Cody J. Callahan,a Rose Lee,b,c Katelyn E. Zulauf,b,d Lauren Tamburello,e Kenneth P. Smith,b,d Joe Previtera,f Annie Cheng,b Alex Green,b,d
Ahmed Abdul Azim,c,i Amanda Yano,g Nancy Doraiswami,h James E. Kirby,b,d Ramy A. Arnaoutb,d,j
aDepartment
hDivision
of Radiology, bClinical Microbiology Laboratories, Division of Clinical Pathology, Department of Pathology, cDivision of Infectious Disease, Department of Medicine, eDivision of Urologic Surgery, Department of Surgery, fDivision of Respiratory Therapy, gDepartment of Medicine,
of Perioperative Services, Department of Central Processing, iDivision of Infection Control/Hospital Epidemiology, Silverman Institute for Healthcare Quality and Safety, and jDivision of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston,
Massachusetts, USA; dHarvard Medical School, Boston, Massachusetts, USA. Rose Lee and Katelyn E. Zulauf contributed equally to this work. Their names are listed alphabetically
Addressing the swab crisis
Creating & testing new swabs Clinical performance
Development of Four New 3D-Printed Swabs
Journal of Clinical Microbiology
Through an innovative, multidisciplinary, cooperative,
rapid-response
translational-re‐
search program,
we emergently
1: Define the mission
developed and
2: Establish norms
clinically validat‐
ed new swabs
3: Leverage expertise
for immediate
4: Communicate clearly
mass production
via the method
5: Stay positive!
of 3D printing.
Lessons learned
FIG 1 Control and prototype swabs. (a) From left to right, the control swab (C; Copan 501CS01), a repurposed urogenital cleaning swab approved for NP testing
through our process (R), prototype 1 (Resolution Medical), prototype 2 (EnvisionTec), prototype 3 (Origin.io), and prototype 4 (HP, Inc.). (b) From top to bottom,
close-ups of the heads of the swabs in panel a. Bars, 1 cm. (c) Examples of Gram stains of cheek swabs using control (top) and prototype (bottom) swabs. Bar,
10 !m. (d) Examples of materials testing. Clockwise from top left, head flexibility and robustness to fracture, neck flexibility and robustness to fracture,
robustness to repeat insertion into and removal from a tortuous canal (diameter, 3 cm), and break point evaluation.
Phase I: preclinical evaluation. (i) Design. An infectious disease physician, a clinical pathologist
(clinical microbiologist), and a respiratory therapist tested each prototype swab for design and mechanical properties (Fig. 1c and d). These included size measurements of the head, neck, shaft, and break point
(requirement of !15 cm to reach the posterior nasopharynx; head diameter of 1 to 3.2 mm to pass into
the midinferior portion of the inferior turbinate and be able to maneuver appropriately without catching
on anatomical variants such as septal spurs or a deviated nasal septum); surface properties, such as
smoothness (with roughness leading to an unpleasant feel and risk of bleeding); flexibility versus
brittleness of the head, neck, shaft, and break point (to avoid fracture during use); durability (e.g., ability
to tolerate 20 rough repeated insertions into a 4-mm-inner-diameter clear plastic tube curved back on
itself with a curve radius of !3 cm; ability of tip and neck to be bent 90° without breaking; ability to
revert to initial form following bend of 45°) (Fig. 1d); strength (to resist breakage under rough but
reasonable manipulation); and other factors as applicable (e.g., stickiness and smell) (Table 1).
(ii) Collection sufficiency. We assessed the ability to collect sufficient material for testing using Gram
staining of a swab of the interior cheek smeared onto a standard microscopy slide as a surrogate for NP
swabbing and comparison to Gram stain of a swab of the interior cheek using Copan Diagnostics, Inc.
(Mantua, Italy), model 501CS01 (FLOQSwab) as the control (Fig. 1c). Cheek swabbing was performed
instead of NP swabbing as the least invasive and most readily available source of secretions, making it
possible to test head designs even for prototypes that were deemed inappropriate as NP swabs. Slides
were heat fixed and Gram stained according to the BD BBL Gram stain test kit protocol (14). Slides were
examined at "40 magnification for the presence of both epithelial cells and bacteria. Prototypes were
passed if the amounts of bacteria and epithelial cells were qualitatively similar to those of the control
(which contained multiple bacteria and epithelial cells per high-power field).
(iii) PCR compatibility. We tested PCR compatibility by placing the swab head-downward after
breaking it off at the break point, when present (as in a typical NP swab collection), in 3 ml of modified
CDC VTM (Hanks’ balanced salt solution containing 2% heat-inactivated fetal bovine serum [FBS],
100 !g/ml gentamicin, 0.5 !g/ml amphotericin B [Fungizone], and 10 mg/liter phenol red [15]) overnight
to allow any PCR-inhibitory material to leach into the medium, spiking 1.5 ml with 200 copies/ml of
control SARS-CoV-2 amplicon target (representing 2 times the limit of detection on our system),
vortexing, and testing using the Abbott RealTime SARS-CoV-2 assay on an Abbott m2000 RealTime
system platform (16), following the same protocol as for clinical testing (37 cycles, with a cycle threshold
[CT] of "31.50 being reported as positive). PCR-positive prototypes passed.
Phase II: production considerations. We considered stability to autoclaving by repeating phase I
All prototypes displayed excellent concordance with
the reference (κ = 0.85 to 0.89). Cycle threshold (CT)
values were not
significantly differ‐
ent between each
prototype and the
control, supporting
the new swabs’
noninferiority (p
≤0.05). Study staff
FIG 2 Categorical concordance versus control swab. (a) Two-by-two tables giving coun
preferred one
of the prototypes over the others and
prototype versus the control swab and for control versus replicate control obtained within 24
samecontrol
individual. Discordant
are in gray,
totals total
for each swab
are below and to the rig
preferred the
swabresults
overall.
The
time
box, and the total number of pairs is in bold. K, Cohen’s kappa. (b) Scatterplot of C values
swabs for which
at least one swab was SARS-CoV-2
For discordant
pairs, the negativ
elapsed between
identification
of thepositive.
problem
and
assigned a C value of 37 (the maximum number of cycles run).
validation of the first prototype was 22 days.
T
Callahan et al.
T
Journal of Clinical Microbiology
of 0.18). Finally, the differences between CT values for the first and secon
swabs were comparable to the differences between control and prototyp
(MWU P values of 0.31, 0.26, 0.47, and 0.44 for prototypes 1 to 4) (Fig. 2b).
Staff and participant preferences. A written staff survey (see Materials a
ods) showed a preference for prototype 4, then prototypes 2 and 3, and then p
1. There was a slight preference for the control swab over prototype 4 (Fi
narrative feedback, prototype 4, which underwent the largest number of
†FIG 3 Subjective feedback. (a) Round-robin A/B testing of net preferences among prototypes 1 to 3 (large bold numbers) and the control (C). Each arrow points
Callahan
ettheal.
JCM
58:e00876
Arnaout
JCMwere59:e01239
through
our
(i.e.,
was
described
asunanimous
comparable
to the cont
from
the less preferred to
more
preferred swab.
Arrow process
weight indicates2020;
strength 28),
of relative
preference.
Preferences
except where2021
noted
with numbers separated by a slash: the first number is the number of responses for the direction indicated by the arrowhead, while the second number is the
(Fig.
number of responses that had the
opposite3b).
preference. The weight of the arrow is proportional to the difference (e.g., 7 ! 3 " a net preference of 4). Unless
otherwise noted, each arrow represents 12 to 15 separate responses. (b) Numbers of positive and negative comments received from study staff who
administered the swabs, tabulated by category.
In each plot, negative
feedback
the left of the zero,
positive
feedback is million
to the right. The
presence
Availability.
Swabs
areis toavailable
to while
order.
Several
have
been used a
of bars on both the positive and negative sides of zero reflects different opinions among study staff. n, total number of comments received about each
Downloaded
We performed a detailed multistep preclinical
evaluation of 160 swab designs and 48 materials
from 24 companies, laboratories, and individuals. We
created a public data repository on GitHub to share
results and feedback. We validated four prototypes
through an institutional review board (IRB)-approved
clinical trial that involved 276 outpatient volunteers
who presented to our hospital’s drive-through testing
center with symptoms suspicious for COVID-19. Each
participant was swabbed with a reference swab (the
control) and a prototype, and SARS-CoV-2 reverse
transcriptase PCR (RT-PCR) results were compared.
Downloaded from http://jcm.asm.org/ on December 17, 2020 by guest
In early 2020 the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) pandemic caused a se‐
vere shortage of nasopharyngeal swabs, which are
required for collection of optimal specimens, creating
a critical bottleneck blocking clinical laboratories’ abili‐
ty to perform high-sensitivity virological testing for
SARS-CoV-2.
�
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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.
Ramy A. Arnaout (<a href="mailto:rarnaout@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">rarnaout@bidmc.harvard.edu</a>)
Project Team
Cody J. Callahan
Rose Lee
Katelyn E. Zulauf
Lauren Tamburello
Kenneth P. Smith
Joe Previtera
Annie Cheng
Alex Green
Ahmed Abdul Azim
Amanda Yano
Nancy Doraiswami
James E. Kirby
Ramy A. Arnaout
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
Clinical Microbiology Labs
Division of Clinical Pathology, Department of Pathology
Division of Infectious Disease, Department of Medicine
Division of Urologic Surgery, Department of Surgery
Division of Respiratory Therapy, Department of Medicine
Division of Perioperative Services
Department of Central Processing, Division of Infection Control/Hospital Epidemiology
Silverman Institute for Healthcare Quality and Safety
Division of Clinical Informatics, Department of Medicine
Harvard Medical School
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Title
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3D Printed Nasopharyngeal Swabs for COVID-19: Innovations and Lessons Learned
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c5fe1bb62788c665a6cc19cfeeed531b.pdf?Expires=1712793600&Signature=l0DWRZ7sXhJ662xZblm2jH3l2wS7h-C3FqSgAOiMCiS9BR575176Itx0AKpEOve9BDwJQgtMbT4SaHTTpBDU7j8QEEx9YuT4YfrejPrQ5R1uh4dET5irmPIeoWx3e%7EcqMMcZQ1LRqOJgRhaTaMXJzPdokLPN39tB5I02omlp7kXxdTPpMgA7jNU7MzYRcfMP0Rtbl3wxHjyTzR%7EHh-fmS17Tl6NNC-0Mfe8cndRF362Lewd2w9UDQQ-ILJ2OF3FhyWVltuhRliicCefYB%7EyprhsE7oeA3Hw31ZtRxERTlU9Te5y2fVrY82FHozsDBfGpsY5f3WDAO2arJmAOz17ZIA__&Key-Pair-Id=K6UGZS9ZTDSZM
c78cb13e753d0bafd7c69151c8ca253a
PDF Text
Text
414 to 12 to 152 Days Between NICU CLABSIs:
The Value of Root Cause Analysis
The Problem
The Results/Progress to Date
Following a series of improvement efforts beginning in 2010-2011, our NICU enjoyed
414 days without a central-line associated bloodstream infection (CLABSI). However,
beginning in June 2012, we experienced 3 CLABSIs within a 3 month period. There
were 12 days between the most recent two incidents.
RCAs revealed all infections were in the lowest gestational age infants, with high
We were concerned about the ramifications for the safety of our patients. Had we
become lax in our initial improvement? Or was there a new special cause
explanation for the increase in CLABSIs?
Aim/Goal
Using an existing working group, the NICU Central Line Infection Prevention Task
Force (NICLIP), we desired to critically examine our data and practices surrounding
the recent infections, and determine causes and barriers to our ability to sustain our
previous improvement in the reduction of CLABSIs in our NICU, with the goal
remaining ZERO.
numbers of line access events.
Nursing input in the review meetings identified a potential special cause as a
recent change in IV tubing for central lines that required greater tubing
manipulations to prevent air bubble formation.
Group discussion at review meetings suggested decreasing compliance with
nd
elements of the insertion and maintenance bundles, particularly around use of 2
observer during line placement.
Renewed educational efforts were undertaken with staff addressing these issues.
As of 1/18/13, 108 days have passed since the last NICU CLABSI (see graphs).
The Team – NICLIP Task Force
Chairs: Rosanne Buck NP and Brenda Sheridan RN
NICU Leadership: Jane Smallcomb RN and Susan Young RN
RNs: Radka Arnold, Melissa Chang, Sarah Farrell, Jen Harris
NPs: Rachel Copertino, Mary Quinn, June Rivers, Laura Tannenbaum
MDs: Dmitry Dukhovny, Munish Gupta
Infection Control: , Fatima Muriel MT(ASCP), David Yassa MD
Central Line Service: Blanche Murphy RN VA-BC PEVA/CVL RN Coordinator
Pharmacy: Greg Dumas RPh
Interventions
The Online Root Cause Analysis (RCA) Tool, formulated as one of the NICLIP
measures, was utilized for each of the 3 episodes. The RCA was sent via email
link to MDs, NPs, and RNs caring for each patient within 48 hours of CLABSI
event.
CLABSIs were reviewed by department at M&M, and a special CLABSI review
meeting was called to review the root cause data and identify possible causes,
develop or identify potential solutions, and determine if further interventions were
warranted.
Lessons Learned / Next Steps
Sustainment of improvements requires continued attention and commitment to
standard practices.
Implementation of new processes, such as the IV tubing system, need
appropriate communication to insure best practices are possible.
We continue to explore new opportunities for improvement, including a new
central line tubing configuration with closed medication administration system;
this configuration should greatly reduce impact of line access events on integrity
of system. Widespread staff communication and education will be crucial prior
to this next tubing change.
We will continue to aggressively use the on-line RCA tool and group discussions
to review new CLABSI events.
For more information, contact:
Rosanne Buck NNP-BC (rbuck@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.
Rosanne Buck (<a href="mailto:rbuck@bidmc.harvard.edu">rbuck@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
NICU
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Rosanne Buck <br />Brenda Sheridan<br />Jane Smallcomb <br />Susan Young <br />Radka Arnold<br /> Melissa Chang<br />Sarah Farrell<br />Jen Harris <br />Rachel Copertino<br />Mary Quinn<br />June Rivers<br />Laura Tannenbaum<br /> Dmitry Dukhovny<br />Munish Gupta <br />Fatima Muriel <br />David Yassa <br />Blanche Murphy <br />Greg Dumas
Dublin Core
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Title
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414 to 12 to 152 Days Between NICU CLABSIs: The Value of Root Cause Analysis
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Format
The file format, physical medium, or dimensions of the resource
pdf
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/fcc173e9a346cf91b8ed26abac639cc5.pdf?Expires=1712793600&Signature=XSj%7E1GQ6UDV6kjsJx0PXDRArHmi04bTNPqjoNvfQMCBDkNxCUgPegbOoHHNZNvo8rnu9k9CKXVtn%7EH96YnmUL8cFglwm2ESCPZFCTQLpfSJUqkeD9Dr2lf5AbO%7EswZ4RcHeGLJX5cStGmursfJQ4mxE7MfS7yak-3J0cS-cz1TrQXW5QYHiX5wzeF-qMb0QApHYW10bicZbItk3%7E1F3JpKNr7TT7Z-Hb3t75bLUQry431JJq5jTBT%7Eje3QkGLPJcBvx0HwgP-vxxi4d6YiaQ%7Et4OvpAvP6M520NGQ-3usCz2KyqiWKa45Q8QLCrqmETuyFdrXcOUdYH9P0ie--cTRA__&Key-Pair-Id=K6UGZS9ZTDSZM
2f845ecf2bafa8760eb5d7ce7ebd82da
PDF Text
Text
5 Feet in 5 Seconds: An Application of Lean Visual Management
Problem Background
Who is the
next patient?
On Stoneman 3, the physical design of the unit is broken into 3 separate pods:
admitting, recovery and procedures. Previously, nurses used printed schedules taped
to a cluttered ‘admitting board’, which were layered over time with check marks, RN
initials, highlight markers, Resource RN notes and cross outs in an effort to better
manage patient flow. Further complicating the issue, the admitting and procedure
areas were at separate ends of the unit, meaning the primary communication method
was constant phone calls to the Procedure Hall RN who is responsible for coordinating
patients, physicians, nurses and equipment among 10 procedure rooms.
Observations for 133 minutes were completed on
a ‘typical’ day, in that time:
More than 1 person was at the board on 24
occasions (ranging from 2 – 6 people)
Iterated 7 versions of a visual
management board, finally implementing
a strategically placed, transparent board
viewable from both the procedural hall
and admitting area
Board referenced 123 times (once every 65 secs)
Max time spent at the board by a RN = 8:32 mins
Total RN time spent at the board = 68 mins
How much time do we spend
coordinating activities at the
"Admitting Board"?
Total staff time spent at the board = 112 mins
What is the “Admitting Board” being used for?
0:43
0:15:07
0:14
0:11:47
0:07
50%
40%
30%
0:10:57
0:06:48
20%
0:05:59 0:05:34
0:04:01 0:03:46
0:00
60%
Cumulative (%)
Total Time (h:mm:ss)
0:21
70%
0:02:57 0:02:34
0:02:10 0:02:06 0:01:35
0:00:59 0:00:39
10%
0%
35
30
25
20
15
10
5
0
5-Jul
6-Jul
9-Jul
9
9
4
27
21
28
4
4
13
9
11
4
Admitting Procedure
Rooms
1
4
2
Reformatted previously available
information with color codes, maps,
flags, and automated patient arrival
labels
Measures of Success
3
7 iterations
over 3 weeks
3
1
1
Before
After*
Total RN time spent at the board
(out of 133 minutes observed)
68 mins
18 mins
↓74%
112 mins
50 mins
↓55%
36 mins
12 mins
↓69%
11
2
7
% change
RN time spend determining which
patient to admit next
48%
43%
39%
3
6
Total staff time spent at the board
(out of 133 minutes observed)
Total Calls by % of Calls from
Date Total Calls Admitting
Admitting
33
Recovery
Recovery Procedure
Rooms
Results
Phone Calls to GI Procedure Hall RN (July 5, 6 & 9, 2012)
80%
36 staffing mins (out of
133 mins observed) was
spent determining which
patient to admit next
0:28
Admitting
5
100%
0:35:48
11/1/12
GI Lean
Team
9/5/12
GI Lean
Team
Visual line of sight
between admitting
& procedure area
Collaborated with nursing, technical, and
physician staff to develop standardized
work to support the function of the new
board
Who is calling the Procedure Hall RN?
90%
0:36
Project Sponsors:
Dr. Ram Chuttani
Alice Lee
Janet Lewis
Jayne Sheehan
Project Team:
Michele Boucher
Julie D’Souza, RN
Kimberly Eng
Maryann Hickey, RN
Ginny Kelly, RN
Regina Loschiavo, RN
Michelle Sheppard
Edna Villamin
Allison Wang
Dr. Jacqueline Wolf
Hanako Yamanaka
7/27/12
GI Lean
Team
6/29/12
GI Lean
Team
The Interventions – Future State Design
Switched the Admitting and Recovery
areas to create line-of-sight between the
2 areas
Current Condition & Cause Analysis – Gathered data through observation & mapped the current process
Owner/
Date
↓82%
Daily phone calls between
admitting & procedure hall RN
New Visual Management Board
*Observations completed after implementation on a ‘typical’ day for 133 minutes
Can we decrease the unnecessary & repetitive
decision making on who to admit next?
Why is admitting calling the procedure hall RN?
If the Procedure Hallway RN has the most up-to-date
information needed to prioritize patients in
admitting, how can admitting receive that
information without having to call?
Goal
Develop a Visual Management System that would improve communication and our ability to consistently
synchronize an available room, patient, physician, nurse with all required equipment
Staff feedback
postimplementation:
Better communication between admitting to
procedure hallway & no phone calls
Obvious for admitting RNs which patient to admit
next, greatly reducing time spent at the board
All disciplines can get needed information at a glance
“I am able to get the
information I need in 5
seconds from 5 feet away”
Lessons Learned
When developing a visual management board, it is necessary to be mindful of who the target users will be. Having a balanced representation
of any associated disciplines that may rely on information provided by the board will lead to a more successful process improvement.
The commitment to implement a change and acknowledge the stressors that are associated with it will also contribute to success
Next Steps/What Should Happen Next
Ongoing continuous improvement of the admitting visual management board
Create connecting visual management boards to improve information flow throughout entire unit
For More Information Contact
Michele Boucher RN, MS mboucher@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.
Michele Boucher (<a href="mailto:mboucher@bidmc.harvard.edu">mboucher@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Lean
Gastroenterology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Michele Boucher
Julie D’Souza
Kimberly Eng
Maryann Hickey
Ginny Kelly
Regina Loschiavo
Michelle Sheppard
Edna Villamin
Allison Wang
Jacqueline Wolf
Hanako Yamanaka
Ram Chuttani
Alice Lee
Janet Lewis
Jayne Sheehan
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Title
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5 feet in 5 seconds: An Application of Lean Visual Management
Date
A point or period of time associated with an event in the lifecycle of the resource
2013
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/cdbf8284edb4a699a15383065072f6d2.pdf?Expires=1712793600&Signature=nSn7E2SNVP3vtA7o075ZDnA8Q5%7EmUZ2Xe37mD5dXmSCDW2XSpNNkXgQz97ria%7EH%7E%7EmNUcGUpQcit1upPtX1iLPk7YrKscvxDxWCMLNsm1NTr9EQYzRdAPqTzxf3XKvIlMEgqiOqnzQSSYrvLyiAcVCqKIks4e56qsTlrmOLe2uifL1AHb3LLdSbZO2BWCVFwSXrRC2zQD7VmHwInWmxpXTHPvLgzwrEAZE5yZ9qn3VrGGp7BtjQcYZcb9pmG3RWy9vonAWp2cja3gF16WRVDo1Rn2C0jkSnV9iapNQjTafpVEpxLx5q%7EL3csZDO2rIMCIyp7ZIYSTJbubohXEESOYw__&Key-Pair-Id=K6UGZS9ZTDSZM
f772535363afcf35ad5f0b164e2f05eb
PDF Text
Text
5S for PACS Supply Closets and Storage Areas
The Problem
The Results/Progress to Date
PACS workstations are used throughout the hospital to view various types of
Radiology images. Servicing these machines is important to ensure images can be
read and interpreted in a timely manner.
Over the years, our PACS storage and work areas on both campuses have become
cluttered with outdated equipment and supplies. In addition, there are many items
that belong to other departments that have been left behind. This clutter has caused
inefficiencies by hunting and fetching for items in non-standard locations.
After LEAN
Before LEAN
Aim/Goal
Utilize the LEAN 5S’s to organize our 2 storage closets on East and West Campus
and the PACS office on the East to improve efficiency with servicing new PACS
workstations in Radiology.
The Team
Scott Campbell, Radiology Informatics Specialist
Joe Keegan, Radiology PACS Technician
Jim Brophy, Manager, Radiology PACS/Informatics
Allen Reedy, Radiology Business Director (LEAN resource)
The Interventions
Lessons Learned
Educated project members on LEAN concepts and tools for process
improvement
Used the LEAN 5S’s to:
o Sort unneeded equipment and supplies with input from team members
as well as other Radiology mangers and service departments
o Set locations for needed equipment and supplies
o Scrub, shine and sweep the immediate work areas
o Standardize equipment and supply locations with associated labels
o Sustain goals by educating staff on the new locations of equipment and
supplies and continually assessing the area and soliciting feedback from
staff related to the changes
In shared work space, it is important to reach consensus by all those with a
vested interest to determine what items are necessary to keep and where they
should be stored
Using the 5S’s in our supply and storage closets has greatly reduced the time it
takes to service our PACS machines
Open communication is essential to avoid unnecessary surprises (i.e. running out
of supplies, redundant ordering)
Next Steps/What Should Happen Next
Perform regular inventory checks
Keep only PACS related supplies in the 3 work areas
For More Information Contact
Jim Brophy, Manager Radiology PACS/Informatics
jbrophy@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.
Jim Brophy (<a href="mailto:jbrophy@bidmc.harvard.edu">jbrophy@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Scott Campbell
Joe Keegan
Jim Brophy
Allen Reedy
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Title
A name given to the resource
5S for PACS Supply Closets and Storage Areas
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f4d890c2328b7c6a173c61097837d6f6.pdf?Expires=1712793600&Signature=vOdRcb-%7EIOj%7EMW0PUz3ji6xsV5vO5MqL5Kd2v9ddS39RITzUxoDFOfr7qqwDM7wCtuVX8YQhovWop9hyqDdnwe5lQ6hA0mAjXHZtOercVzAbJ7eVg3aKfhVJj6w5vGtlZT2iURJ11EHk0NASymOEV4U9BXqgGdkaK29QF%7ExEGXhhkE-tzvqp68v%7EiAN8YCM%7EoT9Q7fU%7Ek9xM2LXz388%7EtPrFsHLI-N%7EJDmdPAbhff2rYD8UauY3qiSzNlPSeXOp%7EjDKMhy2V1O8pJVVbUnXFd9GL78DtGGc8IrrNqHa4xIW0B-tF5hjlBQr0IVof0BgA6iJlidQeSoVghwdc5oYEeQ__&Key-Pair-Id=K6UGZS9ZTDSZM
746340b68bd268bbdbe097f23fa519f5
PDF Text
Text
TAP TO GO BACK
TO KIOSK MENU
6S Project on 2 East
Betsy Charron RN, BSN
Introduction/Problem
Utilizing the departments Idea board, staff generated several ideas pertaining the need for organization
and standardization of the unit’s medication rooms.
RNs as well as materials management staff expressed frustration with the amount of time spent looking
for supplies. Supplies could be kept in any of the three med rooms and in a different location in each.
Supplies were overstocked making it difficult and time consuming to find items, tying up capital as well as
increasing the likelihood of the supply expiring.
A Workgroup was tasked with eliminating the waste of searching & overstock in the 2 East Medication,
Supply and Clean Equipment Rooms in order to give more time back to meaningful work; i.e.. direct
patient care.
The Interventions
1.
2.
3.
4.
5.
6.
Utilizing Lean Principals including 6S Methodology
Sort
Set
Scrub
Safety
Standardize
Sustain
Results/Progress to Date
Aim/Goal
•
•
•
•
Increase ease of work for Nursing & Materials
Management
Organize supplies
Dedicated space for every item
Prevent expired supplies
•
•
•
Removal of obsolete supplies
Reduce the amount of capital tied up in overstocked
supplies
Item layout consistent throughout all rooms
The Team
Betsy Charron, RN, BSN
Cori Perri, RN
Catherine Papadopolous, RN
Denille Carr, RN
Dianne Erickson
Nikki Caputo, RN
Lilly Elwell, UC CNA
Deb Crowley, UC CNA
Bobby Bowser
The above graph details the downward trend of inventory distributed & money spent.
For more information, contact:
Betsy Charron RN, BSN echarron@bidplymouth.org
�6S Project on 2 East
Betsy Charron RN, BSN
More Results/Progress to Date
Waste
Before and after photos of the pilot medication supply room.
The above photos picture the overstock waste that was removed from the unit’s medication and supply
rooms.
Lessons Learned
Include all stakeholders from the beginning
Encourage feedback from all users throughout implementation
Subcutaneous needle used appropriately
Importance of daily monitoring for sustainment and success
Next Steps
Before and after of the spread process to the unit’s supply room
Continue to spread to all med rooms house wide
Expand efforts to inpatient medical supply rooms
Right size color coordinated bins
Cluster closets
Identify a standard storage space for each piece of equipment
For more information, contact:
Betsy Charron RN, BSN echarron@bidplymouth.org
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Elizabeth Charron (<a href="mailto:Echarron@bidplymouth.org" target="_blank" rel="noreferrer noopener">echarron@bidplymouth.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
2 East Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Plymouth
Project Team
Elizabeth (Betsy) Charron
Cori Perri
Catherine Papadopolous
Denille Carr
Dianne Erickson
Nikki Caputo
Lilly Elwell
Deb Crowley
Bobby Bowser
Dublin Core
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Title
A name given to the resource
6S Project on 2 East
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/42ca5f0499f1c969163df3a851d91848.pdf?Expires=1712793600&Signature=YvptkLDuiOGmU1amu1eagItO8Esqg2Avd05UF3F7VaDmjdPn1ZctUO4D5Q5LehXgjod%7EV5Fs5I2iiXyq5D%7E5enwSIUlca9QRitvHjKWXVT-eurdS8MKT9dXCyzcqXwSqddzcvxW2Cn-PG4N9BnocJWrQzPf9dEwgf%7EOBGWspcCDJXCi5u189vf2lrF1pV2JNyb1EC3I3zdGNYoLmUhAiOrGJFp4l2AaVM0J-Ng6gl-lrUp-vUN68mVrk35vhXy5BW29mJdrQ6VoigesivHYRNoa0AU13bRxqyiWBGyJ5g2D46PfG5781hr1BeJZVxMK6h0SRnRMy%7EATdvBN2sFm9Bg__&Key-Pair-Id=K6UGZS9ZTDSZM
4cb2644cd82c00dc565fe8549d271d43
PDF Text
Text
Sustaining
Change
Award
Over the last 2 years we observed a rise in our NICU CLABSI (Central Line-associated
bloodstream infection) rate up to 4 infections/1000 line days. This was above the NHSN
threshold and also higher than other Massachusetts NICUs.
Decreasing the Fall Rate on the Oncology Units
Our NICU did not have a central line bundle
WeProblem central line infections for our patients were largely preventable
and
The believed that
impacted the safety for our patients
While the fall rate in the Med/Surg population was decreasing hospital-wide, the fall
The Results/Progress to Date
rate in
Weon the Oncology Units continuedsafety needed to be raised for our NICU community
recognized that a culture of to rise.
Aim/Goal
To decrease the
fall risk in this specific patient population.
Evidence illustrated that the Institute for Healthcare Improvement’s (IHI) Falls
2
# Patient Falls on 7 Feldberg Oncology Unit
M ay - September 2011
0
As of
1/12/11
Better
250
200
150
100
50
0
Threshold is NHSN Pooled Me an Rate for Level III NICUs (2006-2008, 2009)
Date of Infections
Last CLABSI in NICU: 5/7/2011 (250 days as of 1/12/12)
Current CLABSI rate: < 1 per 1000 line days (12-month rolling average, 12/31/11)
1
NICU Central Line Infection Prevention (NICLIP) who are at a true risk to fall. By
Task Force
bundle could do a better job of capturing patients
Rosanne Buck NP and Brenda Sheridan RN Chairs fall prevention efforts more
focusing on these patients, we could concentrate our
RNs:efficiently and potentially reduce chair and Dalton, Jen Harris
Melissa Adams, Radka Arnold, Meg bed alarm fatigue.
NPs: Rachel Copertino, Mary Quinn, June Rivers, Laura Tannenbaum, Mary Whitlock
The Team
NICU Leadership: Jane Smallcomb RN, Susan Young RN
Kathy Baker, RN, CNS
Chris Kristeller, RN, CNS
RT: Candace Buckley
MDs: Dmitry Dukhovny, Munish Gupta
Pat Folcarelli, RN, PhD
Kim Sulmonte, RN, MHA
Infection Control: Fatima Muriel MT (ASCP), Tardanico, RN, UBE
Meggie Galligan, RN, UBE
Erin David Yassa MD
Central Line Clinical Specialist: Blanche Murphy RN
300
Better
4
3
s
n
o
t
i
c
e
f
n
I
n
e
e
w
t
e
b
s
y
a
D
IHI Bundle Start
The Morse Fall Score was not capturing our patients that were most at risk to fall.
Chemotherapy treatments,
educatedsupportive medications increased patients risk to fall.
Patients were not
on their heightened risk to fall
To organize a task force to rapidly assess the problem and implement a bundle with the goal
of reducing NICU CLABSIs to ZERO.
350
Days Between Central Line Associated Bloodstream Infections
BIDMC NICU, October 2008 to January 2012
G-chart
May
June
July 1-19th
July 20th-31st
August
September
ChangeJuly 19 )hard! The newly created 20 )
Pre-pilot (May- was
IHI Bundle Implemented (July observer role was new for RNs and added a staffing
th
th
burden during admissions and PICC placements.
NICLIP hosted a unit-wide celebration the week of November 7th, celebrating 6 months free
of CLABSIs.
A poster detailing our accomplishments was presented at the Vermont Oxford Quality
th
Congress December 4 , 2011. Many NICUs face similar challenges with CLABSIs. Copies of
our Insertion and Maintenance checklists were shared with over 30 NICUs.
Since the start of NICLIP, the opportunity to join a National NICU CLABSI project arose. Our
The Interventions
improvement opportunity to more accurately
We hypothesized that we had an
NICU along with 8 Massachusetts NICUs has joined. Many of the recommended practices had
already been adopted by NICLIP interventions. Through this project, we will continue to
measure our compliance with insertion and maintenance checklists, and compare our
Learned
performance with NICUs across the country.
identify patients at 2011. to fall by using criteria from the IHI Fall Bundle for
Meetings began Mayhigh riskCentral Line Bundle was developed and introduced in the NICU
th
evaluating ALL patients.
on July 15 2011, including:
1. ensuring that the bed is in the lowest, locked position
Lessons
Insertionnurse call light is new assistant/observer role during central line placementPatients should be an active part of their care team. By educating patients about their
2.
the Checklist with in reach
3.
the IV pole is on the side of the on daily the patient would exit
Maintenance Checklist completedbed whererounds noting condition of site, dressing to fall, we can decrease the potential for falling and falls with injury.
risks
Upon completion of the line access, and complications
integrity, frequency ofabove, the nurse must answer the following question:
Ongoing goals for Happen Next
“Is the patient able and willing to reliably and consistently use the call light to ask
Next Steps/What Should NICLIP:
InstitutionIfof On-Line Root Cause Analysis Toolinterventions will be any bacteremia
for MD/NP/RN for
for help?” the answer to that question is ‘No’, fall
implementation of additional bundle items re: tubing, CVL carts, closed medication
Continue to assess the fall rate on the Oncology Units
implemented, such as bed and hooks in med room room close TPN nurses
Systems issues such as more chair alarms, low beds,for hangingto the tubing and more timely the IHI fall bundle hospital-wide
Spread
administration system for PICCs
station, of
deliveryetc. TPN from West Campus addressed
In addition, a former oncology patient wrote a prospective patients describing
On-going performance measurement andletter to currentmonitoring
her personal experience with a fall as a patient, and how she thought it would
never happen to her. She then shares practices that patients should take to help
protect themselves from a fall. This letter and list of interventions was given to
each patient upon admission.
Continue to have patients be a part of their care and work with the interdisciplinary
recruit a parent volunteer/advisor for NICLIP Task Force
team to decrease their risk to fall
Look at medications continue withthe fall risk to ZERO CLABSIs for our NICU!!
contributing to our goal and evaluate dosing and the patient’s
need for these medications
For More Information Contact
Chris Kristeller, RN, CNS
ckriste1@bidmc.harvard.edu
31
�
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.
Rosanne Buck
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
NICU
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
NICU Central Line Infection Prevention (NICLIP) Taskforce
Rosanne Buck
Brenda Sheridan
Melissa Adams
Radka Arnold
Meg Dalton
Jen Harris
Rachel Copertino
Mary Quinn
June Rivers
Laura Tannenbaum
Mary Whitlock
Jane Smallcomb
Susan Young
Candace Buckley
Dmitry Dukhovny
Munish Gupta
Fatima Muriel
David Yassa
Blanche Murphy
Dublin Core
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Title
A name given to the resource
9 Months Without A NICU Central Line Infection...And Counting! The NICLIP Experience
Date
A point or period of time associated with an event in the lifecycle of the resource
2012
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Safety
-
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
PDF Text
Text
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
�
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.
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
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
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/a03d14f9d3eead5b4afe85be6f1d7af1.pdf?Expires=1712793600&Signature=GCbBnnt0LZ-IGcnj9YxNAcic-kfcZrfRXMl358BWNlCLCwjmipsaSwtqafaYQlpRCqZMtFQtqXvgMHjJQURx6%7E7eKDDRipYkqk54sXRiK1VQBO-AfT-YRG442h89j%7EYvkYutOY2Nv4zHqSW6peWCbslUZ6i3dYsS-f4QAtdL0ecB%7Ebqm4Y-ZIaObfnZAmLRwSLCvzk5YOi9CVkdHzT865Aw6cZIPB7%7EEdDciLANXTuv%7E3N1CIdU3W0fAAKSJsswwFnfQ5nu5XkaRCxVN1gx1w5ddNSbkOLmBV3rT%7E91reIwWOV003wFMA2TXQFVgX2FOG4E1%7EWGSa2yR9YainP6URg__&Key-Pair-Id=K6UGZS9ZTDSZM
37c96ba39276256117b1669ca1bebe6f
PDF Text
Text
��
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.
Stephanie Tarantino (<a href="mailto:starant1@bidmc.harvard.edu">starant1@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiation Oncology
Hematology / Oncology
Facilities
Pathology
Pharmacy
Business Transformation
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Clinicians
Administrators
Facilities Staff
Patients
Architects
Dublin Core
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Title
A name given to the resource
A Cancer Center "Built From The Patient Up"
Date
A point or period of time associated with an event in the lifecycle of the resource
2015
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ad9d23ea44b9176cde0f0f8b12d1d4d2.pdf?Expires=1712793600&Signature=Ud3LI9ivjrDKLtkX7Kfrg4OAXYDgeCJhABqvjAgtEkY9SpUI%7Em7SSoWeLWo1DUw7c4GwjjqzrDUZjmTgmnkEVuJPnH34dTs2RCLCeJYREg8ThDhx4loK1hwwPY2pGhSuAb--kzx1WT1-r7i7W1zmFBipFGUrwhU6VkY7aa4k1pfqYsA%7EoCmYxnUAnql42V1oJ9QFuu3-134WzQtWJIESEKTfGGbDqDQ105GnlV7PVF9xLCC58T8xbCrwGEJ0AgoO19bAwjNhAdGn5ligL4X9tDIKLAyyM75yFNOyiLCZQiF91dgU3%7EG4AjJN8Fzf5Nfh5K-xPo%7EYF3NhUfr1pvjFmw__&Key-Pair-Id=K6UGZS9ZTDSZM
866cd18a2ff16ab1d834274f6891d8c3
PDF Text
Text
CC6 Workflow Improvement Plan A3
8 Step Problem Solving A3
1. Problem Statement
Direction
Business Measure
Performance Measure
Process Name
Team Leads:
Alison Small
Natalie Fealy
V1:
CC6 RIE Team/
09‐30‐2010
V2:
J.Davignon/
10‐13‐2010
V3:
A. Small/
01‐15‐11
V4:
V5:
5. Proposed Countermeasures
Future State Map:
• Improve the efficiency and communication, between team members and patients
• Work to decrease waste
• Work to decrease redundancy
• Improve staff and patient satisfaction
• Increase staff and patient safety
Project Sponsors:
Jane Foley
Jenine Davignon
Owner/
Date
Project Team:
Stacey Adamson
Jason Bates
Suzanne Burger
Dawn Casto
Michael Crowley
Sandra Espinosa
Alani Gabriel
Oscar Juarez
Deb McGrath
Laurie Phillips
Amy Sparby
Scott Herman (Ad hoc)
Martha Rower (Ad hoc)
Plan
2. Current Condition
Current State Map:
Wastes Observed:
Plan
6. Implementation Plan
ID
1
Title
Print copies of assignment/census (from Zetler for PT, etc.
every morning)
2 Pagers clipped to assignment sheets for PCTs
3 Staff remain on unit & available until end of shift
PROBLEMS
Location of supplies/equipment/linen/kitchen/Omnicells are not
optimal for work flow and patient care
Communication among members of the patient care team is not
2
efficient
Teamwork is lacking
1
3
3. Goals/Targets
2
How much:
Decrease motion/
walking by 50%
n/a
3
Shared expectations of CC6 staff members to provide excellent pt care
n/a
3 months
By when:
1 month
10/4/2010
UCO
Everyone!
10/4/2010
10/4/2010
Alison, Amy W., all staff
RNs/ PCTs
Dawn, Alani
Alison, Jane, Edgardo
11/05/2010
Complete
In Progress
Complete
Complete
In Progress
Amy, Dawn
TBD
Complete
Laurie, Natalie, Alison
TBD
10 Create case mgmt. rounds poster
In Progress
Standardized process for safe coverage of pagers for lunch &
Complete
breaks
Huddle at 7am and 7pm to identify key problems on floor..
Complete
12
Fall risks, potential triggers, new admits
11
Trial small supply cart in one pod with supplies used every
13
In Progress
day. Keep counts every day to determine need and par levels.
14 Assemble CC6 Lean Steering Committee
Complete
10/5/2010
10/12/2010
10/15/2010
Laurie, Cynthia, Work with CC7
TBD
Workgroup RNs/ PCTs
11/1/2010
Alison, all staff
1/2/2011
Alani, Musa, Deb
2/1/2010
Jane, Alison, Dawn/Alani, Oscar, Laurie,
Jenine, Amy
Ongoing
7. Follow Up & Verification (Check both Results & Processes)
Plan
Fishbone Diagrams:
• The CC6 Lean Steering Committee will meet on the 2nd & 4th Thursday of each month to review progress of projects,
continue momentum and ensure sustainment of work completed to‐date.
• CC6 Lean Steering Committee Members are Jane Foley, Jenine Davignon, Alison Small, Natalie Fealy, Dawn Casto, Alani
Gabriel, Laurie Phillips, Michael Crowley, Carlos Ortiz.
8. Standardize and Share Success
What prevents
communication during
a shift between RNs &
PCTs?
•
•
•
•
•
•
•
Why can’t we
locate needed
supplies?
Specify the root causes
Location: \\Sr11hawk\shared\Lean\Departmental Documents\CC6\Pod Workflow RIE (09‐28‐2010)\RIE Documentation\A3
A3 Author: A.Wang
Created: 09/30/2010
PCT/UCO (evenings)
Complete
Complete
9 Standardize script for case management rounds
3 months
Continually question
WHY?
Complete
8 Redesign white board in backroom
Plan
Do what:
Eliminate/decrease wasted motion for supplies (linen, meds, kitchen, office,
med‐surgery supplies)
Collaborative care planning at specified times of the day between PCT + RN
Brainstorm potential
cause factors of stated
problems above based
on facts
Target Completion Date
4 Develop CC6 staff expectations
Waste of time and motion frustration increases pt wait time
P
U
Lack of care coordination, increase wait time for pts + staff,
S frustrating patients and staff
H Leads to low staff morale, frustration for pts + staff which
4. Cause Analysis
Who
5 End of shift restocking ‐ H2O/ IVF/ needs
6 Scripting huddle/ Re‐education
7 PCTs in each Pod stock linen carts in their Pod
EFFECTS
creates a divide among members of the team
#
1
Status
Plan
All day assignments are done utilizing the POD Model which means close geographical assignments.
ACS team Rounds with nurses early so nurses can have most current information for case management rounds.
PCTs obtain report from Nurses prior to seeing their patients for most current information while previous shift covers.
All Staff Huddle at 7am and 7pm so there is global knowledge of all important issues to be aware of.
All staff sign out whenever they leave the floor and write name of covering person so UCO knows who to page for patient requests.
Case Management rounds done using script in 30 minutes or less.
White Board designed and utilized by Resource nurse during Huddles and Case Management Rounds
Do/
Study
Study/
Adjust
Adjust
For More Information Contact
Alice Lee, Vice President, Business Transformation, alee1@bidmc.harvard.edu
Jane Foley, Director of Operations, Patient Care Services, jfoley@bidmc.harvard.edu
Alison Small, Nurse Manger, CC6, asmall@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.
<p>Alison Small (<a href="mailto:asmall@bidmc.harvard.edu">asmall@bidmc.harvard.edu</a>)<br />Jane Foley (<a href="mailto:jfoley@bidmc.harvard.edu">jfoley@bidmc.harvard.edu</a>)<br />Alice Lee</p>
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jane Foley<br />Jenine Davignon<br />Alison Small<br />Natalie Fealy<br />Stacey Adamson<br />Jason Bates<br />Suzanne Burger<br />Dawn Casto<br />Michael Crowley<br />Sandra Espinosa<br />Alani Gabriel<br />Oscar Juarez<br />Deb McGrath<br />Laurie Phillips<br />Amy Sparby<br />Scott Herman<br />Martha Rower
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
A CC6 Workflow Improvement Plan A3
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Patient and Family-Centeredness
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
PDF Text
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
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.
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
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
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/4e04b385970967739dbaa51d6559d7bb.pdf?Expires=1712793600&Signature=IgdqLoyXBMRGIbUwonuPRwIPEJ1P2T07D9tBMiluyRQxBOBzYMmgNpPIO5IBTsRNMQkiIRiNTqMCkXa2iQN7saCWnJy%7EX-Ynp1T5B1uwqgVu6GUj2TdIZvsvY07BEUBBnOGtCCZdBYaQNTKFdsGByhBb%7EBWuwiGD-aDu1fqXxALJvsUytML%7EJgaPL01aVIwo9dL6wjdnXiKIe8xmPsLHzI58hdTPvglvGsSRkuv8BafA500tQ%7EI1CTPFAkWy4XcMBIrJI4htUn9kIHdaPzgXQcqSTauoS9DgOXkZXv6f08GfPbdFyyqc-RvH5aFFiYQ8QSqv0tORUUMpgyi7dV7w2A__&Key-Pair-Id=K6UGZS9ZTDSZM
24d8ea74941fb79963756a9d3879f171
PDF Text
Text
A comprehensive stroke educational curriculum for neuroscience nurses
Introduction/Problem
Results/Progress to Date
The American Heart Association estimates more than 700,000 strokes occur each year
of which 600,000 are new and 180,000 are recurrent (Summers et al., 2009) . As the
numbers of stroke cases increase and care becomes more complex it is of utmost
importance that nurses remain up to date with evidence based guidelines and
recommendations and this can be achieved by providing nurses with stroke specific
education that addresses various domains in the care of the acutely ill stroke patient.
Advances in Stroke care are rapidly evolving and it is important for nurses to remain
educated on the complexities of the care of the stroke patient for the goal of improving
outcomes. As part of the journey to become a Joint Commission Comprehensive Stroke
center and meet the educational needs of the neuroscience nursing staff and Beth Israel
Deaconess Medical Center a complex and robust eight hour computer based learning
curriculum was created and assigned to approximately 110 neuroscience nurses.
Staff Satisfaction with CSC Training
Aim/Goal
Training was meaningful
5
4.5
4
3.5
3
2.5
2
1.5
1
There is a clear
connection between this
training and my work
Training provided me
with a better
understanding of topics
Will help me improve
my perormance
The goal was to create an educational program that would enhance and
develop the knowledge of the neuroscience nurses in the area of complex
stroke care for the ultimate goal of meeting a Joint Commission requirement for
becoming a Comprehensive Stroke Center.
The Team
Justin DiLibero, DNP, RN, APRN-CNS - Clinical Nurse Specialist for the Neuro ICU, NIMU, SICU
Joanna Anderson, BSN, RN, CCRN, CNRN - Unit Based Educator for the Neuro ICU and SICU
Lauren Sullivan, BSN, RN, CNRN, SCRN – Unit Based Educator for the Neuro Intermediate Care
Unit
Kym Peterson, MSN, RN, CNL, - Nurse Specialist for the Neuroscience and Medical-Surgical
Suzanne Joyner, MSN, RN – Nursing Director Neurocritical Care
The Interventions
A review of the literature was conducted.
Current competencies were compared with evidence based practices and guidelines
to prioritize educational needs.
A comprehensive 8 hour stroke education computer based learning curriculum was
created for all neuroscience nurses.
The curriculum was assigned to all neuroscience nurses in the Neuroscience ICU,
Neuro Intermediate Care Unit, and the Neurosciences Medical-Surgical Unit.
Moving forward the curriculum will be updated and assigned annually to all
neuroscience nurse and to each new hire
Lessons Learned
Advances in stroke care are rapidly evolving and for nurses to remain competent and
up to date on the current evidence based practices it is important to provide
meaningful education for the end goal of ensuring high quality care and improved
patient outcomes.
The feedback from the nurses has been overwhelmingly positive with many
expressing how the curriculum has enhanced their knowledge base and practice.
Next Steps
We will continue to re-inforce curriculum content throughout the year
The team will update curriculum annually based on program outcomes and
analysis of gaps between best evidence and current practice.
For more information, contact:
Justin DiLibero, DNP, RN, APRN-CNS jdiliber@bidmc.harvard.edu
Kym Peterson, RN, MSN, CNL kpters7@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.
<p>Kym Peterson (<a href="mailto:%20kpeters7@bidmc.harvard.edu">kpeters7@bidmc.harvard.edu</a>)<br />Justin DiLibero (<a href="mailto:jdiliber@bidmc.harvard.edu">jdiliber@bidmc.harvard.edu</a>)</p>
<p></p>
Project Team
Justin DiLibero
Joanna Anderson
Lauren Sullivan
Kym Peterson
Suzanne Joyner
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A Comprehensive Stroke Educational Curriculum for Neuroscience Nurses
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/884f2b1eeedd10eac485b21e35be8f1f.pdf?Expires=1712793600&Signature=hQcdbYzM-6TiX5AlO%7ErCuv4QbgX8DuLFR98Yc3xHVHMGaLGZuvvqRk%7EWnPrHZk9jS9kx-HzzRsXjNU0DdcOtPb9okLf-xFqGDEWguWPQDX3pVUEDjb6fh8kN1gBPQuWj9L3I-Tbo9t-E4%7EDe276LRFcNCyclTeBLQm3bOmMyuR9Uxpc8glD0ZoFZsEmeYEe4Lf8XVkzE%7E-6ukDYb2zk--fKmyyVOng3LN6jsWcYfU8SHm4yhhgogmZyp6NkJNy3X7AHPGpjiy9SrRJWh4XnugKg238YN1ut-fPIzh9yWp0jdwM6ARL75-0GXMYalt8ECIS5KRj0koas2Ww5Iem9DDw__&Key-Pair-Id=K6UGZS9ZTDSZM
366f25dd30c66e30a8232184782258c1
PDF Text
Text
A Conceptual Framework for Improved Patient-Physician
Communication and Shared Decision Making
The Problem
The Results
How can we structure the patient-physician encounter so that patients and their
advocates gain better understanding of medical information and become active
partners in their care?
Problems with patient-physician communication include:
One way communication from physician to patient limit shared decision making
Lack of a step-wise plan and timeline leading to fragmented care, poor follow-up
and patients’ inability to readily communicate with their physicians
Inability to access and appropriately utilize the latest information, especially in the
era of personalized medicine, genetic testing, and emerging technologies and
therapies
Aim/Goal
Create two-way communication between patients and physicians to empower
and enable the patients and their advocate(s) to make informed decisions
Implement an interactive, stepwise care plan that can be readily accessed and
acted upon by patients and all of their health care providers
Educate physicians and patients in real time with latest information and its impact
on an individual’s care
The Team
Steven Freedman MD, PhD, Gastroenterology; Mark Aronson, MD, General Medicine; Camilia
Martin, MD, MS, Neonatology; Tom Isaac, MD, MBA, MPH, General Medicine; Russell Phillips,
MD, General Medicine, Edward Marcantonio, MD, Meredith Rosenthal, PhD, Health Policy and
Management, Rima Rudd, PhD, Society, Human Development, and Health, Richard
Scwartzstein, MD, Ramy Arnaout, MD, PhD, Pathology; Naaman Neeman, MSc, Medicine; Scot
Sternberg, Medicine QI; Tina Damonda, RN; Bolanle Bukoye, MS, General Medicine; Suzanne
Leveille, PhD, Clementina Dimonda, RN, Jacob Shin,MS
The Interventions
Conducted Phase I study implementing the TRUST Encounter tool
Enrolled 108 patients and 7 attending level physicians in 5 sub specialties:
Gastroenterology, Hematology / Oncology, Pulmonary, Rheumatology and
General Medicine.
Study. Implemented TRUST Encounter tool, a trifold document with a templated
note, where the physician lists the problem and presenting symptoms, possible
causes of the patient's symptoms in lay terms, recommended tests or treatments,
the timeline for each step, how subsequent communication will occur, and the
patients/family’s thoughts or concerns.
Pre and post-study measures. Surveyed patients about their general health and
function, and their attitudes about communicating with their physicians.
Physician Survey. Conducted qualitative interviews with physicians in the study
to learn about their experiences with the TRUST Encounter and their perceptions
on its impact on patient-doctor communication, workflow and satisfaction, as well
as their perceived feasibility of expanding this initiative to other settings and
institutions.
Survey Response Rate: 97 patients, out of 108 patients who participated in the pilot
study (89.8%) completed the pre-visit patient survey. 70 of the 108 patients (64.8%)
completed the post-visit survey, and 55 patients completed both surveys.
94% of patients who completed surveys were satisfied with their physician
using the TRUST encounter as compared to 38% satisfaction with their prior
physician visit.
Survey Questions
Do you feel that your problems and questions
were adequately addressed at this visit?
Do you feel that your problems and questions
were adequately addressed by your other
physicians prior to this visit?
Yes, all of the
time
66 (94.3%)
Yes, some
of the time
4 (5.7%)
No
26 (37.7%)
28 (40.6%)
15 (21.7%)
0
97% of the patients who completed surveys found the TRUST document
helpful and 69% of the patients shared the document with their family or
friends.
Survey Questions
Yes
No
Don’t Know
Did your doctor provide you with a written
62 (88.6%)
4 (5.7%) 4 (5.7%)
summary of the plan to address your
concerns?
-- If Yes, did you find the summary helpful?
60 (96.8%)
0
2(3.2%)
-- If Yes, did you share the summary with
43 (69.4%)
19 (30.7%)
0
others in your family or with your friends?
Results from physician interviews indicate a generally high level of satisfaction with
the TRUST encounter with 57.1% of participating physicians indicating that they
were “very satisfied”.
Lessons Learned
Developing a stepwise care plan, the TRUST encounter form, and sharing it in
writing with patients, is helpful and can improve satisfaction and communication.
Implementing the TRUST encounter tool requires increased office time and needs to
be integrated into work flow and the online medical record.
Next Steps
Build web based and electronic communication version of passport to TRUST
Create a step-wise individual patient management plan with timelines; a medical
GPS equivalent that will serve as roadmap to receiving quality medical care.
Conduct a randomized trial to test the electronic TRUST tool in patients across
multiple sites and evaluate the impact of these interventions on health outcome
measures.
For More Information Contact
Steven Freedman, MD / sfreedma@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.
Steven Freedman (<a href="mailto:sfreedma@bidmc.harvard.edu">sfreedma@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine, Gastroenterology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Steven Freedman
Mark Aronson
Camilia Martin
Tom Isaac
Russell Phillips
Edward Marcantonio
Meredith Rosenthal
Rima Rudd
Richard Scwartzstein
Ramy Arnaout
Naaman Neeman
Scot Sternberg
Tina Damonda
Bolanle Bukoye
Suzanne Leveille
Clementina Dimonda
Jacob Shin
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
A Conceptual Framework for Improved Patient-Physician Communication and Shared Decision Making
Date
A point or period of time associated with an event in the lifecycle of the resource
2011
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness