1
20
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70e35aec7b5441c4d5a480e335ee48b0
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A Post-Acute Care Transition (PACT) Program: Targeting 30-Day Readmissions
Beth Israel Deaconess Medical Center, Boston MA
The Problem
The Results/Progress to Date
Avoidable 30-day readmissions represent unfavorable health outcomes for patients and
are now associated with significant financial penalties for hospitals.
• Our hospital’s readmission rate was too high.
• Care transitions post-hospitalization were fragmented and confusing for patients.
• Changes were needed to smooth care transitions for patients across all diagnoses in
order to improve outcomes and avoid costly readmissions.
We have achieved a significant reduction in 30-day all-cause readmissions over the
first 12-months of the three-year demonstration project.
Aim/Goal
To improve patient outcomes and prevent avoidable cost in the high-risk 30-day period
following acute care hospitalization.
The Interventions
• Program deploys a nurse and a pharmacist to visit newly admitted patients and to
provide 30 days of telephone support following discharge.
• 2011-12 pilot achieved a 20% reduction in readmission rate for the targeted
population and led to an expanded program with $4.9 million funding from the
Center for Medicare and Medicaid Innovation.
• Innovative staffing model employs 10 nurses and 5 pharmacists who are each paired
with one of six primary care practices, facilitating collaborative relationships with
primary providers.
• PACT clinicians visit patients from their assigned practices who have been
hospitalized and facilitate all aspects of post-discharge care according to patient needs:
ensuring medication compliance, facilitating in-home and outpatient support,
communicating with primary care team, helping to ensure patient gets to follow-up
appointments, and more.
Lessons Learned
• Intensive care management takes time but yields results.
• Inpatient nurses have been well suited to the PACT role, being familiar with
acute care needs of newly discharged patients.
• Aligning care transition staff with particular practices enhances communication
but creates variation in caseload for PACT staff.
• Having PACT team members sit in an open space facilitates cross-fertilization
of ideas and sharing of information on community resources.
• Patients at home will almost always respond they are “doing fine.” PACT nurses
have learned to unpack “fine” and assess how the patient is really doing.
Next Steps
•
•
•
•
Continue to refine systems throughout the demonstration period.
Enhance relationships with post-acute care facilities and home care organizations.
Refine metrics to measure effects of particular interventions.
Identify populations that benefit most from PACT services.
Team
Julius Yang MD
Lauren Doctoroff MD
Sarah Moravick MBA
Norma Wells RN
May Adra PharmD
PACT Nurses and Pharmacists
�
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Title
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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
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Norma Wells (<a href="mailto:nwells@bidmc.harvard.edu">nwells@bidmc.harvard.edu</a>)
Department
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Health Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Julius Yang
Lauren Doctoroff
Sarah Moravick
Norma Wells
May Adra
PACT Nurses and Pharmacists
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Title
A name given to the resource
A Post-Acute Care Transition (PACT) Program: Targeting 30-Day Readmissions
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Patient and Family-Centeredness
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6621e9089de2e16cd656d356efe1c4b6
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ACMS Stable Patient Extended INR Protocol as a model for reviewing, assessing, and
implementing new clinical guidelines into patient care practices.
men
Jennifer E. Mackey, PharmD; Lynde K. Lutzlow, Scot B. Sternberg, MS; Diane M. Brockmeyer, MD;
A teaching hospital of
Harvard Medical School
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Problem:
The 2012 update to the American College of Chest Physicians (ACCP) Guidelines included
a recommendation that patients with “consistently stable INR results” on warfarin may extend
the INR monitoring interval from the every 4 week standard to “up to 12 weeks.”1
Anticoagulation Management Service (ACMS) patient care practices must continually evolve
to incorporate updated evidence-based guidelines. A formalized process is necessary to
review, evaluate, and implement new procedures to reflect current recommendations.
Objectives:
Establish a model process for review of new clinical recommendations and patient care
protocols as they pertain to BIDMC Anticoagulation Management Service (ACMS) patients.
Create a protocol that incorporates updated INR testing frequency recommendations and
standardizes anticoagulation clinic practices.
Reduce patient INR testing burden while maintaining safe warfarin therapy.
Context and Intervention:
The BIDMC ACMS is composed of nurses, pharmacist, and a medical director who manage
warfarin care for about 800 patients with primary care doctors in a large academic care
practice.
ACMS established the below process for new evidence review to be utilized:
Identify new
published
practice
guideline
Review
primary
evidence
and expert
opinions
Draft new
patient care
protocol
Multidisciplinary
external review,
input, and
approval
Staff Training,
Pilot the protocol,
Assess staff
compliance
Assess outcomes
and revise
protocol
The updated ACCP Guideline INR frequency recommendation and supporting clinical
studies were critically evaluated by the ACMS team.
Review of primary data led to team assessment that the data for extending test interval
to 12 week INR checks are not robust. The team decided on a conservative approach
of maximum duration between INR tests of 6 weeks.
A Stable Patient Extended INR Testing Protocol was created.
Inclusion, exclusion/discharge criteria were defined:
General inclusion criteria: patients enrolled in ACMS with therapeutic INR results
and no maintenance warfarin dose changes for the previous three months.
General exclusion/discharge criteria: 80 years or older; home INR monitor use;
recurrent thrombotic event or major bleeding history; recent INR values less than
1.5 or greater than 5.0; episodes of being overdue for an INR; requests for more
frequent testing.
Eligible patients were offered the option of extending their INR testing frequency to
every 6 weeks. The standard process followed by the ACMS includes:
Reminding the patient to contact ACMS if there are changes to medications, diet,
scheduled procedures, and/or clinical status. This occurs at the time of protocol
enrollment and with each subsequent INR assessment.
Informing the patient that more frequent INR tests will be required if subsequent
results are outside of goal range; clinically significant to medications, diet, or clinical
status occur; warfarin is held as part of a peri-procedural plan; or episodes of being
2 weeks or more overdue for an INR test arise.
Standardized documentation in the electronic medical record was defined.
The protocol was reviewed and a plan to pilot over a 6 to 12 month period was enacted:
Healthcare Associates QI Committee and ACMS Leadership approved the protocol.
ACMS staff were trained regarding the new protocol and completed a competency
test before proceeding independently with patient assessment and enrollment.
The protocol was initiated into ACMS daily practice in February 2013.
Measurements of Improvement:
Clinic adherence to the protocol.
Decreased INR test burden and increased convenience for patients.
Maintenance of INR results within range and overall safe warfarin care.
Findings to date:
Patients were enrolled in the extended INR testing protocol and electronic medical records
were reviewed to assess outcomes at 6 and 11 months following piloting of the protocol.
Overall staff adherence to the extended INR testing protocol process was 95%.
Analysis was performed on patients with at least 12 weeks of data over the last 11 months:
58 patients enrolled
41 males (71%), 17 females (29%)
Average age 67 years (range 41-79)
45 anticoagulated for cardiac condition (78%; 37 patients (82%) with atrial fibrillation/flutter), 13 for DVT/PE (22%)
Duration of anticoagulation: <1 year: 2 (3%) ; 1-5 years: 31 (53%) ; 6-10 years: 16 (28%); >10 years: 9 (16%)
46 patients with > 12 weeks data
Average length of time on protocol 40 weeks (range 14-48)
402 INR results were recorded:
Reasons for early
Days
INR tests
between
INR results
[Average
(range)]
INR results
INR results Reasons recorded for Dose adjustments
within goal range outside goal out of range INRs
(% of occurrences)
range by
>0.2
29 (1-88)
315 (78%)
MD appointment
Hospital admission
Pre/post procedure
Antibiotics
Last INR outside goal
38 patients (83%)
had >65% INRs
within goal range
88 (22%)
Unknown (48%)
Illness (18%)
Dietary change (16%)
Periprocedure (8%)
Dosing error (7%)
Interacting med (3%)
66 one time changes
32 weekly changes
Clinical events that were noted during the pilot period included:
2 patients stopped warfarin (failure to thrive and apixaban conversion, respectively).
1 patient moved out of state and transitioned to a local anticoagulation service.
13 hospitalization episodes involving 9 patients: influenza-like illness (#2), mechanical fall
(#2), failure to thrive (#2), TIA/stroke (INR within goal) (#1), epistaxis (INR 3.39) (#1), atrial
fibrillation (#1), atrial tachycardia s/p PVI (#1), leg injury (#1), non-warfarin allergic reaction
(#1), ileus (#1).
o 2 patients were discharged to rehabilitation facilities following hospitalization.
9 patients had procedures performed: colonoscopy (#3); endoscopy (#1); epidural steroid
injection (#1); eye surgery (#1); prostate biopsy and seed placement (#1); PVI (#1); rectal
banding (#1)
4 patients were 2 weeks or more overdue for an INR tests. One patient had four overdue
episodes of 2-4 weeks. Six subsequent INR tests (86%) were within goal range.
No patients met protocol discharge criteria.
Key Lessons Learned:
A standardized multidisciplinary process for addressing new clinical guidelines is an
effective method for evolving patient care in safe manner.
Extending INR interval to 6 weeks in stable patients appears to provide safe care in pilot.
Next steps include continuing to monitor and track patient success in the pilot program;
refining protocol inclusion criteria based on additional data; and standardizing protocol
resumption following temporary discontinuation (e.g. out of range INR, overdue episodes).
Acknowledgements:
BIDMC Coumadin Clinic team members include: Patricia Glennon, RN; Lisa Jachowicz, LPN; Marie
Mahony, RN; Colleen Monbleau, RN
For More Information, Contact Jennifer E. Mackey, PharmD: jemackey@bidmc.harvard.edu
¹ February 2012; 141(2_suppl) Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines
�
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Title
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.
Jennifer Mackey (<a href="mailto:jemackey@bidmc.harvard.edu">jemackey@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Patricia Glennon
Lisa Jachowicz
Marie Mahony
Colleen Monbleau
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Title
A name given to the resource
ACMS Stable Patient Extended INR Protocol as a Model for Reviewing, Assessing, and Implementing New Clinical Guidelines into Patient Care Practices.
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
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Beth Israel Deaconess Hospital-Milton
Antibiotic Stewardship: Applying Vancomycin Kinetics
The Results/Progress to Date
The Problem
Vancomycin has become one of the most commonly used antibiotics in US hospitals for
the treatment of gram-positive infections, especially those involving Methicillin-resistant
Staphylococcus aureus (MRSA). Necessary changes in Vancomycin dosing guidelines were
fueled by the increase of Vancomycin resistant Staphylococcus aureus and Vancomycin
resistant Enterococcus species (VRE). Patients were traditionally dosed with universal
dosing of 1 g every 12 hours with no regard to patient weight or renal function.
In 2009 Vancomycin therapeutic monitoring guidelines were developed by the Infectious
Diseases Society of America and the American Society of Health-System Pharmacists
(ASHP).
In review of Vancomycin ordering, dosing and monitoring practices at BID-Milton,
significant variation relative to these published guidelines was identified.
Aim/Goal
Provide optimal management of Vancomycin to inpatients relative to dose, frequency and
monitoring as a means of optimizing therapeutic effect, mitigating potential harm from
drug toxicity, reducing the number of vancomycin peak/trough levels drawn and
decreasing drug resistance.
The Team
Rachel Kleiman–Wexler: Pharm. D, Msc., R.Ph, Director, Pharmacy Services
Jorge Barinaga: MD, Infectious Disease
Maria Pia Sanchez: RN, MSc, MPH, Manager, Infection Prevention
The Interventions (Select Actions Taken)
Program presented and approved by Medical Executive Committee (April 2012)
Roll out of program began in May 2012: Pharmacy Director reviewed 100% of
all Vancomycin orders, evaluated dosage, frequency, drug levels, monitoring
parameters (including weight and creatinine clearance), and trough levels
Pharmacy ordering of trough levels
As necessary, recommendations made to ordering physician re. Dose/frequency
changes, monitoring etc. Order revised based upon physician approval.
2012-2013, additional pharmacists trained on the process of Vancomycin order
review and clinical decision support
Outcomes shared quarterly at Pharmacy & Therapeutics, Clinical Oversight and
Medical Executive Committees
Lessons Learned
Despite protocol-driven recommendations and physicians education, % of recommendations
is
unchanged
since
start
of
program,
reflecting
that
clinicians
have
not adopted weight-based ordering of Vancomycin
Positive response from Medical Staff. Majority of recommendations made by pharmacy (>
90%) are implemented
Pharmacy recommendations that are not accepted by provider are reviewed for patient
impact/potential harm by the Antibiotic Stewardship Team and communicated to the
Department Chief as necessary for review and follow up
Next Steps/What Should Happen Next
Identify feasibility of Vancomycin dosing etc under the full direction of pharmacy. Physicians
would order first dose and then adjustments and monitoring would be performed by
pharmacy. Changes/findings would be communicated to the attending physician.
Currently working on a similar program model for aminoglycoside drugs
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
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An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
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Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
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Pharmacy
Infectious Diseases
Infection Prevention
BIDMC Location
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BID-Milton
Project Team
Rachel Kleiman–Wexler
Jorge Barinaga
Maria Pia Sanchez
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Title
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Antibiotic Stewardship: Applying Vancomycin Kinetics
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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Safety
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ASA Classification: What does it mean for your patient?
The Problem
*
ASA Classification
ACS NSQIP (American College of Surgeons National Surgical Quality Improvement
Program) is recognized for as nationally validated risk-adjusted, outcomes based
program to measure and improve quality of surgical care. The American Society of
Anesthesiologists Physical Status Classification System (ASA classification) is just
one variable that NSQIP utilizes in case severity and has an impact in the SemiAnnual Report, once risk adjusted. During data abstraction of lower extremity
endovascular variables, the nurse reviewers observed a discrepancy in the ASA
classification assignment between patients receiving nurse administered moderate
sedation and Monitored Anesthesia Care. These inconsistencies exposed
vulnerabilities associated with the reporting of ASA classification. Accurate
documentation is essential to comply with hospital quality standards and policies.
Aim/Goal
The goal of this quality initiative was to elucidate the methodology of ASA
classification and educate the procedure nurses and Vascular physicians on the
implications and importance of accurate ASA classification.
The Team
Sheila Barnett, M.D. Department of Anesthesia
Mary Beth Cotter, R.N, NSQIP Program Manager
Marc Schermerhorn, M.D., Division Chief Vascular Surgery
Mary Ward, R.N., NSQIP
Richard Whyte, M.D., Vice Chair for Clinical Affairs, Quality and Safety
The Interventions
The Department of Anesthesia provided education of ASA definitions to
Vascular surgeons and procedure nurses.
Education was provided to Interventional Procedure areas where conscious
sedation is utilized include the Cardiac catheterization laboratory and the
Endovascular suite.
The electronic medical record was modified to require documentation of ASA
classification by the operative physician.
The Interventional Procedures intranet page has been updated to include
ASA classification definitions.
The Results/Progress to Date
The baseline ASA class distribution for the initial six week period was ASA
classification= 2.0 +/- 0 (N=19). Following the intervention, the ASA
classification distribution was 2.90 +/- 0.55 (N=39). Average ASA classification
and distribution were significantly increased (p < 0.01) after the intervention.
Lessons Learned
ACS NSQIP is just one tool for data abstraction of surgical outcomes. Assigning the correct
ASA classification impacts the NSQIP data for case severity and impacts the O/E ratio in the
Semi-Annual Report. Working with Anesthesia to address this issue allowed for education to be
provided to staff in Interventional Procedures areas in addition to the Operating Room.
Key Lessons:
What does the data mean?: Significance and implication of documented information
Where does it go?: Importance of a standard location of electronic documentation
Why does it matter?: Compliance with quality standards of hospital documentation, as
well as awareness of policies and procedures regarding moderate sedation.
Next Steps
Ongoing education to Vascular surgeons and procedure nurses.
Audits of Medical Records to ensure that the ASA classification is
correctly assigned by NSQIP nurse reviewers.
Biannual feedback regarding audit compliance to Interventional
Procedures Committee.
Review results of the next NSQIP semi-annual report.
For more information, contact:
Mary Beth Cotter, R.N. NSQIP Program Manager
mbcotter@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mary Beth Cotter (<a href="mailto:mbcotter@bidmc.harvard.edu">mbcotter@bidmc.harvard.edu</a>)
Department
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HMFP Department of Surgery
BIDMC Location
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BIDMC
Project Team
Sheila Barnett
Mary Beth Cotter
Marc Schermerhorn
Mary Ward
Richard Whyte
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Title
A name given to the resource
ASA Classification: What does it mean for your patient?
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
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e0a2a6ac2e6e4b71ceda2393e62d600f
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BIDMC Universal Access Advisory Council
The Opportunity
The Results/Progress to Date
BIDMC was one of the first hospitals in the country to be reviewed by the Department
of Justice for compliance with the Americans with Disabilities Act (ADA). Many areas
of non-compliance were noted and the hospital entered into a 5 year improvement
plan for very specific changes. BIDMC chose to use this opportunity to engage “user
experts” - patients with disabilities and their families - in the process. The Universal
Access Advisory Council (UAAC) was created in 2010 to give user expert
perspectives to BIDMC staff responsible for issues affecting people with disabilities.
This proved to be a key driver in the value of this work, and broadened the
perspective and goals well beyond the basic equipment and facility requirements of
the settlement agreement.
Aim/Goal
To create a thoughtful, fully representative forum to exchange perspectives on
accessibility at BIDMC, and to inform changes in the physical plant and hospital
operations that reduce barriers or close gaps to health care for patients with
disabilities. To maintain full consumer representation across all disabilities to
regularly join with staff responsible for overseeing improving accessible facilities and
clinical operations.
The Team
Universal Access Advisory Council Consumer Advisors: Bob Chiaramonte;
Barbara Cone; Elizabeth Dean-Clower; Michele Finnell; Richard Hackel;
Alyce Lanoue; Sandy Novack; Dana Tilkin
BIDMC Ambulatory Operations Staff: Sarah O’Neill
BIDMC Facilities Staff: Dennis Monty; Ed Incerto; Amy Chee; Christine
Trotta
ADA Consultant to BIDMC: Katherine McGuinness
Patient and Family Engagement Staff: Elana Premack Sandler
The Interventions
Recruitment for BIDMC patient/consumer advisors that represent all areas of
disability.
Development of ADA expertise and planning in Facilities.
o Review and inventory of necessary access improvements.
o Bring in consultative support to guide work.
o Train facilities staff and senior management for improved
understanding of ADA goals and requirements.
o Develop annual funding commitments to ensure ongoing
improvement.
Integration of clinical operations staff into process – in 2012 committee cochaired jointly by Directors from Facilities and Clinical Operations.
Lessons Learned
The partnership of consumers and staff has significantly improved the depth of
understanding and the actions taken to reduce barriers to care, and leveraged
the scope to better achieve accessibility.
Accessible equipment and facilities is the first step in making BIDMC accessible.
Importance of addressing visible access needs (i.e. mobility, physical) alongside
less visible needs (i.e. sensory, cognitive, emotional).
Need for clear policies, protocols and staff training to ensure the appropriate
availability and use of accessible facilities, equipment and accommodations.
BIDMC is one of very few hospitals pioneering an accessible health care model.
Universal Access Advisory Council members serve as internal and external
ambassadors of BIDMC access initiative spreading the word on the importance
of these efforts, and the truly universal benefits.
Next Steps/What Should Happen Next
Ongoing recruitment of user experts, expanding representation to include staff
from inpatient operations and patients with cognitive impairment.
Broaden focus to emphasize more complex operational initiatives, especially
clear policies and staff awareness and training.
For more information, contact:
Sarah O’Neill, MBA, Director, Ambulatory Operations
soneill@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.
Sarah O'Neill (<a href="mailto:soneill@bidmc.harvard.edu">soneill@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Facilities
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Bob Chiaramonte
Barbara Cone
Elizabeth Dean-Clower
Michele Finnell
Richard Hackel
Alyce Lanoue
Sandy Novack
Dana Tilkin
Sarah O’Neill
Dennis Monty
Ed Incerto
Amy Chee
Christine Trotta
Katherine McGuinness
Elana Premack Sandler
Dublin Core
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Title
A name given to the resource
BIDMC Universal Access Advisory Council
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Equality
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/af81c91b4431fc12bff44260eb76f0f2.pdf?Expires=1712793600&Signature=CEp26IcrOvlMDlhWZMKXqcPfsu3l3SDxkfJFrFeoJ8QoY8QeURkGf5Wfb-CxvOciruzGLVOoDwATCrdlIdsYehqIhTzYpTX4q-FWQ54CW0b2YkIKZz3sstkoVVmSZ%7EQP9WsLg6Tl7cC5sJfEeVPnroX%7Etz61KvlhiQatZqvHwclTyjZqMML0q3nIQ60HsKuAEw%7EtLadBC%7EyWaggBzcHc1kD0SYf3sswsYr0ybKO4xOLCZFUVtis9aulo9tpNoMrpw7UpKD1GU15kTZrIvYjeBLnFjIylAhiPDKhgqI8YHiYzNiGAazKEd020%7E3OC%7EeFJ1Zbf92jLhjBSVmwKlMDRqw__&Key-Pair-Id=K6UGZS9ZTDSZM
7fc6cbf87209467ff539f7a65e88143c
PDF Text
Text
Beth Israel Deaconess Hospital-Milton
CAUTI: Sustaining the Reduction and Elimination of Preventable Patient Harm
The Results/Progress to Date
The Problem
Catheter-associated urinary tract infection (CAUTI) is the most common hospital
associated infection (HAI), accounting for more than 1 million cases each year in
US hospitals and nursing homes (Behnaz, 2012). The significant number of
infections, associated costs, potential for patient harm and dissemination of
resistant bacteria in hospitals make it important to find ways to decrease their
incidence.
Catheter Associated Urinary Tract Infection Rates 2009 - 2014
G
O
L
In 2009, BID-M’s Infection Prevention surveillance process identified an increase
in the number of urinary tract infections acquired during inpatient
hospitalization and associated with the use of urinary catheters.
Aim/Goal
Eliminate the incidence of Catheter Associated Urinary Tract Infection (HAI
attributable) by implementing evidence-based criteria for catheter use and
implementing processes to reduce device days and faciliate prompt removal
once indicated.
The Team
Lessons Learned
Nursing
Medical Staff
Clinical Education
Infection Prevention
The Interventions (Select Actions Taken)
Implementation and adherence to IHI endorsed CAUTI practice bundle
Purchase and utilization of a bladder scanner device as a means to determine
the need for catheterization prior to insertion
Extensive education and competency development for involved clinicians
Daily renewal of all inpatient catheter orders, including justification for
continuation of use
Post-operative urinary catheter order set as a means to ensure prompt postoperative removal (CMS SCIP Measure #9). Hospital has maintained 100%
compliance with this measure for > 2 years.
Outcome validates the efficacy and benefit of implementing evidence-based
practices
Used as a sentinel success to support the implementation of and buy-in from
clinicians in regards to other evidence-based practice guidelines
Focusing on this important safety measure positively impacted other externally
reported metrics i.e., CMS/JC measures, Hospital Acquired Conditions (HACs)
Reduction of non-reimbursable costs associated with Hospital Associated CAUTI’s
Next Steps/What Should Happen Next
FY 2014 Goal for Infection Prevention and the Hospital’s Antibiotic Stewardship
Committee:
o Eliminate the non-evidence based use of antibiotics for patients presenting with
asymptomatic bacteruria (ASB) as a means to mitigate/reduce antibiotic
resistance
Explore the development and implementation of nurse-driven protocols associated
with urinary catheter utilization
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Medicine
Infection Prevention
Healthcare Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Nursing
Medical Staff
Clinical Education
Infection Prevention
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Title
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CAUTI Sustaining the Reduction and Elimination of Preventable Patient Harm
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d8e2bb9ec7c2e0c169c81186a336eb48.pdf?Expires=1712793600&Signature=asCcoJ-JXWYBV4Hn1f%7EvByNZna7LT73EWuwFsEKmZ0qxS0Hrb-lRZwXtaEdm9vJhsXGWLu-6cYN6F9mvf0LJOQtX2mphQchcZR-2FENu-e2X00PTzQfD-lfeQJdbcFHvs5qhA3aocd0vo42fj6sCIe6%7EqjymGH4WaD69CX8pX-tfxwqVgMtaP%7EMfFeOf4ysPYF2IHE9DSG5Gm5pO%7EI9dTglvqbLMMeTZ9He7NlSpZH3P7eFEgHDeWgJTLMfTYuw7QxVOtlueZQKqY8sJcV2UVeGfCP3fsMQd0GflPAlKiIDyZ1tLkbx4cfUuJFDgvyEF8RnUpxl11XX04Fgxxpw5nQ__&Key-Pair-Id=K6UGZS9ZTDSZM
00677ebcd6a4a3dc72a035e4ee85290f
PDF Text
Text
Collaborative Outreach Initiative to Improve Colorectal Cancer Screening:
One Year Later
Scot B. Sternberg, MS; Diane M Brockmeyer, MD; Daniel Leffler, MD; Adebayo Oshin; Gila Kriegel, MD; Hans Kim, MD;
Kim Ariyabuddhiphongs, MD; Gail Piatkowski; James Heffernan, MD; Mark D. Aronson, MD
The Problem
Colon cancer is a leading cause of death but can be prevented. Colorectal Cancer (CRC)
Screening is recommended for most people at age 50 (or younger if patient is at high risk).
CRC Screening rates for Healthcare Associates (HCA), a large academic primary care
practice at BIDMC, is 74.6%. While consistent with national averages, there are
opportunities for improvement.
Given limited resources in primary care to manage a growing number of health concerns, a
collaborative HCA and Gastroenterology (GI) outreach initiative was developed.
Aim/Goal
To maximize resources and develop a collaborative HCA and Gastroenterology (GI)
initiative to provide outreach for CRC Screening
To increase the number of HCA patients with appropriate CRC Screening.
To assess what type of written communication – informational; question/answer interactive;
alternative Fecal Occult Blood Test (FOBT) emphasis; or patient stories – is the most
effective form of outreach in facilitating patient action and follow-up on CRC screening.
To assess clinical impact of screening
The Team
Scot B. Sternberg, MS; Diane M Brockmeyer, MD; Daniel Leffler, MD; Adebayo Oshin, MPH;
Gila Kriegel, MD; Hans Kim, MD; Kim Ariyabuddhiphongs MD; James Heffernan, MD; Gail
Piatowski; Eileen Joyce: Sara Montanari; Julia Navon; Louise Mackisack; Chris Healey; Susan
Johnson; Mark D. Aronson, MD
The Results/Progress to Date
Primary Care‐Gastroenterology Collaborative Colorectal Cancer (CRC) Screening Outreach Initiative
Number of Patients
Patients aged 50‐75 years overdue for CRC Screening
Post Intervention Colonoscopy
Post Intervention Fecal Occult Blood Test (FOBT)
Post‐intervention CRC Screening To Date ‐ All*
2281
490
27
517 (23%)
*The results to‐date include 400 patients who received the outreach only 4 weeks ago, and some of whom
may subsequently complete CRC Screening
Clinical Findings from Colonoscopy from Target Outreach Group
Patients who received a Colonoscopy following outreach
490
Adenoma
127
Adenocarcinoma
3
Serrated Adenoma
1
Sessile Serrated Adenoma
16
Patients with CRC Screening with one or more significant findings
141 (29%)
To date, there is insufficient data to indicate patients responded more to one type of
communication. Response rate by letter version ranged from 20-25%.
Preliminary data query of new cohort of patients for 2013 (which includes newly eligible
patients) indicates that 80%(13940 of 17445) of HCA patients had appropriate CRC
screening.
The Interventions
Lessons Learned
Identified patients who had not had appropriate CRC Screening using procedures
performed at BIDMC and Boston Endoscopy Center; screening sheet data from OMR; and
insurance claims.
Patient lists were distributed and reviewed by their primary care physicians who were given
the opportunity to opt out any of their patients from outreach.
Outreach letters to inform and recommend patients for CRC Screening were drafted Four versions (i.e., informational; question/answer interactive; informational including
FOBT alternative; and patient stories). Letters were reviewed for readability and for
content by the team.
Patients were randomly assigned to receive one of four outreach letters.
Follow-up to letters, patients received an outreach telephone call at 2 and 4 weeks.
Outreach letters and follow-up were sent out in batches to patients and spread out
over a year period based on resources available to support outreach.
Administrative support staff in GI tracked outreach calls, scheduling of tests, and when
the test occurred.
Initial outreach pilot to 500 patients, resulted in 61 patients having colonoscopies and 3
patients who had FOBT
Integration of various data sources, along with physician review of populations, can offer
improved identification, but is resource-intensive.
Structured fields in Online Medical Record (OMR) can enhance data capture of screenings
completed external to our health system and save time.
A medical neighborhood approach with collaborative outreach by primary care and GI
specialty practice can be effective model to share resources and increase screening rates.
Next Steps
Implemented
Implemented new structured fields for Screening Sheets in OMR to improve data capture.
Incorporated lessons learned and continue outreach intervention with new cohort.
Developed registry reports that regularly update patients who are due for CRC screening
and CRC screening completed.
Developed outreach letters that incorporate date of next scheduled visit to encourage
timely follow-up on screening.
Continued assessment of response to different types of outreach letters.
For more information, contact:
Scot B. Sternberg,MS/sbsternb@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.
Scot Sternberg (<a href="mailto:sbsternb@bidmc.harvard.edu">sbsternb@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Scot B. Sternberg<br />Diane M Brockmeyer<br />Daniel Leffler<br />Adebayo Oshin<br />Gila Kriegel<br />Hans Kim<br />Kim Ariyabuddhiphongs <br />James Heffernan<br />Gail Piatowski<br />Eileen Joyce<br />Sara Montanari<br />Julia Navon<br />Louise Mackisack<br />Chris Healey<br />Susan Johnson<br />Mark D. Aronson
Dublin Core
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Title
A name given to the resource
Collaborative Outreach Initiative to Improve Colorectal Cancer Screening: One Year Later
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f6a4e30f6a7b92ef0917c088fc9b2653.pdf?Expires=1712793600&Signature=tUqnDyNxqZYLz5zNC1PlSV9bbTA8BlPhSNL0RNnwiF4OOTx7qb-bYPlQrYk1tx2WOQSg-%7E5-aMOGV248Cr3Q9jKxXGC8J6srsGyn00BBqTOj5xeCBd8hkMjhrX9-CLMBAd3U6mMwVfnxkJ7S3kWGW0jiy4NdRyAitID7M9J0L9cFE0PWWqesHl7A4XBm5OPeN5SyoZ1iWciU6c%7EnV3QrYVG3abktfVzYLavYBWuqJBWcG4kGWEeOl-4DBUMYGBlE-4pDXDiQ7y0WscIsOAjdRSJbcGALrQgC%7ENcTn2LC9M4E5FCHn%7EQyut4pHf4jX-cq8h-x-uIFx0LDBjsa3Zn2Lw__&Key-Pair-Id=K6UGZS9ZTDSZM
929ed635f8d1c9d6e8035551accb2b7d
PDF Text
Text
Completeness of CT Examination QA
The Problem
The Results/Progress to Date
CT examinations have many components that are merged into a single file in PACS
for radiologic interpretation. Feedback from the radiology QA system, as well as on
the spot communications from radiologists indicated there were cases with missing
information, incomplete examinations or studies not performed as requested per
protocol.
Oct‐12
Jan‐13
Jun‐13
Feb‐14
Aim/Goal
Our Goal was to create a sustainable QA program that would identify trends that
could be used to increase compliance in examination presentation and to provide
education in exam protocol selection.
samples
48
53
51
81
Cases with Cases with
Ave # of
no
some missing missing
omissions
criteria
criteria
26
22
1.75
40
13
1
51
0
0
61
20
1.4
The Team
Carol Wilcox (Advanced Imaging Lab Technologist)
Pam Roberge (Weekend CT Supervisor)
Anthony Gattonini (WeekDay evening Supervisor)
Tim Parritt (CT Manager)
.
Data collection began in FY13. 46% of exams reviewed were missing some of
the components listed below. Immediate feedback was given to staff, as each
case reviewed was shared with the technologist, so we could provide positive
feedback on cases completed correctly and identify areas for improvement in
the remainder. 8 months later we had 100% compliance for criteria being
reviewed.
The Interventions
We performed random screening of routine CT exams on the overnight shift,
screening for 9 specific components that we would expect to see in a complete CT
examination.
Scout Cross
Reference
Smart Prep
Graph
Exam done
per
protocol
Lessons Learned
Giving timely feedback to technologist about missing CT examination
components reduced incomplete cases from 46% to 0% over an 8 months
period. However, sustaining the program proved difficult. The work is manual
and it is time intensive to evaluate 9 components for each individual
examination. In the absence of the QA program, the percentage of complete CT
examination decreased with 25% being incomplete in February 2014.
Next Steps/What Should Happen Next
Document
uploaded
Smart Prep
Images
CT QA
Exam
Review
Communica
tion tool
complete
ROI as per
protocol
Questionna
ire
completed
Contrast
per
protocol
Continue Program in the Evening shift
Early stages of Implementing on the Day shift
Review the 9 criteria (are all still relevant?)
Focus on what directly affects image quality and
Evaluate compliance with new regulations
For more information, contact:
Tim Parritt, CT Manager
tparritt@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tim Parritt (<a href="mailto:tparritt@bidmc.harvard.edu">tparritt@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Carol Wilcox
Pam Roberge
Anthony Gattonini
Tim Parritt
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Title
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Completeness of CT Examination QA
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/6f2520c581ce3c12668347b288ece88d.pdf?Expires=1712793600&Signature=LNRPS%7E08Ns5iFnjGL%7EKsOH979ni4PdWS0%7EciP9llWBIH%7EXXbhAGSrYrVQbB%7ERmeashCu378UVZTmYG1XwV3FSeTSgEmpB5nBzD3p%7Ed-Df7TnsO2zXolA9r7e3Y-tlVH3CNy5msFPqT2R3fthlQf2kdfIg8VEU82Gv3H49kVMUhBzBClmQATfg5qXbzMi8foqA9fw9S1IqBgDTP81H%7Ei6-0Ou53AZlEyTj9Yk98jIMb8eSGOKSaVDwPOD9xyY5RK--QQKQS2xRe4poYELKMbQfwrhJY6dFAGgWzaaGpLU2v5S4TJVIIMSsHg%7E51ZyOuR%7EkQl69FN-wxhVffdh69aAjg__&Key-Pair-Id=K6UGZS9ZTDSZM
9cc9f066faf584315253eb1cadfd50ee
PDF Text
Text
EMS ARRIVAL TO CT SCAN TRIAL
Overview
The Results/Progress to Date
The American Heart Association/American Stroke Association (AHA/ASA)
currently recommends a door‐to‐Computed Tomography (CT) time of ≤ 25
minutes for suspected CVA or TIA. The ultimate goal for ischemic stroke care
is to achieve door‐to‐thrombolytic (tPA) time of ≤ 60 minutes. Historical
data showed that Beth Israel Deaconess Hospital – Needham (BID‐N) had a
door‐to‐CT time of ≥ 25 minutes. In response, a pilot program was created
to facilitate immediate CT scanning for patients with suspected stroke. .
To reduce door‐to‐CT time in accordance with current AHA/ASA guidelines
using an interdisciplinary model of BID‐N ED and EMS care coordination.
The Team
Team Leaders: Adam Houk, RN (BID‐N ED); Edward Ullman, MD (BID‐N ED);
Jason Pierce, EMT‐P (Needham Fire Department)
Team Members:
Gerry Bushey (Manager, Lab)
Gay Calo, RN (Stroke Committee Liaison/Data Analyst)
Katie Davis, RN (Interim Resource RN, ED)
Barbara Doherty (Interim Manager, ED)
William Hallett (Director, Radiology)
Christopher McKay, RN (Staff, ED)
Methods
Retrospective collection of historical Stroke performance data
Collaborated with Needham Fire/EMS for:
o Implementation of “Direct to CT” for all suspected stroke
patients
Interdisciplinary training with Radiology Team to develop new Code
Stroke pathway
Inclusion criteria: all patients entered into the ASA data
base, categorized by arrival modality
Pre‐Needham EMS Trial
60
Needham EMS Trial
50
43.5
Average Time (in minutes)
Aim/Goal
EMS Arrival to CT Scan Trial
43.4
39.6
40
Needham EMS
N-26
N-19
26.1
30
N-14
20
Other EMS
N-14
10
0
5/01/2012 - 4/30/2013
5/01/2013 - 12/31/2013
Results
The stroke trial with Needham Fire Paramedics resulted in a 40% reduction in
door‐to‐CT time.
Future Directions
Incorporate protocol to all EMS services
Identify effects on door‐to‐tPA time
For more information, contact:
Adam Houk, RN, Emergency Department
ahouk@bidneedham.org
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Adam Houk (<a href="mailto:ahouk@bidneedham.org">ahouk@bidneedham.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Emergency Department
Radiology
Lab
Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Needham
Project Team
Adam Houk<br />Edward Ullman<br />Jason Pierce<br />Gerry Bushey<br />Gay Calo<br />Katie Davis<br />Barbara Doherty<br />William Hallett<br />Christopher McKay
Dublin Core
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Title
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EMS Arrival to CT Scan Trial
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f3cca4dd22557d8c6cf01695799f635a.pdf?Expires=1712793600&Signature=XfXoRdGfD5MIysR2Dx8cIXFJQCnuhN0SftrHGlD7M8gu%7E99b-8V9fndd%7EzqvndtA3WSN93nyEjKRiTBFKrvzTaeYvHOD5xUSChRW2fZzWvXszTLK8mMwuHOlEIuIH470i5L9uhjGf9IpdhkJjwRewOAFKAqsZmEjV766S3XrMZKw74niX%7EQujq%7EhxoMxRFFGScPgGrBguHs4fgNsBBX5izLrCSG10diDDM3XpE7LnGH6Evz-8X437mXU4Qcz0c5v8itouHqaNCPjVGRFyI0yN4TlnA17yQouuj8jsC6OUffu4ueMSMkGREoFhFLpuODLwQMKnfphFgOxctjt2688IA__&Key-Pair-Id=K6UGZS9ZTDSZM
f3cce86689f85ff509a6438a16625d16
PDF Text
Text
End Tidal CO2 Monitoring During Moderate Sedation
The Problem
The Results/Progress to Date
In 2011 there was a change in ASA Standards related to monitoring. “During
moderate or deep sedation the adequacy of ventilation shall be evaluated by
continual observation of qualitative clinical signs and monitoring for the presence of
exhaled carbon dioxide unless precluded or invalidated by the nature of the patient,
procedure, or equipment.”
100% of procedure units outside of the OR where moderate sedation is used
now have technology and have begun to monitor ETCO2 during cases.
101 Staff have completed the online module titled End Tidal Carbon Dioxide
Detection and Monitoring For All Non-Anesthesiologists or received on-site
Hands –On ETCO2 Philips Medical Device training
This impacted 4 major Moderate Sedation Areas at the hospital: the GI Endoscopy
Suites, Interventional Radiology, Cardiology and the Pain Center
Respiratory depression is a potential complication of sedation and analgesic
administration. Ventilation monitoring using capnography has been determined to be
the earliest indicator of hypoventilation and episodes of no-breath.
Monitoring End Tidal CO2 (ETCO2) will improve patient safety in procedure areas and
the Interventional Procedures Committee has charged all BIDMC areas with
complying with this ASA best practice recommendation.
Aim/Goal
Our goal was to ensure that all procedures outside of the OR that used moderate
sedation were fully compliant with the new ASA standards for monitoring by 2014
The Team
Sheila Barnett, MD
John Whitlock, RN
Michele Boucher, RN
Bridgit O'Bryan, RN
Lisa Hird, RN
Paul Anderson, HIMDI
Interventional Procedures Committee Members
Michelle Sheppard, RN
Elizabeth Carvelli, RN
Arthur Durkin, PHILIPS
Lessons Learned
Monitoring End Tidal CO2 allows for all team members to visually monitor the impact of
medication dosage in the same room.
The Interventions
Identified all interventional areas providing deep and moderate sedation
Did an inventory of the current monitoring capabilities, did a gap analysis of
the required equipment to make all areas compliant.
Through assistance of CVQA committee gained approval to update or replace
existing monitoring modules soliciting input from patients, colleagues, and
testing potential solutions;
A team of procedure area staff created an online competency to introduce the
2
ETCO concepts and implementation expectations.
Partnered with Philips Healthcare to schedule onsite training days for one to
one staff training and trouble shooting
Modified BIDMC Policy – “Moderate Sedation Training for the NonAnesthesiologist” to include an ETCO2 component.
Launched as expected Jan 1, 2014.
Staff appreciated the on-site personalized training. They had many moments to trouble
shoot with the Philips rep. They learned valuable lessons beyond just recognizing wave
patterns. They learned how to quickly manipulate the monitor and navigate through
screens.
Next Steps/What Should Happen Next
Will perform follow up surveys on the quality of sedation from patient and
proceduralist perspectives. We can then compare this data to baseline data
obtained prior to ETCO2 monitoring.
Analyze outcome data to see if sedation adverse events or medication patterns
have changed following ETCO2 monitoring.
For more information, contact:
Jason Laviolette, Healthcare Quality Project Manager/
jlaviole@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jason Laviolette (<a href="mailto:jlaviole@bidmc.harvard.edu">jlaviole@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Quality
Cath Lab
Radiology
Gastroenterology
Pain Clinic
West Procedures Center
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Sheila Barnett<br />John Whitlock<br />Michelle Sheppard<br />Michele Boucher<br />Bridgit O'Bryan<br />Elizabeth Carvelli<br />Lisa Hird<br />Paul Anderson<br />Arthur Durkin<br />Interventional Procedures Committee Members
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Title
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End Tidal CO2 Monitoring During Moderate Sedation
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f31b2a7022658c2e3fa3836c1c4b2ae8.pdf?Expires=1712793600&Signature=dAhT9L9isPot0P0EdKGaZgTH2GZ-%7Eqnra7OUQug5U%7EGELt7rgH7BDXKjdvKmantdGkMg0pAz%7E59Vrf6yR%7Ex60wAVgb0ofgk%7E9VgVZAzjJxK%7EUlrnKCwR6suq4nZF-6wiO3q3ag0vq2ktkBhRjI-Mkn8huMBLyyPdB3T48N3zofV7hxFLNyxx73D9pry2htMn0NM7PdrRx9pFZbKlL0rhs5Fahk4I%7E3TbaGQdvQtjlu53SqiWm7GjeIRvpPwYDdQtxoMNQGvfJ%7EM7WiM1RoC63Iv119O%7EFT3IobZnaMpRG%7EcZx-Mzdl61b5RXLAHUZh-01ljykWEHOwDLgwM5dqNPxA__&Key-Pair-Id=K6UGZS9ZTDSZM
55fee0c507909d8acdf11ff9b66619ed
PDF Text
Text
Enhancing Hemoglobin A1c Analysis for Bowdoin Street Health Center
The Results/Progress to Date
The Problem
Individuals with diabetes have an increased risk of developing retinopathy and neuropathy, as well as
increased long‐term risks of cardiovascular and kidney disease. The Hemoglobin A1c (HbA1c) laboratory
test assesses long‐term glycemic control over a period of 2 to 3 months by measuring the degree of
hemoglobin glycation and also allows for the calculation of the estimated average glucose (eAG)
concentration. The American Diabetes Association recommends that clinicians test diabetic patients for
HbA1c at least every 6 months in an effort to improve glycemic control outcomes. Monitoring levels
twice annually is also required to meet compliance guidelines for pay‐for‐performance payment models.
Laboratory Medicine validated the Afinion™ analyzer against the Roche Integra immunoassay method
(Clinical Chemistry Laboratory) in August 2013. The manufacturer’s reportable range was validated
from 4.0 – 15.0% HbA1c.
Samples with known HbS (red) and HbC (green) variants were included in the validation and showed
acceptable correlation without any interference.
Bowdoin Street Health Center staff members were trained to operate the analyzer and documented
competency by comparing finger stick samples to venipuncture samples in October 2013.
Aim/Goal
Scheduled visits with the healthcare provider to outline and assess individualized treatment plans are
thought to improve patient outcomes. In addition, access to an instrument that utilizes a finger stick
sample in the clinical setting would allow the provider to obtain HbA1c in real‐time and less invasively.
Immediate results also impact workflow in reducing the need for follow‐up calls and return patient visits.
Both patients and clinicians are reluctant to have blood collected by venipuncture; preferring instead
finger stick samples. The ability to perform the HbA1c test in the clinical setting, at the point of care
(POC) with a finger stick sample is thought to improve management of diabetic patients by allowing real
time interventions while the patients are meeting with the provider.
The Team
Bowdoin Street Health Center
Laboratory Medicine
Harvey Bidwell, MD
Adela Margules
Fran Azzara, RN
Rose O’Brien, RN
Maria Perez
Lynne Uhl, MD
Gary Horowitz, MD
Nicole Tolan, PhD
Gina McCormack
Avril Jean‐Noel
Bernadine Williams
The Interventions
A review of CLIA Waived HbA1c analyzers was conducted by Laboratory Medicine because several
methods are known to have interferences from hemoglobin variants. Given the diverse patient
population, it is important to be able to obtain a result without interference from these variants.
The Alere Afinion™ AS100 Hemoglobin A1c POC analyzer method is certified by the National
Glycohemoglobin Standardization Program (NGSP) and is standardized to the Diabetes Control and
Complications Trial (DCCT) assay.
The method is reported to have no interference from the following hemoglobin variants: HbC, HbD,
HbE, HbF, HbJ, and HbS.
This method allows finger stick samples (sample size 1.5 l of whole blood) to be used in place of
venipuncture and gives HbA1c results within 3 minutes.
Bowdoin Street Health Center has replaced venipuncture for HbA1c with finger stick samples. In the
month of January, 90 samples were tested – averaging 4 samples per day.
Increased efficiency for clinicians and office staff by improving the test turn‐around‐time. Samples are
no longer sent to the main lab where results are available the next day; eliminating the need for call‐
backs and follow‐up visits.
Overall, replacing off‐site laboratory HbA1c measurement with POCT has increased clinician and
patient satisfaction.
Lessons Learned
Initiatives that change existing care practices can significantly improve patient care and outcomes, but
require carefully planned multi‐disciplinary and multi‐departmental collaboration.
Next Steps/What Should Happen Next
Implementation of a second Afinion™ analyzer at Bowdoin Street and assist MCCN Chelsea with the
validation of the Afinion ™ analyzer for their clinic.
POCT may allow for better compliance with pay‐for‐performance guidelines. Evaluation of the number
of HbA1c measurements for each patient will capture the potential improvement.
Real time HbA1c results have been reported to improve the clinician/patient interaction by allowing
clinicians to counsel their patients face‐to‐face. This may result in better patient understanding,
compliance, and improved outcomes. Long‐term, review of HbA1c patient‐specific means will
determine efficacy of POCT to reduce HbA1c and improve glycemic control.
For more information, contact:
Avril Jean-Noel, POC Specialist ajean@bidmc.harvard.edu
Bernadine Williams, POC Specialist bwillia2@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.
Bernadine Williams (<a href="mailto:bwillia2@bidmc.harvard.edu">bwillia2@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Laboratory Medicine
Bowdoin Street Health Center
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Harvey Bidwell<br />Lynne Uhl<br />Adela Margules<br /> Gary Horowitz<br />Fran Azzara<br />Nicole Tolan<br />Rose O’Brien<br />Gina McCormack <br />Maria Perez <br />Avril Jean‐Noel <br />Bernadine Williams
Dublin Core
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Title
A name given to the resource
Enhancing Hemoglobin A1c Analysis for Bowdoin Street Health Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/6b3ae4b643a69ef3aa5c9f29c5ac7700.pdf?Expires=1712793600&Signature=TKLmXS5Cp24sGG6c5vYKkK4vADMGxCg8LjxHk9QsrepmdO4sxtFjIlWOU3XR2lOyqTkhLErbG6kjAu0v7mUXkivojmn1Pce8%7E%7EKbxeO0xVSvO3zf6N6%7EegupgUnu6k6lxSLdw-msfTYY90z2odVwEt7wkk1O1TkqWJfa8vw3W1yxl-QbfeKrW8nLANyUKE1N2I5QoM74Ul%7E39G50DBMaEhbzXuHMqboRdSJmMGt3RvdjCYcta-g9VCl56PprLwUqSoITtFDUIGrpUOhSIxNupZPlN7T4djtFPoyjD%7EXUPA5rAzoTYhp3y05ggAFoeqNwcFaqLcCxVp1yvSRlwlFCOg__&Key-Pair-Id=K6UGZS9ZTDSZM
6616dbcb6a3515c7b47380756b6e9362
PDF Text
Text
Enhancing the Coding Workforce for the ICD-9 to the ICD-10 Transition
The Problems
The Interventions
The Health Information Management (HIM) Department was challenged in hiring
Experienced Coders.
Shortage of qualified coders in the area
HIM college program closures and curriculum shifts within the past 5 years
Competition for recruiting and retaining qualified staff
In October 2014, the U.S. will make the transition from ICD-9 to the ICD-10 coding
system. All coders must be trained into ICD-10 by then.
Preparing for the loss of productivity when ICD-10 transition begins
HIM needed to grow and retain more coders with the skill sets required to code for an
academic hospital.
Concern about future staffing needs and productivity requirements as result of
planned ICD-10 transition requiring additional coding staff
Due to increased specificity and documentation requirements coding staff will require
additional technical training for the transition to ICD-10
Conducted a market analysis.
Created a four level career ladder for coders.
Account for experience; skill set distinctions; coding certification
Includes both Inpatient and Outpatient Coding Staff
Created facility-specific training practicum modules.
Facilitate I-10 transition training activities for current HIM validation and coding staff
Focused training modules for both pipeline and bridge program training
4.
Launched HIM Pipeline Program.
Marketed pipeline program to BIDMC employees and had 34 applicants
Through a series of assessments, chose 6 pipeline participants, will go through a 36 week
didactic training followed by a 6-month training practicum
Successful participants will move into coding roles in September 2014
Launched HIM Coding Bridge Program.
Marketed Bridge program to area medical coding program graduates and had 64
applicants
Through a series of assessments, chose 10 bridge participants, who are in the process of
going through a training practicum
Successful interns will be hired in April 2014
5.
140,000
Number of
Codes
1.
2.
3.
17,000
ICD‐9 System
PREVIOUS CAREER LADDER
Validator
ICD‐10 System
(effective
October 2014)
2.
3.
Create the right career ladder, training programs, and compensation structure
to get the HIM Coding workforce we need.
Develop pipeline and bridge programs to identify and train high potential
employees and recruit external individuals into the field.
Be sufficiently staffed and prepared for dual coding in April 2014 and the
October 2014 transition to ICD-10.
Coder II
Coder I
The Results/Progress to Date
Designed training curriculum for Bridge and Pipeline Programs
Four employees currently enrolled in Pipeline Program
Seven interns currently participating in Bridge program
Lessons Learned
The Team
Coder III
Validator
Coder
Aim/Goals
1.
NEW CAREER LADDER
Gerry Abrahamian, Director of Health Information Management
Babak Bagheral, Program Administrator, Workforce Development
Luisa DiIeso, Health Information Management - Training Coordinator
Laurie Fitzpatrick, Program Manager, Workforce Development
Alicia Gonser, Compensation Manager
Diane Jean, Health Information Management – Coding Manager
Ann Langwig, Health Information Management – Validator & Coding Instructor
Joanne Pokaski, Director of Workforce Development
Ashley Quirk, Senior Staffing Partner
Jing Wang, Senior Compensation Analyst
Selene Williams, HMFP – Compliance Auditor & Coding Instructor
It is good to get a full sense of an area’s workforce challenges in order to create an
optimal solution
BIDMC already had the staff with the talent to teach the classes
Area medical coding graduates need additional training in order to be successful coders at
an academic medical center
Next Steps/What Should Happen Next
Create onboarding and retention plans for interns and pipeline participants
Select and hire interns to move into coding roles in April 2014
Begin dual coding in April 2014
Move pipeline participants into coding roles in September 2014
Transition to ICD-10 in October 2014
For more information, please contact:
Laurie Fitzpatrick, Program Manager Workforce Development
lkfitzpa@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.
Laurie Fitzpatrick (<a href="mailto:lkfitzpa@bidmc.harvard.edu">lkfitzpa@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Workforce Development
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Gerry Abrahamian<br />Babak Bagheralgram<br /> Luisa DiIeso<br />Laurie Fitzpatrick,<br />Alicia Gonser,<br />Diane Jean<br />Ann Langwig<br />Joanne Pokaski<br /> Ashley Quirk<br />Jing Wang<br /> Selene Williams
Dublin Core
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Title
A name given to the resource
Enhancing the Coding Workforce for the ICD-9 to the ICD-10 Transition
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/7e436e78a5c0cb8dcfe7bdb1a901eee9.pdf?Expires=1712793600&Signature=PWzb6nM2mLeJGAcZ11JfXOV-HpjXLOAMpIJfNSs5mH5iN-E1XW5tv1K6DT-MiCgIncmySkAEIB62v-v4fe8PZIV6Gg7qeS9D4wJ2KI8K9oeleEWyYquAUgMl5vyhYXntTJxXD6-L-VMwdsPjoDbRaWyTegcwPMHv0lQxuTYC%7EBm3FmeBRexyV0K2aIUmrzX6U7KrAVBhWO6uZ4HJInestHifndE7wgAkmM%7Ee6oizvV1DGn1d9QMy%7ER%7ElpXsNQKxpG6ZAvOHD4XdUc2oEkBijHmVYUtGt8LcruSINpEpnBVM2gqiUFHMRazAHCAW6RrhvJYEz8WqeFVsTquLZ3ekwgQ__&Key-Pair-Id=K6UGZS9ZTDSZM
1ab21fa4ca375ebd53562e55e7699501
PDF Text
Text
Beth Israel Deaconess Hospital-Milton
Fall Reduction Strategy: Elimination of Restraints from Medical/Surgical Floors
The Problem
The Results/Progress to Date
A hospital's decision to use restraints on patients is a difficult one, involving complex
issues which can pose significant risks for both patient and hospital. According to Vassalo
(2005), evidence does not support the use of restraint as an effective intervention in
reducing the incidence of patient falls, including those with injury.
Additionally, the application of restraint poses numerous other dilemmas, e.g., ethical
considerations, cultural attitudes, societal values as well as a substantive risk for harm
and injury to the restrained patient, both physically and emotionally. In response to these
hazards, regulatory agencies have established comprehensive but challenging standards
for hospitals to comply with.
In a review of 2012 restraint utilization on the medical/surgical floors, it was identified
that only 1-3 patients per month had been restrained.
Aim/Goal
Eliminate the use of restraint on the medical/surgical floors as a means to reduce the risk
for potential harm associated with their application, as well as eliminate the risk for noncompliance with stringent regulatory standards and demonstrate this intervention did not
adversely impact the hospital’s overall fall rate.
Calculation methods: Standard throughout industry:
1.
2.
The Team
Nursing Leadership
Direct care nursing staff (Medical/Surgical areas)
Non-nursing direct care clinicians
Medical staff
Hospital Leadership
Fall Rate: # Falls per 1000 patient days
Lessons Learned
The Interventions (Select Actions Taken)
Restraint Rate: % M/S patients restrained/Total M/S patient discharges
Hospital restraint policy revised to eliminate the medical/surgical floors as
an approved area for the application of restraint
Fall prevention program was revised to reflect this change
Medical/Surgical nursing staff educated/supported during this transition
Hospital leadership supported transferring patients to the ICU for restraint
application, if necessary
Other key stakeholders including Medical Staff were educated on changes
to practice
The elimination of restraint use from the medical/surgical floors did not result in an
increase in overall fall rate
Between November 2012 – December 2013 (period without restraints) – the fall rate fell
by > 33% in comparison to the 12 months preceding restraint elimination
Greater confidence of compliance with regulatory standards due to decreased utilization
Only 1 patient between Nov. 2012 and Dec.2013 was transferred to the ICU exclusively for
restraint application
No evidence of transfers out of ICU being delayed due to restraint need
Next Steps/What Should Happen Next
Identify whether further reduction (not elimination) of restraint use can be applied in other
areas, e.g. ICU
Determine whether restraint policy/practice exceeds minimum regulatory expectations
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.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.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Medical Staff
Hospital Leadership
Healthcare Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Nursing Leadership
Direct care nursing staff (Medical/Surgical areas)
Non-nursing direct care clinicians
Medical staff
Hospital Leadership
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Title
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Fall Reduction Strategy: Elimination of Restraints from Medical/Surgical Floors
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/02e1cde1328554c01c93871f32a4d1d1.pdf?Expires=1712793600&Signature=e43yG-tnbTxUbmfmthatfT1CdFlIw1VrTow3Jq5VwAQaUYK5V63TK3LBYCMY2tOiOLPc9aV17CpmVOGuIl26QPryOXEZ6LImIXwEFPZcGs0c8MmhiEejXYCGs3f8qlWp%7E8DJcc8MN%7E0BZ1b7pdJsXFvxFEGPObF34NZPTUU%7EJnLDlBWqO81ITc58G8LNDOonvPmsfpLmQcF6h-AgjFcEZLr2WI-aJT2YssYqk8C30JxvMmIBTlbmX3DgpU70pG7xrsCtfGMWBIj5DS9N4tL%7ESWYl4S3dPjHryVPClCkxMk1qr0uCPw6lI3FmBNXIk%7EPFOmrrucjNLnKZBdi3VK3VjQ__&Key-Pair-Id=K6UGZS9ZTDSZM
3948db2dc21b84ea21944f8b2698f1b2
PDF Text
Text
Getting the Service Right: Non-Surgical Admissions
The Problem
The Results/Progress to Date
BIDMC’s rate of admission to nonsurgical teams over a 6 month period ranged
between 5-21% (July-Dec, 2012) – most months well above the established goal of
<10%.
BIDMC holds an American College of Surgery (ACS) Level I Trauma Verification,
which promotes and upholds standard around the quality of care, the
interdepartmental services and the outcomes of trauma patients.
The ACS requires trauma programs that admit more than 10% of injured patients to
nonsurgical services demonstrate the appropriateness of the practice through its
performance improvement process (PIP)
Aim/Goal
The aim of the PIP is to develop a consensus based plan for most appropriate
surgical service for non-surgical trauma admissions coupled with other service
(medicine/gerontology, etc..) consultation within the first 24 hours of admission.
The Team
Carl Hauser, MD FACS – Trauma Medical Director
Julius Yang MD PhD – Director Inpatient Quality/ Hospitalist
Carlo Rosen, MD - Emergency Medicine
Suzanne Hartmann, MD - Gerontology
Darlene Sweet BSN, RN – Trauma Program Manager
Tyler Howrigan, RN – Trauma Educator
Amy Hersom – Trauma Registrar
Monica Nasser – Trauma Admin Coordinator
Larry Markson, MD – Information Systems
Larry Nathanson, MD – Emergency Medicine Information Systems
The Interventions
Multi department ‘look back’ at the nonsurgical admissions over a 12 month
period to analyze and reconcile the service at admission decision to the injury
severity scores, the extent of comorbid or pre-existing chronic conditions
requiring medical management, patient age and patient/family goals of care
preferences
Collaborative agreement between surgery services, medical and gerontology
services regarding lead vs. consultant role in the complex trauma patient’s
hospitalization ( established the TIGER Protocol)
Education and Orientation to assessment protocols, appropriate use of
consultation provided to residents and hospitalists (ongoing)
Lessons Learned
Continuous data collection and regulatory requirement duties benefit from period
‘deep dive’ to understand trends (positive/negative), any root causes and
opportunities. The patient data registries can be useful when interpreted into
information that can stimulate and focus action teams
Key principle in process change that added value in this effort was gathering
representation from all departments from the very beginning
The ACS standards and expectations acted as very good guide and framework for
the process and communication improvements that ultimately support patientcentered care and the right expertise at the right time for each of BIDMC’s Trauma
patients.
Next Steps/What Should Happen Next
In the upcoming months, the Trauma Program will
Obtain MEC approval (completed 12/2013)
Communicate and roll out the TIGER Pathway
Include Medicine and Gerontology representation at Trauma Care
Committees
Improve the overseeing and reporting of meaningful interpretation of
Trauma Registry data at monthly committee meetings
Perform real time case review of patients not placed in TIGER Pathway
For more information, contact:
Darlene Sweet, BSN, RN – Trauma Program Manager
dsweet1@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.
Darlene Sweet (<a href="mailto:dsweet1@bidmc.harvard.edu">dsweet1@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
Trauma
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Carl Hauser
Julius Yang
Carlo Rosen
Suzanne Hartmann
Darlene Sweet
Tyler Howrigan
Amy Hersom
Monica Nasser
Larry Markson
Larry Nathanson
Dublin Core
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Title
A name given to the resource
Getting the Service Right: Non-Surgical Admissions
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
-
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00e39d84ee4cbb8a66855732383f39b8
PDF Text
Text
Getting to YES: Challenges of Creating an Institution-wide
Multidisciplinary Peripherally Inserted Central Catheter (PICC) Consent
Abstract #
25
Beth Israel Deaconess Medical Center (BIDMC)
Andrew Mackler, RN, MHA, VA-BC, Venous Access Consultant; Barbara M. Carney, RN, BA, MSN, Nurse Manager; Salomao Faintuch, MD, MSc, Interventional Radiology; Deborah Stepanian, QI Project Manager
Introduction
Interventions
Insert your information here
Confirmed ordering MD /LIP designee would obtain consent per hospital policy
Developed and finalized the PICC Insertion consent form describing both VAT
Peripherally Inserted Central Catheter (PICC) insertion is defined as an invasive
procedure by the Joint Commission and by our hospital. Per hospital policy, all
PICC insertions require informed consent by the ordering provider [or his/her
licensed independent practitioner (LIP) designee].
At BIDMC, the Venous Access Team (VAT) nurses perform the majority of PICC
insertions (approximately 200/month) at the bedside; failed attempts are
referred to Interventional Radiology (IR). This process creates an unusual
scenario where the inserter and the person obtaining consent are not the same
individual.
and IR procedures
Provider Order Entry Screenshot:
Created and implemented a Guide to Obtaining Patient Consent for a PICC
Implemented the patient information tool: Central Venous Lines FAQs
Linked PICC request order and consent form in electronic ordering system,
enabling printing of consent form at time of order.
The hospital has struggled with compliance with our policy due to a lack of a
well-defined process for consenting PICC insertions.
Objectives
To define and establish a solid, streamlined process to ensure all patients with
an order for a PICC placement are provided with the appropriate information
related to PICCs, enabling an informed decision to consent for this procedure.
Explore opportunities to integrate the consent process for PICCs within the
electronic ordering workflow to facilitate access to resources for obtaining
patient consent.
Ensure informed consent is obtained by the patient (or health care proxy when
applicable) prior to all PICC procedures.
Methods
Reviewed hospital policies and Joint Commission standards that define
informed consent requirements.
Conclusion
Identified and involved key stakeholders (VAT, IR, Infectious Disease, Central
Line Workgroup, Forms Committee, Legal, Health Care Quality) and:
• assessed benefits, risks and complications that are unique to PICC insertion
• created a multidisciplinary informed consent form specific to PICCs which
accurately presents these benefits and risks in a manner that supports
reader comprehension as well as hospital policy and regulatory
requirements.
With the involvement of key stakeholders over the past year, we have created
well-defined process for consenting PICC insertions. Barriers included engaging
multiple departments, reaching consensus on language, defining consent
responsibilities, and streamlining access to consent forms.
Due to the involvement of key stakeholders in defining our process and educating
staff, BIDMC has experienced a smooth implementation of this new process.
Requested integration of consent process into electronic ordering workflow
References
using limited Information Systems (IS) resources
Identified tools/resources necessary to support educational needs of patients
who require PICCs as well as the clinicians obtaining consent.
•
•
•
•
Joint Commission Standards UP01.01.01 EP #2; RI.01.03.01
CMS Conditions of Participation, Tag A0955 482.51(b)
Journal of Infusion Nursing Vol. 34, No. 1S, Jan/Feb 2011
Infusion Nursing: An Evidence-Based Approach. 2010. 3rd Ed.
�
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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
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Andrew Mackler (<a href="mailto:amackler@bidmc.harvard.edu">amackler@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Venous Access Nursing
Interventional Radiology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Andrew Mackler
Barbara M. Carney
Salomao Faintuch
Deborah Stepanian
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Title
A name given to the resource
Getting to Yes: Challenges of Creating an Institution-wide Multidisciplinary Peripherally Inserted Central Catheter (PICC) Consent
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Patient and Family-Centeredness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ede7f4f19a20f0e23d9563e79c2a928c.pdf?Expires=1712793600&Signature=BrGDfQTdUcV3qmfgodfa73Rvfu15D9hfKQCBIz1dFHau8EAlj%7EBrfP73lYJ0iCTrJuAOU2Sqago9p898UNRfekhdhW20WZ1QnoBPtfS%7ELv01PqA6qe8QnIW-drf%7Ei%7EWEeO5ubrS8YQ-phEL5IMA35qjc%7E-2sizyVcSIQlDS838PPSrwNjHs%7EtCPpkxwfxq9XhxJywYrFG3Vm4G8zqT75RKM225BevaUFnF7K5dReguQ5oweSvmqz7BTqFLAIU8FiIafRvHH8bKjoQW9y66dT6PGZZHC-1FSO48KbQ%7E0adl4B3XZkZYQAMOk0uCjQiRoZP-%7EZnzSYmIs4-VIVh6zsXg__&Key-Pair-Id=K6UGZS9ZTDSZM
05580a8a24d1d34949d23658971d85d1
PDF Text
Text
Hide and Seek: Searching for EMS Run Sheets
The Problem
The Interventions
When trauma patients are brought to BIDMC, the EMS team rarely leaves behind the
“run sheet” – a data rich log of care and treatment performed in the field and
necessary pre-hospital information for the BIDMC Trauma Service. This data is
required by the MA DPH and National Trauma Data Bank (NTDB). Referring EMS
agencies currently batch send their run sheets after the fact to the Health Information
Management (HIM) Department. As presented in the American College of Surgeons’
Green Book (standards and elements of performance for accreditation), EMS patient
care records are important for building and maintaining trauma registries. The BIDMC
Trauma Service notes that approximately 5% of all run sheets are found in patient
records. Multiple problems and inefficiencies ensue, including:
Lack of trauma patient labeled EMS run sheets, thus requiring further
resources for HIM to reconcile patient identification and record storage; and
HIPAA limitations on the Trauma Registry having direct access to EMS
databases, thus requiring EM/EMS collaboration to relay this data request;
and
Trauma Administrative Coordinator’s responsibility to track EMS trips,
generate reports, and in conjunction with EM/EMS, they communicate said
requests with various EMS companies on a bi-monthly basis; and
Delay in Trauma Registry abstracting data points/reporting to state and
NTDB due to lack of information and detail; and
The increase in trauma patient volume; this requires additional collaborative
resources between EM/EMS and the Trauma Service to retrieve EMS run
sheets.
Chronic deficiencies in obtaining EMS run sheets are a major problem in the state of
Massachusetts.
BIDMC Emergency Medicine created an innovative solution. The BIDMC
Emergency Department Dashboard is electronically linked to the Boston EMS
electronic medical record. EM is currently refining the algorithm for matching
records so that there is real time access to the EMS run sheets.
In addition, we established an electronic method of obtaining EMS run sheets
directly from Boston EMS, and our other major EMS agencies.
We also created a Trauma Outreach Committee to specifically follow this
problem, and Committee members are in direct contact with EMS to ensure that
we are able to have the run sheets directly sent to the Trauma Service.
We are working with HIM to ensure EMS sheets ultimately make it into the
online medical record (OMR).
The Results/Progress to Date
We increased compliance and now capture an average of 40.80% of all EMS run
sheets through the various efforts described above.
Aim/Goal
Within the next nine months, our goal is to reduce the amount of missing run sheets
generated by EMS, and ultimately receive an average of 75% of EMS patient care
records direct to the Trauma Service within 30 days of admission without prompts
from BIDMC.
The Team
Lessons Learned
Bradford Cohen, EMT-P
Ronda Clifton, Trauma Registrar
Jonathan Fisher, MD, MPH, Vice Chair, Emergency Medical Services
Carl J. Hauser, MD, Trauma Medical Director
Amy Hersom, Trauma Registrar
Tyler Howrigan, RN, Education, Outreach and Injury Prevention Coordinator
Monica Nasser, Trauma Administrative Coordinator
David Schoenfeld, MD, Emergency Medical Services
Darlene Sweet, RN, BSN, Trauma Program Manager
Next Steps/What Should Happen Next
Missing EMS run sheets is a systemic issue affecting not only BIDMC, but is observed at
other Massachusetts hospitals. By approaching the problem in an integrated manner, we
are working to improve communications, accessibility, processes, and outcomes.
This problem may improve as more agencies move to electronic medical records. An IT
based solution linking theses records to OMR may be useful. In the meantime, the
Trauma Service will work with EMS contacts on a bi-monthly basis to retrieve EMS run
sheets, and strengthen the communication pipeline. Efforts at the system level to resolve
missing EMS run sheets will be taken on by way of BIDMC EM/EMS and Trauma Service
with the help of Information Services and HIM. In addition, efforts at the state level to
develop solutions through representation at Massachusetts Emergency Medical Care
Advisory Board (EMCAB) meetings are taking place.
For more information, contact:
Monica Nasser, Trauma Administrative Coordinator:
mnasser@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.
Monica Nasser (<a href="mailto:mnasser@bidmc.harvard.edu">mnasser@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Trauma Surgery
Emergency Medicine
Emergency Medical Services
Health Information Management
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Bradford Cohen
Ronda Clifton
Jonathan Fisher
Carl J. Hauser
Amy Hersom
Tyler Howrigan
Monica Nasser
David Schoenfeld
Darlene Sweet
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Title
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Hide and Seek: Searching for EMS Run Sheets
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
Safety
Timeliness
-
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6d4232e0210dd905d1bedf7686c26047
PDF Text
Text
Housestaff Adverse Event Reporting at BIDMC
The Problem
The American College of Graduate Medical Education (ACGME), which is the
accrediting body of all our residencies and fellowships, has now mandated that all
trainees be aware of how to report adverse events, what their responsibility is in
reporting, and play a role in the patient safety architecture of their training institution.
Though residents and fellows are frontline providers at BIDMC and are engaged, it is
unclear whether they understand what a reportable event is, how to report an event to
the institution, and what the barriers to reporting are.
Aim/Goal
The Housestaff Quality Improvement Council (HSQIC) has chosen Adverse Event
Reporting as their inaugural cross departmental QI project. We aim to educate
trainees across BIDMC on how to access the adverse event reporting system and
their responsibility in reporting errors. Our goal is to improve trainee awareness of the
system by 50%, and to increase trainee reporting by 25%.
The Team – BIDMC Residents and Fellows
Project Leader – John Torous
HSQIC Members: David Lucier, Andy Hale, Caitlin McGinty, Samir Jani, Emily
Kaplan, Elizabeth Foley, Michael Buggia, Lauren Gleason, Jessica Zerillo, Brian
Hollenbeck, Lester Leung, Luisa Solis-Cohen, Katherine Armstrong, Margaret
Chory, Rebecca Harris, Sergey Pyatibrat, Allyson Berglund, Elizabeth Asch, Dre
Irizarry, Peter Soden, Nakul Raykar,
Faculty Mentor - Anjala Tess
The Interventions
Needs
assessment
survey
Develop baseline understanding of trainees’ current use of
departmental reporting structures and the institutional reporting
system (AEM)
Determine barriers to reporting
Identify best methods to educate trainees on reporting
Educational
intervention
Multidepartmental educational programming based on survey
responses
Ongoing
assessment
Lessons Learned
Although almost half of residents know how to report an error via the AEM, the vast
majority have never navigated the error reporting system and some even fear doing
so due to negative consequences. In addition many seek some form of feedback
about the errors they report. This represents several opportunities for improvement
via education:
Repeat survey at regular intervals
The Results/Progress to Date
290 BIDMC residents and fellows from 9 departments completed the baseline survey.
46.5% reported understanding how to use the BIDMC system to report adverse
events. 86% have never reported an error using the Adverse Event Reporting System
but 69% feel doing so will lead to tangible change. 63% do not know what happens
to an error after it is reported but many wish they did. 22% fear negative
consequences after reporting an error.
Teach housestaff across departments about the use of the AEM, the types of errors
to report via this tool and the reasons to report these errors.
Teach housestaff about the feedback mechanism built into the AEM, as well as
creation of a means to provide feedback on reported errors to the general
housestaff
Publicize and educate housestaff on the HSQIC subcommittee for confidential
reporting of: quality issues, patient safety issues, or adverse events/errors.
Next Steps/What Should Happen Next
A more detailed understanding of barriers to reporting needs to be completed
Working with the Departments of Healthcare Quality and the Office of GME, HSQIC
will help create an education program to support trainee participation in error
reporting.
The Department of Healthcare Quality has committed to changing the AEM to
better track resident and fellow participation in adverse event reporting.
For more information, contact:
John Torous MD. JTorous@bidmc.harvard.edu
Andrew Hale MD. AHale@bidmc.harvard.edu
David Lucier MD, MBA. DLucier@bidmc.harvard.edu Anjala Tess MD. ATess@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
John Torous (<a href="mailto:jtorous@bidmc.harvard.edu">jtorous@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
Internal Medicine
Obstetrics and Gynecology
Neurology
Emergency
Surgery
Pathology
Anesthesia
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
John Torous
David Lucier
Andy Hale
Caitlin McGinty
Samir Jani
Emily Kaplan
Elizabeth Foley
Michael Buggia
Lauren Gleason
Jessica Zerillo
Brian Hollenbeck
Lester Leung
Luisa Solis-Cohen
Katherine Armstrong
Margaret Chory
Rebecca Harris
Sergey Pyatibrat
Allyson Berglund
Elizabeth Asch
Dre Irizarry
Peter Soden
Nakul Raykar
Anjala Tess
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Title
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Housestaff Adverse Event Reporting at BIDMC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ac0c3f9f216547508c871fa03ded2341.pdf?Expires=1712793600&Signature=qbuabrENcP9oahCJE9D02qatcw8DhUzAmHlEZt5wqPE9jY6nYeJoxR6Tpcc0wzxT38gPnWS0VvrRV5viwEOhQBhTvcrUWRXnKtW9W6Qv%7E6IhXzkVVS7GKmQDPKa8YFcKUQKP8gqIq5F-VWd3433zxbscbBdP7vRFK11XSqD6q1rbrlcJ3kuho7PfYZoTc%7EOxNMbTKob6FYg9LYI7wvLSlpp9H%7Eki0vHQUR4CJtE6HFxGoFkKWD7W77q6ScBH7nsbSGXdHixABJqruliuUZtPaxwCf%7EDY17nIwM5wk5IPJbufe5BQQ7n7G0BHsd3N69%7Ebgxdd2wUz0IBw%7EXPmwWvTkQ__&Key-Pair-Id=K6UGZS9ZTDSZM
68e369b4aa7f9f25b68651349d34fa88
PDF Text
Text
How Readable Are Hospital Discharge Instructions?
The Problem
Patients discharged after hospitalization are provided with written
instructions to complete the course of prescribed treatment; to identify
reasons to return to the hospital; and to ensure that they know about their
outpatient follow-up.
The Results/Progress to Date
The Joint Commission recommends that written material given to patients to
be at the 4th grade standard reading level; The Centers for Medicare and
th
Medicaid also recommend a 6 grade reading level for patient instructions.
When instructions are not presented in a clear and understandable manner,
patients may not follow them. This, in turn, may increase relapse and/or
readmission rates.
Aim/Goal
To evaluate BIDMC patient discharge instructions from different departments to see if
they meet JCAHO and/or CMS standards.
The Team
Kaarkuzhali B. Krishnamurthy, M.D. – Director, Women’s Health in
Epilepsy program, BIDMC.
Lisa Knopf, M.D. – Resident, Harvard Longwood Neurology
Residency, BIDMC.
Patricia Folcarelli, Ph.D. – Director, Patient Safety, Silverman Institute
of Health Care Quality, BIDMC.
The Interventions
A random sample of 50 discharge instructions was obtained from the
Neurology, Medicine, and Surgery services. The sample was selected from
patients discharged from 1/1/13 – 6/30/13.
The reading level for each set of instructions was analyzed using the
automated Flesch-Kinkaid reading level calculator in Microsoft Word.
th
than 4 grade level.
There was no statistically significant difference between the different
departments, or between the different services within one department.
Next Steps/What Should Happen Next
We will prepare templates for use in the Neurology Department that
meets grade level suggestions; they will be placed on OMR to be
available for use by all members of the department.
We compared:
o
o
Lessons Learned
In general, the reading level of discharge instructions is significantly higher
After six months, we will repeat this experiment to see if use of the
template has decreased the overall readability level of discharge
instructions.
We will also investigate other ways to improve patient comprehension of
discharge instructions. This may involve using video or other non-verbal
methods of communication.
reading levels between the three departments; and
reading levels within the neurology department broken down into three
categories: stroke, epilepsy, and other.
For more information, contact:
Lisa Knopf, M.D. – lknopf@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kaarkuzhali Krishnamurthy (<a href="mailto:bkrishna@bidmc.harvard.edu">bkrishna@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Neurology
Silverman Institute
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kaarkuzhali B. Krishnamurthy
Lisa Knopf
Patricia Folcarelli
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Title
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How Readable Are Hospital Discharge Instructions?
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/64b7836fcb815a762ba1ce55ca48fd9b.pdf?Expires=1712793600&Signature=ulAld2BZ3vyPgXmbCJ9EQoy6goqAyVKN5WUQegPwizy0iwvSdVPq2S9-jBKefD0T9VwA22ziK%7ET39d3QBy3oA9hghw-J9h7s7yok2PPwHsCBPA0Ntdgb6H3Gyhx-krv0s-hyGSIg2yaJIMJwpUKClYBvIaAJQjLN2xVm6%7EBTt9t68o3J9fX4RePrAqJBlo4YeLQ6zoSHT0uAMa4s3JuObaV4MuP5BesueEwFmzkHu3rDBIvHRoZsFDHl0L-tHDGodnde4HVfuFtYi54JimII1cAolSP8EM5GRqEyNvOaplCnCpKJqIE24BGZh3m043wOZ%7E606Z3uYfMS2tWkNbJ9xQ__&Key-Pair-Id=K6UGZS9ZTDSZM
658762eb5fc6c8b69c2270cacfcec585
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Text
Impact of an eMAR with BCMA on the PSRS reports
The Problem
The Results/Progress to Date
A significant number of medication events in the Patient Safety Reporting System
(PSRS) had themes of breakdowns in non-standard manual processes regarding
medication administration and documentation; posting MAR labels, proper
scheduling, recognition of due times, omission/co-mission and the wrong medication
being administered.
For each floor that has gone live such floor
Medication events in
2011, categories with red
arrows represent manual
processes that should be
improved by eMAR.
Lessons Learned
Aim/Goal
To decrease these manual errors by further standardizing the medication
administration and documentation process.
The Team
Kevin Afonso, IS
Mary Biagiotti, IS
Tricia Bourie, RN
David Grosso, Project Manager
John Hrenko, RPh
eMAR Testing Team
Rachel Hutchinson, RN
Jean Hurley, IS
Rachel Hutchinson, RN
David Mangan, RPh
Samantha Ruokis, BTO
Cindy Phelan, RN
The PSRS does have self reporting bias, so not all medication errors of this
nature will be captured.
The majority of PSRS reports after go-live were on patients coming from
PACU.
Published reports describe errors of a different nature that automation can
cause.
Next Steps/What Should Happen Next
Continue rollout of eMAR to the remainder of the inpatient units in FY14
and FY15.
Deploy eMAR to PACU’s in FY14.
Monitor Live floors for PSRS caused by eMAR.
Full rollout annual projection:
The Interventions
Develop an electronic Medication Administration Record (eMAR) together with
Barcode Verification at Medication Administration (BCMA), informed by the ideal
nursing/patient interaction and the 5 Rights of medication administration.
Have the scheduling function be driven by the physician order and BIDMC
policies and procedures.
Allow flexibility for rescheduling due times of meds
Clearly display due time
Require barcode verification of each medication package before it can be
administered.
For more information, contact:
David Mangan, PharmD, RPh. Manager of Operations-Pharmacy
dmangan@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.
David Mangan (<a href="mailto:dmangan@bidmc.harvard.edu">dmangan@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Nursing
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kevin Afonso
Rachel Hutchinson
Mary Biagiotti
Jean Hurley
Tricia Bourie
Rachel Hutchinson
David Grosso
David Mangan
John Hrenko
Samantha Ruokis
eMAR Testing Team
Cindy Phelan
Dublin Core
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Title
A name given to the resource
Impact of an eMAR with BCMA on PSRS reports
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
Environmental Sustainability
Safety
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f11df3b4061261702a554baafb324b5b.pdf?Expires=1712793600&Signature=hnwfW%7E%7E54a7GeFbAF%7ELy--gJuSkYdge52vxuDZcSSW6OgUKQjobciDq6HlQ116EePXRFeSFOQYyRd7qzt0Y5pIicY7C%7EeZf6GzIUVs43vNwWPNnk4-gLpTyeRV%7EaM9Io5bLSGL1XX7DDdYDieJV11OFlsYyvdy1pyZpDW4PVsLTnOW%7EBMv12nERyyW2RzfuW32QtJ7Ohms3pZX3aVnF6gTEKpRWZz95vsZe9NYZRDjugBSG1WMhuDkt86Npb8un3K5orwPf2ZfTp155eCVGKbJjMaAa-H1u3ZWfYfiRwf4xZTDFL5rTZFCSNUl2d9uyAM5b8hIqnJ9l2QuE0m-UjrA__&Key-Pair-Id=K6UGZS9ZTDSZM
a95e17330e58888d9b91e503c2658d08
PDF Text
Text
Implementation of a Phenobarbital-based Alcohol
Withdrawal Pathway in Critical Care
The Problem
The Results/Progress to Date
Timeline
Alcohol abuse/dependence affects 20% of inpatients and 50% of trauma
patients
9-30% of inpatients with alcohol withdrawal syndrome (AWS) require intensive
care unit (ICU) management
ICU admissions complicated by AWS have increased ICU and hospital lengthof-stay (LOS), hospital acquired infections (HAIs), sepsis, and in-hospital
mortality
Alcohol dependence is associated with poor outcomes in the trauma
population (2-3 fold increase in mortality, 50% longer LOS, Inferior 3-month
post-operative outcomes)
Symptom based administration of long-acting benzodiazepines is the current
standard of care at BIDMC
Problems:
o Resource intensive
o Assessment confounded by co-incident diseases (e.g. alternative
etiologies of delirium, mechanically ventilated patients)
o Difficult to differentiate between AWS and benzodiazepine intoxication
o Cross tolerance with alcohol
October, 2013: Finard ICU implementation
December, 2013: TSICU implentation
February, 2014: Implementation of pathway in all MICUs and SICUs
Patients Treated with Phenobarbital
Aim/Goal
To implement a standardized phenobarbital pathway for the treatment and prevention
of severe alcohol withdrawal in critically ill patients at BIDMC.
Lessons Learned
The Team
Douglas Hsu, MD
John Marshall, PharmD
Kathryn Butler, MD
Randy Hollins, PharmD
Annmarie Anderson, RN BSN CCRN
Peter Clardy, MD
Susan Holland, RN MS
Kristin Russell, RN BS
Sharon O’Donoghue, RN MS
The Interventions
Development of a phenobarbital guideline for the treatment and prevention of
severe AWS in critically ill patients
Identification of unit-based nursing champions, in-service training of ICU
nursing
Attending and housestaff education
Development of a POE order set
Rolling implementation in all BIDMC ICUs
With a staggered, unit-based implementation, there is the risk of contamination
as the intervention can be utilized in non-implementation locations
Identification of stakeholders is critical in the implementation of a
multidisciplinary treatment guideline
Next Steps/What Should Happen Next
Complete implementation of the guideline in all ICUs at BIDMC
Pre-post evaluation of the intervention, with assessment of:
o Time to resolution of AWS
o ICU and hospital length-of-stay
o Hospital-acquired infections
o Mean arterial blood pressure and heart rate
o Rates of delirium as assessed by the Confusion Assessment Method for
the ICU (CAM-ICU)
For more information, contact:
Douglas Hsu, MD
Pulmonary Critical Care Fellow
dhsu@bidmc.harvard.edu
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Dublin Core
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Douglas Hsu (<a href="mailto:dhsu@bidmc.harvard.edu">dhsu@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Nursing
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Douglas Hsu
Peter Clardy
John Marshall
Susan Holland
Kathryn Butler
Kristin Russell
Randy Hollins
Sharon O’Donoghue
Annmarie Anderson
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Implementation of a Phenobarbital-based Alcohol Withdrawal Pathway in Critical Care
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety