1
20
773
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/53452562af5b1b4e2be0a6f2a01f738e.pdf?Expires=1712793600&Signature=PQmYMvSrtygbKmKA12keMdN-9XO3-HIypQt-fQmbGllaVqciGtGais8%7EaCKmj3POny8nl2VeJiMJH3b1bSk%7EBx8ZZMQptym%7En9L0ZdFzBlXwnyzDSDTjcjtXNx%7EUEEv0ffLpRfibQGn953-CXuOzYlELEbHLg3sZ0RWaYYJRdgndCEuc9QnBew9T52VQQa5jiclBMzzpz8hwJzpr9OGoDBYtzDq9QGJdmW%7Ez-NW8JmskzF%7EDKosOEWFhgp7gnNZHtF34JNjL-QvsSPbVmse2luCM6Pm2TTZbSdZf%7EoA4axYLl7k-vnxkBgdKw-NZoJiXNxVseNkf18lz-vm11zVcAw__&Key-Pair-Id=K6UGZS9ZTDSZM
2a231b62089c47f4e60db3a741ba1e14
PDF Text
Text
COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
Introduction/Problem
The Interventions
* March 2020 World Health Organization declared a global pandemic
* Massachusetts was one of the first states affected by COVID 19
* Skin impairments noted on COVID 19 patients evolved differently from Deep
Tissue Injury (DTI) despite similar appearance.
* COVID 19 skin impairments were identified on areas on the body that were not
on pressure points.
* Review of literature: dearth of data related to novel virus
* NPIAP white paper validated our suspicions that these skin manifestations were
a result of a systemic process . Patients had coagulopathies, multisystem
organ failure , hemodynamic instability
•
•
•
•
Prevent pressure injuries
Optimize nutrition
Meticulous local wound care
Safety for patients and staff
Wound care for COVID 19 patients was approached with a conservative manner honoring the principles
of topical therapy
Bundled Care: repositioning patients every 4 hours, decreasing amount of PPE used by staff,
decreasing exposure
Education: pictorial resources for pressure injury prevention, application of foam dressings and offloading techniques
A mobile cart for the proning team and ICU staff. This cart included a checklist and readily available
supplies
Alternate air mattresses from in-house distribution
Debridement avoided due to risk of bleeding; conservative topical therapy
Results/Progress to Date
Aim/Goals
The Team
Covid skin Manifestation: top down injury located on soft tissue , lacy appearance , intact and non-intact
skin with epidermal sloughing to reveal partial thickness skin loss. Lesions very friable
D. Loehner
A.Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
For more information, contact:
Donna Loehner RN BSN CWON Clincal Director Wound Ostomy Nursing Team
�COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
More Results/Progress to Date
Impaired blood flow to epidermis due to COVID 19 systemic coagulopathies. Top down injury that can
lead to partial or full thickness skin loss.
Covid skin manifestations most commonly seen on lower extremities , hands, feet, trunk.
Lessons Learned
•
•
•
•
DTPI defined as injuries that can have both intact and non-intact skin with localized area of persistent non
blanching deep red maroon pigment change resulting from prolonged pressure and shearing forces. If
not reversed can evolve into unstageable PI
Tissue Injuries seen on Covid patients appeared as DTPI but were found to have a vascular etiology as
evidence by histological tissue analysis and are now classified as Covid Skin Manifestations
Patients that require proning cannot be placed on low air loss support surfaces, this is a
contraindication
Coagulopathy caused by the Covid -19 virus require a conservative approach to Wound Care, surgical
sharp debridement is to be avoided
Is it possible that not all DTPI's are from pressure but rather from systemic inflammatory conditions?
Next Steps
Education of Medical and Nursing staff on the etiology and management of Covid skin manifestations
Further exploration and research into whether Covid skin manifestations could be classified as Acute Skin
Failure and if so, is this applicable to other critical ill patient populations that develop skin impairments
Further investigation into the progression and deterioration of some Covid skin manifestation into full
thickness wounds
For more information, contact:
Donna Loehner RN BSN CWON Clinical Director Wound Ostomy Team
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Donna Loehner (<a href="mailto:dloehner@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dloehner@bidmc.harvard.edu</a>)
Project Team
D. Loehner
A. Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Wound Ostomy Nursing Team
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Skin Manifestation in the Acute Care Setting
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4ae528ce9f9d839f475a82b29a5e17a5.pdf?Expires=1712793600&Signature=vFLsJuyK8qQoxTLd33xYR4RIYiq5X2pLhson2xbusD9a1jYJ7IQZETbNpm1lowsUprlp7B9bvKN0fRpxepw%7EyViV1MNN417zrXYKmVY8yMN5Uzv8pbGubgMNh1dYBLSFrvqiQkaicv2Irk4zK4TGONlfvhEFg%7ETAFvqUUyIXPBQO%7ErvaYtlQ7gDjs011oolR847oDakHlmEa4BCLw4iatvEPzo-zsgPPv-NST5L9tpT2uAkIc6bE9KPYPcRPPNygzZpsmTjPD5bxjEWGsmlc5ccbZ15nINCNSl%7Eqd7oJOf3vH4u%7EXlwpne4LHe3Ap5Lmhf-2TbE7cTzFkIjm37htCA__&Key-Pair-Id=K6UGZS9ZTDSZM
a645b9158e660ba2e3730907bfdab848
PDF Text
Text
Relationship of Viral Load and Infectivity to the Limit of Detection of SARS-CoV-2 Antigen Tests
James Kirby1*, Stefan Riedel1, Sanjucta Dutta1, Ramy Arnaout1, Annie Cheng1, Donald Hamel2, Phyllis Kanki2
1Department of Pathology, Beth Israel Deaconess Medical Center, 2Harvard School of Public Health
1.0
0.0
6
AUC = 0.92
2
109
0.5
0.5
AUC = 0.94
0.0
2
109
0.0
0.5
105
104
103 102
log10 v.l.
107
6
AUC = 0.94
4
108
1.0
105
104
103 102
sensitivity
6
4
108
2
109
1-specifity
0
0
5
10
log10 sample viral load
in genome copies/mL
Figure 2. Quantitative Relationship Between
Culturable Virus and Sample Viral Load. Day 3 viral
culture supernatant for each sample was analyzed by
RT-qPCR. The viral load in log10 genome copies/mL of
culture supernatant is plotted against the log10 viral
load in genome copies/mL of the original patient
sample. Linear regression (solid line) with 95%
confidence intervals (dashed lines) shown. R2 = 0.55
log10 v.l.
AUC = 0.97
0.5
103 102
log10 v.l.
8
6
AUC = 0.97
4
108
2
109
0.0
8
107
0.0
104
0.5
1.0
1-specifity
E
106
105
107
0.0
0.5
106
0.5
2
109
0.5
1.0
8
sensitivity
106
0.5
0.0
1.0
1-specifity
1-specifity
5
8
D
1.0
10
log10 v.l.
4
1.0
C
0.0
Sensitivity/Specificity versus Viral Culture
LumiraDx 90% (83-94% C.I.) / 70% (59-79%)
Other Ag 74% (65-82% C.I.) / 92% (84-96%)
102
6
107
1-specificity
0
Figure 1. Antigen Testing Results Compared
with Log10 Viral Load. Viral load in genome
copies/mL POS = positive antigen test result.
NEG = negative antigen testing reslt. Lumira =
LumiraDx Ag test; BD = BD Veritor Ag test.
103
104
108
0.0
log10 day 3 culture
supernatant viral load
105
106
sensitivity
sensitivity
Log10 Viral Load
B
log10 v.l.
10
4
1.0
From Arnaout et al. CID. PMC7302192
102
8
107
0.5
0.0
INFECTION VERSUS INFECTIVITY
INFECTIVITY SURROGATE =
VIRAL CULTURE
103
108
sensitivity
PCR
SLOW
EXPENSIVE
SENSITIVE
5
Lu
m
ir
Lu a P
O
m
ira S
N
EG
B
D
PO
S
B
C
ar D N
eS
EG
ta
C
rt
ar
eS PO
ta
S
rt
N
O
sc EG
ar
P
O
sc OS
ar
N
EG
ANTIGEN TESTS
RAPID
INEXPENSIVE
POINT-OF-CARE
INSENSITIVE?
104
105
106
1.0
Figure 3. Receiver operator curves (ROC) comparing
SARS-CoV-2 sample viral load levels as a predictor of
viral culture and antigen detection. For each plot,
sensitivity versus 1-specificity was plotted for each viral
load value (genome/copies/mL) determined by RT-qPCR
for each sample in our study when used as a lower limit
threshold for scoring positive and negative detection for all
other viral load results with qualitative viral culture or
antigen test determinations, respectively, as the
comparators. (A) Log10 viral load (v.l.) in genome copies/
mL versus detection by viral culture. (B) Log10 viral load
versus LumiraDx antigen detection. (C) Log10 viral load
versus BD Veritor antigen detection. (D) Log10 viral load
versus Oscar Biosciences antigen detection. (E) Log10
viral load versus CareStart antigen detection. Viral load
values along the ROC curves are labeled in log10 intervals
and demarcated in color as indicated in accompany
heatmap legend bar. AUC (area under the curve) for each
ROC curve is denoted on respective plots.
109
108
107
106
105
104
103
102
101
100
infectious risk
1.0
viral load
A
10
QUESTION:
When/how should we use SARS-CoV-2 antigen
versus PCR tests?
LFAs
LumiraDx
PCR
-5
0
5
10
15
days post symptoms
Figure 4. Model of Infectious Risk versus SARS-CoV-2 Detection by
RT-qPCR and Antigen Tests. Both Lumira and lateral flow-based antigen tests
(e.g., BD Veritor, CareStart, and Oscar Biosciences) are able to detect individuals with viable, culturable virus and who therefore pose an immediate infectious
risk to others. Dotted lines indicate reliable detection threshold predicted for
each method. Presumptively, infectious risk is proportional to the amount of
culturable virus which is roughly proportional to the viral load in samples.
Antigen tests are excellent in detecting patients with the highest viral loads
which may be four to five log10-fold greater than viral loads detected at the
lowest levels where virus can be consistently cultured. PCR and to a lesser
extent, the LumiraDx test, can detect individuals before and after the expected
infectious period and therefore may be more appropriate for screening
programs where testing is performed at longer intervals. The viral load curve
shown is for representational purposes and may not reflect viral load kinetics in
any specific individual.
Conclusions:
1.
Use Ag tests to identify infectious individuals at time of testing. Will allow isolation of significantly
infectious individuals from communal events, same-day healthcare procedures, communal travel
arrangements, and other functions with significant person-to-person contact in settings where universal
masking is neither feasible nor desired.
2.
PCR tests for no-margin-for-error situations (hospital admission), vulnerable populations; sample pooling
strategies; and screening of cohorted populations (e.g., school) at decreased intervals.
Support:
Accelerating Coronavirus Testing Solutions Grant from the Massachusetts Life Sciences Center; Ag tests donated
by LumiraDx, Ginkgo Biosciences (CareStart Ag test), and Oscar Biosciences.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
James E. Kirby (<a href="mailto:jekirby@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jekirby@bidmc.harvard.edu</a>)
Project Team
James Kirby
Stefan Riedel
Sanjucta Dutta
Ramy Arnaout
Annie Cheng
Donald Hamel
Phyllis Kanki
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
Harvard School of Public Health
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Relationship of Viral Load and Infectivity to the Limit of Detection of SARS-CoV-2 Antigen Tests
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4d0a1d14314fe0b450fa0bee22224cc9.pdf?Expires=1712793600&Signature=j6FHaYCQF1%7ExK5LSMGYNQ9DT66owFfldrCGMSsetFX-y9UiCgLyKASV2m4UQ3BiRZsr8bBawFH%7EIeG0FRJsWpb-s-yPX%7E3KU6M2NmeO4eKc-pAou%7EjDZEZnfPzgh5chkPXM5RxOCZngrOigoY2ifzFX9y3KbFNYRzhYNG80%7E6xRWJXFomyRw9cq9hLhPqE9UAuh-uxMpJD4zFKhEcA0dxWQ51HGsFRaXb7VozR-3-OtIXCF7avjdIvDUIZvCir3FecDKY7GMF-%7EVTa4gZoBQkxAaE8z7kQ7bmEs3U5ZrN5Lz%7Eq-6jX1x%7E1imCc9xXFcRmLbYPl-Pu9WWThnHwTYaKA__&Key-Pair-Id=K6UGZS9ZTDSZM
98e9e892dc3235754c30237015852f05
PDF Text
Text
Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
In February of 2020, our group purchasing organization announced concerns for supply chain disruptions
given the reliance on active pharmaceutical ingredient (API) production from China. Conversely, none of
the wholesale distributors were experiencing any supply disruptions and that they anticipated none.
Historic experience with high acuity influenza surges (2009, 2017) and natural disasters (Hurricane
Maria) lent perspective to the potential impact of manufacturing and disproportionate demand leading to
shortages. However, the trajectory of this yet to be defined global pandemic left Pharmacy Operations
and Clinical Management without a clear direction for anticipatory purchasing or a watch and wait
approach.
After weeks, medications of concern affected were agents thought to treat CoVID-19 (e.g.
hydroxychloroquine, azithromycin), and agents to treat the symptoms of CoVID-19 (e.g. respiratory
medications-inhalers, nebulizers).
As the pandemic intensified, agents to address the influx of intensive care admissions (e.g.,
vasopressors, sedatives, intravenous opioids, neuromuscular blockers) became on short supply. The
shortage list continued to expand faster than any other time period across multiple categories threatening
to interrupt patient care.
Aim/Goal
To balance unclear and fast evolving demand with supply chain availability, fiscal responsibility, clinical
evidence, and avoiding a hoarding process, to avoid negative consequences in patients. There are no
available benchmarks for shortages other than avoiding stockouts, implementing therapeutic
substitutions and forestalling negative clinical outcomes.
The Team
John Hrenko, PharmD
Operations Supervisor
Gordon Hubbard
Purchasing Manage
Jamie Levash RN
Project Manager
Margaret Stephan MS
Chief Pharmacy Officer
Ifeoma Eche, PharmD
Clinical Manager
Howard Seth Gold, MD
Clinical Director
Julius Yang, MD
Clinical Director
Christopher McCoy, PharmD Clinical Manager
Department of Pharmacy
Department of Pharmacy
Health Care Quality
Department of Pharmacy
Department of Pharmacy
Health Care Quality, Infectious Diseases
Health Care Quality
Department of Pharmacy
Given the escalation and dynamic nature of supply chain disruptions daily huddles and communications were
enlisted,
Purchasing and Pharmacy Operations Administration continuously monitored supply chain announcements
from multiple sources, the group purchasing organization, manufacturers, wholesalers multiple times a day.
Purchasing sought out alternate suppliers and allocation methods to order/purchase items in high demand
continuously.
Pharmacy Operations used tactics including centralization of product supply, alternative route selection.
Clinical Pharmacy Managers worked with Infectious Diseases/Antimicrobial Stewardship to investigate and
reported out guidance relative to CoVID 19 therapeutics (e.g. high demand for azithromycin and
hydroxychloroquine). Alternate dosing strategies and algorithms for pain management, sedation and
neuromuscular blockade were created to standardize practice.
Invocation of the Drug Shortage Task Force including Health Care Quality was used to prioritize care, build
consensus with thought leaders and experts and devise algorithms and protocols.
A continuous modification of Provider Order Entry clinical decision support was designed and implemented to
guide best care and avoid shortages
Detailed interventions
Identify the key medications to
treat the complications of CoVID
19 infection.
• Dypsnea/Pneumonia
• Inhalers/nebs
• Antitussives
• Expectorants
• Sepsis
• Vasopressors
• Sedatives
• Antibiotics
• Analgesics
• Supportive meds
• Neuromucscular
Blockers
• Experimental CoVID tx
• Antibiotics
• Antivirals
Drugs completely out at the manufacturer and wholesaler level
Respiratory
Albuterol Inhaler
Albuterol Neb
Budesonide NEB
Epoprostenol IV
Ipratropium Bromide Inhaler
Ipratropium Bromide Neb
Tiotropium inhaler
Electrolytes
Calcium Gluconate IV
Magnesium Sulfate IV
Vasopressors
EPINEPHrine IV
NORepinephrine IV
Phenylephrine IV
Vasopressin IV
Intensive Care Unit Supportive
Artificial Tears
Chlorhexidine Gluconate PO
Sodium Bicarbonate IV
Sedatives
Dexmedetomidine IV
Ketamine IV
Midazolam IV
Propofol IV
Antibiotics
CefePIME IV
CefTAZidime IV
CefTRIAXone IV
Piperacillin-Tazobactam IV
Vancomycin IV
CoVID experimental therapeutics
Azithromycin IV
Azithromycin PO
Chloroquine PO
Cobicistat PO
Darunavir PO
Doxycycline PO
Doxycycline IV
Hydroxychloroquine PO
Lopinavir-Ritonavir PO
Neuromuscular Blockers
Cisatracurium Besylate IV
Etomidate IV
Rocuronium IV
Analgesics
Symptom Care
Benzonatate PO
GuaiFENesin PO
Fentanyl IV
HYDROmorphone IV
GuaiFENesin-Dextromethorphan PO
Ondansetron IV
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy .
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Therapeutic specific
demand and utilization
during surge 1 & 2.
Introduction of a
Performance Manager View
Overarching Planning and Execution detailed for our team
Continuous
monitoring of
demand and
retrospective
lookbacks:
Antibiotic demand during the first surge of 3 months dwarfed antibiotic use for
years prior and patients with CoVID were 10x more likely to receive antibiotics.
Continuous shifts directed by our team were necessary to keep supply.
Tracking and movement of key meds
with grading of next phase readiness.
• Par levels needed to be adjusted to
the new normal for daily/monthly
utilization
• A safety stock to get through
national shortages was required
but had to balance fiscal
responsibility and good global
citizenship (e.g. no hoarding)
• Omnicell (floor supply) had to be
readjusted to meet new floor
demands and centralization.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Situational awareness and community
building
Standard processes for ordering preparing
and administering meds all required
reframing across disciplines
Example of adjustment to steep demand
curves through therapeutic substitutions, in
this case from IV to PO for sedativeswithdrawal meds.
Example communications to all Hospital Staff
Early pandemic guidance suggested that all
items be disinfected to protect staff
In order to rein in the reflexive use of
agents thought to aid in treatment of the
infection given short supply and
prophylactic use.
Inhalers became in such short supply but critical
to care of all inpatients
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Drug substitutions were necessary but required
education and communication.
Drug Shortage Task Force Prioritization Schemes
Example communications and clinical therapeutic
summaries
Cisatracurium outages
Midazolam critical lows
Lessons Learned
Fentanyl Mitigation
Therapeutic demand and supply chain interruption is nearly impossible to predict during a global pandemic
Interdisciplinary involvement and broad communications are essential to keep available supply and ensure public health safety
Time required to address all the clinical decision making, inventory control and supply allocation is more than 50% of dedicated
time.
Next Steps
Utilize similar tactics for management of acute shortages early with engagement of therapeutic area leads, inventory tracking
and demand curves.
Apply modeling for network engagement and resource sharing.
Utilize global facing platforms like PowerBI through Performance Manager.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
John Hrenko
Gordon Hubbard
Jamie Levash
Margaret Stephan
Ifeoma Eche
Howard Seth Gold
Julius Yang
Christopher McCoy
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Healthcare Quality and Patient Safety
Infectious Diseases
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pharmaceutical Supply Chain Management Before, During and After the Inpatient CoVID 19 Pandemic Surge(s)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b4021f2b223c5abadd774ed9b8f1d4b7.pdf?Expires=1712793600&Signature=FYASO4RkMm0xnp5GLu-i4Fhb7wwHSRz%7EbKO2yNmT83SqI98ulBRpJIDTN7oeaUGgzCQqswqr6nm0IyQHRBAd%7Ezv9DaSOkwjoupnLorIKk5ty9vaVM15lwZcxR5eVxb8-dzgnLmoxH3TwdOT-tUHjtKseUKCtIdTCt3JpyBqOlWMZ3sss8fbDRJMWZluX6cxpx3qAc07Nb9at1yVY2LJp1o-0Z8MJ38q%7EKxN9Lx2JgJFygJpZH8OS7dzCkwyeQkpOc-Q-habs12R94ZRj44yHszpAPdwvbOIDzdsZXjbGbVgFZyHrtB1w7l4Xwmu4ChhUapKIRx1lzIouOVFusBgelw__&Key-Pair-Id=K6UGZS9ZTDSZM
b82a5f46d6b6bd429361c72940ef9715
PDF Text
Text
Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
Remdesivir was an early front runner for therapeutic agents of interest given activity against other
coronaviruses, some experience with Ebola and a relatively clean adverse event profile.
Notably the agent was used in the first published experience of a patient in Washington state who received the
drug as part of his hospitalization for CoVID-19
Gilead and the NIH had designed early trials to examine its usefulness in hospitalized patients in a placebo
controlled fashion but also in trials to examine the duration of therapy (5 vs. 10 days) in patients with varying
degrees of illness
Prior to initiation of these trials, the only access to the agent was through compassionate use via the FDA and
Gilead.
Once BIDMC was selected as a trial site for two trials, a process of rapid evaluation and enrollment was
necessary before patients received unapproved therapies, notably hydroxychloroquine which would become
exclusionary.
Remdesivir was then approved for Emergency Use Authorization just four months into the pandemic requiring
a level of regulatory compliance not seen at BIDMC.
Four months after EUA approval, the drug was FDA approved in full with limited restrictions to use lending to
the need for a stewardship process to ensure safe, equitable and responsible prescribing.
Aim/Goal
To enable access to remdesivir through its life cycle from compassionate use to emergency use to FDA
approval while meeting regulatory requirements and conscious stewardship.
The Team
Jamie Levash, MSW
Project Manager
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Disease
Julius Yang, MD
Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
Healthcare Quality
Infectious Diseases
Pharmacy
Health Care Quality
Health Care Quality, Infectious Dis
Pharmacy
Initiated compassionate use access to remdesivir through an FDA-Gilead-BIDMC pathway for patients with limited treatment
options
Incorporated remdesivir into treatment guidelines for review for research enrollment
Reviewed CoVID 19 admissions for hydroxychloroquine initiation requests through stewardship and directed primary teams
to the remdesivir local study team
Developed the Emergency Use Pathways for important inclusions and exclusion details and daily treatment tracking with
Health Care Quality
Once study results were published, provided education and review for the treatment collaborative
Tracked adverse events of concern from the Emergency Use experience
Worked with Health Care Quality to devise an allocation scheme when early release of product did not meet demand
With EUA transition to FDA approval, worked collaboratively to develop a treatment guideline and stewardship review
Continually reviewed study data publication, local results, national guidance and provided BILH network guidance for best
practice
Results
Early review of
access limited to
a restrictive
compassionate
use process with
limitations to
degree of illness
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
K Stephenson/BIDMC
selected as site for two
trials
US Clinical trial
development and linkage
Work with trial team and
Research Pharm given rapid
enrollment
Initiated compassionate use
prior to study launch
38 yo M transferred from BI-Milton
for ICU admission
Patient excluded from two trials due to
need for ventilation enrolled in
compassionate use protocol
58 yo M, high risk w/ obesity,
hypertension had to be rapidly
intubated.
Created a reference document,
snippet below for compassionate
use consideration to ensure
accepted and not study eligible
24 yo F pregnant excluded from trials
enrolled in compassionate use acces
Developed an early review
by Stewardship team for
potential enrollment in
remdesivir trials
Developed a primer for
primary teams to enable
study drug release given
high volume
Response to primary team demand
May 2020 Emergency Use
Authorization granted but
allocation process in
question
1 Completed 5 days hydroxychloroquine
2 Completed 5 days hydroxychloroquine
3 None
4 Hydroxychloroquine
5 None
6 Hydroxychloroquine
7 HCQ 3/17-18, stopped
8 Lopinavir/ritonavir
9 Hydroxychloroquine
10 Hydroxychloroquine
11 Hydroxychloroquine
12 Hydroxychloroquine
13 Hydroxychloroquine
14 Remdesivir compassionate use
15 Completed 5 days hydroxychloroquine
16 Completed 5 days hydroxychloroquine
17 None
18 Hydroxychloroquine
19 None
20 Hydroxychloroquine
22 Lopinavir/ritonavir
23 Hydroxychloroquine
24 Hydroxychloroquine
25 Hydroxychloroquine
26 Hydroxychloroquine
27 Hydroxychloroquine
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Remdesivir EUA guideline
developed locally
Algorithm for trial versus EUA
Includes an algorithm to allow for
continued enrollment in the clinical trials
to avoid dipping into the EUA limited
supply
Stewardship team daily tracking
and dose release approval to
avoid waste
Development of unique guidance for
an Emergency Use Authorization to
meet regulatory compliance and
receive further allocation
Built cPOE screens to encourage
laboratory screening before
entry as well as special
considerations for other study
meds
Engaged Drug Shortage Task
Force for prioritization
scheme
Developed and sent out
Communications given
limited supply and
restrictive criteria
June 2020: Remdesivir
supply opens up lending to a
transition to Stewardship
only approval
Tracking sheet developed to
communicate between Health Care
Quality and Stewardship team
Last COVID
Admission Date
Test
MV at Enrollment
Priority
05/11/2020
05/11/2020
No
3
05/09/2020
05/08/2020
Day 1
1
05/03/2020
05/03/2020
DAY 9
2
05/11/2020
04/26/2020
DAY 2
1
05/11/2020
05/02/2020 Not at enrollment, now intubated 3, now 1
05/12/2020
05/10/2020
DAY 2
1
05/10/2020
05/12/2020
dAY 1
1
05/11/2020
05/11/2020
DAY 3
1
5/15/2020
5/15/2020
No
3
5/15/2020
5/15/2020
No, O2 sat<94%
4
5/14/20
5/15/20
Day 3
1
5/16/20
5/16/20
No, 02 sat <94% RA, 3L
4
5/15/20
5/16/20 No, 02 sat <94% RA, oximizer 10L
3
5/17/20
5/17/20
Date
Approved
05/12/2020
05/12/2020
05/12/2020
05/12/2020
05/12/2020
05/14/2020
05/14/2020
05/14/2020
5/16/20
5/16/20
5/18/20
5/17/20
5/17/20
5/18/20
Consent
Completed
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Planned
RegimEn
(day)
5
10
10
10
10
10
10
10
5
5
5
5
5
5
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
June 2020
BILH Network Remdesivir EUA review
done
FDA approves Remdesivir fully
and it earns a brand name
Approval is broadly permissive
for inpatients with CoVID-19
A more transparent and
functional tracking system of
remdesivir developed for
Performance Manager
Examination of ethnic/race
diversity
OMR Macro development
to ensure data integrity and
documentation
Stewardship group engages in a full review of remdesivir trial
publications, local experience and FDA submission to present to
treatment collaborative, local and system P&T
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Remdesivir: From research to Emergency Use to FDA approval and Stewardship
Christopher McCoy, Ryan Chapin, Jamie LeVash, Julius Yang, Katy Stephenson, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Final recommendations for approval with restrictions
Formulary Review: Study Details
Lessons Learned
Fielding the “in time” trajectory of drug research, compassionate use access, expanded use access and translation of published
experience to best practice requires collaboration and human resources to avoid unintended consequences and optimize
efficiency.
Education, intensive tracking and communication are key to meeting regulatory compliance and optimizing care
Open discussion and collaboration during an acute stressful surge allows for more transparent decision making and engagement
Remdesivir Stewardship across the Network
Next Steps
High utilization at low volume hospitals
High demand and utilization necessitated
network shifts of supply
Use the experience from remdesivir to build upon future Emergency Use Guidance
Continue to steward remdesivir to gain benefit in the early infection stage of viral replication
Optimize Stewardship resources for the network to build upon experience and higher level controls
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Jamie Levash
Katy Stephenson
Ryan Chapin
Julius Yang
Howard Seth Gold
Christopher McCoy
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Quality and Safety
Infectious Diseases
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Remdesivir: From Research to Emergency Use to FDA Approval and Stewardship
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/8c3cf010b56fccf6495e21fb86001593.pdf?Expires=1712793600&Signature=dWn0Owc6u0s-eDFvDIE3k52Ot-3MxxNUmRvePm9cY%7EjnBFQ0NoirZTQiHpJDtSVAidvdwqRIlsaZFsDAky7i7m6LBESug32e0LQcoB0lKfgyYwYVHWWrhO4OxzS69s3pbIFZ%7Er1dnq%7EAFkGORedHAdfdHRK14c15PHQlVtgQO32ZPxZwaOIwix6wnmIestfMGtXccGPAMOipiHGVuc7sBnLZNmrcSM51JpRSKBFTiWOqclqq6hS7d20fWolvoOWAeGYmA5tMHVh5uPlDQov1m-z6rq4LRfaUZuZCJRmPtEKMLuWeIPTgNUwyvAn%7EzUPVp%7EmCTJn1GHWOiYv-Xq5uww__&Key-Pair-Id=K6UGZS9ZTDSZM
39171dfad4e8ec20a27153eae4f10b9e
PDF Text
Text
Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
With the impending pandemic and its unclear impact, we convened a multidisciplinary workgroup across
Pharmacy, Infectious Diseases, Research, Transplant, Hematologic Malignancy, Critical Care and Health
Care Quality and others to begin to plot out a treatment guideline for CoVID-19.
The unknowns were many given the lack of approved treatments, the lack of peer reviewed published
literature and unclear trajectory for the breadth and depth of care at our institution.
The need for a rapid response and clear guidance became increasingly pressured during the first surge as
our census for those infected went from 3 to 192 from March to April 2020 with a high percentage of patients
requiring ICU level care and many remaining here for weeks.
Sources of data were limited to a World Health Organization outline, preprints from China and Italy and basic
science reviews of agents thought to have antiviral activity.
Early guidance were often completely refuted by well controlled trials, e.g. recommendation to given empiric
antibiotics to all patients with SARI, avoidance of systemic corticosteroids.
Over 273 medication shortages were making broad treatment recommendations difficult.
Active research protocols had to be introduced to promote systematic exploration
Aim/Goal
To provide a central and locally balanced resource for clinicians for the treatment of CoVID-19 bifurcated by
disease severity and predictors for advanced disease based on an ever evolving evidence base.
To grade therapeutic modalities and frame experimental therapies with risk considerations and newly
launched local research.
The Team
Roger Shapiro, MD
Attending Physician-HIV researcher
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Diseases
Sabrina Tan, MD
Attending Physician- Viral Researcher
Margaret Hayes, MD
Attending Physician- Critical Care Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
CoVID 19 Treatment Collaborative
Infectious Diseases
Infectious Diseases
Pharmacy
Infectious Diseases
Critical Care Medicine
Health Care Quality, Infectious Diseases
Pharmacy
Built a multidisciplinary team with incorporation of the network and representation from key clinical areas
Developed a review process for preprints through MedrxIV, national guidelines (NIH, IDSA)
Scribed a treatment algorithm by severity of disease presentation.
Continuously evaluated and incorporated best practice for collection and interpretation of biomarkers and
laboratory values as well as comorbidities for risk stratification
Reviewed investigational therapeutics for linkage to local research studies (e.g., remdesivir, favipiravir)
Researched and provided dosing, drug interaction, screening and place in therapy guidance for all agents
Facilitated weekly data/literature summary meetings across a BILH network collaborative to build consensus for
guideline changes.
Reviewed drug shortage updates to alter treatment guidance toward a prioritization scheme
Directed restrictive criteria/clinical provider order entry guidance for therapeutic agents to promote safe and
evidence based utilization of scarce resources
Results: Data Review
Early but
continuous
review of
prepublished,
published
and
guideline
data.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Most basic outline created Feb 2020
Basic tenets from WHO and CDC
Ongoing trial of remdesivir
Weblink guidance for early therapeutics
From basic science to WHO guidance to
National guidelines
US Clinical trial
development and linkage
HIV Antiviral adaptive
research
Agents not recommended
Earliest treatment algorithm
incorporating a single experimental
agent
First iterative
multidisciplinary multisite
algorithm: March 20
Early investigational
Agents with unknown utility
Severity graded guidance
Lab and Imaging guidance
Risk analysis for progression
Special Populations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
Late March 2020
Began populating an ever growing
annotated citation list
Held first in a series of
Network Meetings
April 2020
Invited content experts and leaders
across the BILH network to build the first
Network treatment algorithm
Introduced Nephrology research on
niacinamide and conditional framework
Expanded sections on
Immunomodulators
Worked with EP/Cardiology
to enhance guidance
evaluation of therapeutic
agents with QT prolongation
concern
Built links to ongoing trials to boost
enrollment
Tocilizumab guidance
Hydroxychloroquine utilization
Hydroxychloroquine +/- Azithromycin
Adverse Event Investigation
JAMA Cardiology Publication
Did quality review of local tocilizumab
utilization and infectious complications
Added more evidence based guidance
for patients who may benefit from IL-6
modulation
Linked ICU teams with ongoing IL6
modulation trial-sarilumab
Identified hydroxychloroquine and
azithromycin utilization as concerning
Removed darunavir-cobicistat from
therapeutic recommendations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
April 2020
Anticoagulation Prophylaxis and
Treatment Guidelines
Convalescent Plasma considerations
added
Tocilizumab Plan
Tocilizumab shortage management
Remdesivir approved for
EUA utilization: need for
local guidance and
separation from clinical
May 2020
trials
National allocation was
small for MA hospitals
requiring prioritization
scheme
July 2020
Communications to staff regarding
remdesivir
June 2020
Network Remdesivir Experience
Exploration
Presented and added dexamethasone
to treatment guidance
Removed hydroxychloroquine and
azithromycin as treatment agents
Lack of HCQ benefit
Added additional sections on
culture based antibiotic
utilization with rapid tailoring
for negative cx
Based on study data, limited
treatment duration to 5 days
Identified population with
benefit with moderate 02
requirements
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
July 2020
Baicitinib initial review
August 2020
October 2020
Convalescent Plasma considerations
clarified given Mayo closes enrollment
BIDMC local abx utilization
and collateral damage
review published
FDA opens Remdesivir to all inpatients
Concern about Bamlanivumab
launch
Remdesivir EUA ends: FDA
approved
November 2020
First CoVID monoclonal Ab
Approved via EUA process
Guidance prepared
Baricitinib EUA guidance prepared
Dec 2020
Resources turn towards vaccine
approvals and EUA rollout
Incorporation of NIH figures
Remdesivir EUA supplies dwindle
prompting network utilization review
% utilization growth
50%
45%
40%
35%
30%
25%
On hold for vaccine launch
20%
15%
10%
5%
0%
Despite high census, BIDMC has strict
control on remdesivir use
For more information, contact:
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Milestones
Ivermectin review
Jan 2021
Infographics for antibiotic overuse
Continued tocilizumab evidence evaluations REMAP-CAP redirecion
February – November 2021
Outpatient and Employee vaccine rollouts
Vaccine recommendations for immune compromised host
Third dose and half dose boosters launched
Monoclonal Antibodies reviewed and infusions begun in June 2021
Additional antibody combinations reviewed and added given variants of interest
Regulatory reports for EUA allocation established and submitted
Tocilizumab shortage addressed with introduction of baricitinib via EUA and other
mitigation processes
Vaccine AE warnings added to screening documents for selection
Lessons Learned
Therapeutic review and guidance for an entity and a pandemic not seen before requires significant human resources to vet
hundreds of citations and build consensus.
A network wide guideline posted to institution specific intranet sites to accommodate resources of size and demand is an
achievable goal with regularly scheduled meetings.
Version control and edits can be daunting
The process of review and utilization reports revealed the potential for reflexive prescribing
Next Steps
Continue network collaborations across the CoVID 19 trajectory, vaccines and preventive therapies.
Determine ways to communicate more broadly and efficiently
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Roger Shapiro
Katy Stephenson
Ryan Chapin
Sabrina Tan
Margaret Hayes
Howard Seth Gold
Christopher McCoy
COVID 19 Treatment Collaborative
Department
Any departments listed on the poster or identified in the spreadsheet.
Infectious Diseases
Pharmacy
Critical Care Medicine
Health Care Quality and Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Development of a Living Guidance Document for the Therapeutic Evaluation and Treatment of Patients with COVID-19
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e77164b53da3fa18ca9587ea3c0e065c.pdf?Expires=1712793600&Signature=e81apZEKzBdMnz-NAjnpzG1ueo%7Er8gwu6FvgsK-xfHMD0V7Hxb%7E1X7ZJbFaVGkRIBoJQ07uT340%7EZ7A%7EqKYUyDZOV-PZUBRKi3%7ECxHT4xhI74AjpTQezkVgKpODyDLQ2%7EEygFBDYvGg0nD70dzr7UU%7ElKjoFSbgKSk4hBu98mRBkXHOcRxNlPdmUjAWMkFv2bANoYqdm5vm8Rbt8HC1zC6TmhI3wVR3KfUQomPVs3G7AbgIzr%7EQHppaOIvW9hE5Ky1FfbVZ%7EpAdTdBM6N5gUm5phjvGBjSPV%7EuZx6G8gnCf5ZYGwodakoBjWpgUrsEAKaOKE8WrxPT96f%7E8QeCTneA__&Key-Pair-Id=K6UGZS9ZTDSZM
cd6a42c09a2967c2c4767321243d6398
PDF Text
Text
Large-Scale In House Production of Viral Transport Medium and 3’ N95 Mask Disinfection Using Universally Available Materials
VTM: Kenneth P Smith1,2 , Annie Cheng1, Amber Chopelas#1, Sarah DuBois-Coyne#1,3, Ikram Mezghani#4, Shade Rodriguez#1, Mustafa Talay#5, James E Kirby6,2 1Dept. Pathology, BIDMC, 2HMS, 3Depart.
Biochemistry, U MA Boston,4Dept, Surgery, BIDMC, 5Dept. Molecular & Cellular Biology, Harvard University, #Contributed equally. N95 Mask: Katelyn E. Zulauf,#a,b Alex B. Green,#a Alex N. Nguyen Ba,c
Tanush Jagdish,d,e Dvir Reif,f Robert Seeley,g Alana Dale,g and James E. Kirbyh; aDet. Pathology, BIDMC, bHMS, cDept. Organismic and Evolutionary Biology, Harvard University
dProgram for Systems, Synthetic, and Quantitative Biology, Harvard University, e Center for Computational and Integrative Biology, MGH, fDepart. Molecular and Cellular Biology, Harvard Univ., gEnvironmental
Health and Safety Department, BIDMC, h,6Corresponding author, #Contributed equally.
Viral Transport Medium (VTM) for SARS-CoV-2
diagnostic laboratory testing– NONE available!
N95 mask disinfection for reuse
SARS-CoV-2
Nine personnel in two isolated
VTM production teams
Sourced available pre-sterilized
medium (HBSS, FBS,
antibiotics), CDC VTM recipe
with added phenol red for visual
QC
MS2 phage – tougher
RNA virus surrogate
4000
per day
Sourced tubes from donors
around Boston (until commercial
supplies available)
Titering MS2 virus plaques
Tissue culture rooms in CLS6
(8 biosafety cabinets)
Liquid handling automation
KP Smith, PhD, with permission
Rock climbing tape (donated) to
prevent repetitive use injury
Accelerated stability testing
Arrenhius equation –
pharmaceutical approach
2 weeks to predict >4 month
room temperature outdate,
sterility, robust support of
SARS-CoV-2 RT-qPCR
Daily QC (each run/lot)
Ref: JCM. PMC7383539
12 member kit assembly team
(added 3-D printed swabs et al.)
in Leventhal Conference Room
>100,000 VTM
collection kits for all
of BILH. Production
March –June 2020,
used into fall of
2020.
Method
1. Add concentrated M2 RNA phage virus to mask.
2. Glass dish, 1/4 cup water, grocery store web
mesh, rubber band, microwave 3 minutes
3. Count phage plaques (number of viable virus
remaining) compared with no treatment control
1.
2.
3.
4.
5.
Ref: mBio. PMC7317796
>150,000 downloads
MS2 phage = norovirus >> tougher than
SARS-CoV-2
> 6log10 MS2 virus titer reduction.
Performed 20X without loss of N95 fit
or filtration
Battelle vaporized hydrogen peroxide
system: >$ 6 million, centralized
Microwave decontamination, point-ofuse, <$10 setup using existing
microwave
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
James E. Kirby <a href="mailto:">jekirby@bidmc.harvard.edu</a>
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kenneth P Smith
Annie Cheng
Amber Chopelas
Sarah DuBois-Coyne
Ikram Mezghani
Shade Rodriguez
Mustafa Talay
James E Kirby
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
Surgery
Environmental Health and Safety
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
Large-Scale In House Production of Viral Transport Medium and 3’ N95 Mask Disinfection Using Universally Available Materials
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Environmental Sustainability
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/47d07ae0897abff317ec841a89f78ebb.pdf?Expires=1712793600&Signature=d05lXgLtDTlC6M%7EUKaj0loIxB6yYQcgyAV%7E3F1UOMbQqRS2yEukmrsmbyzYjhG7FOLh6HtXrKeRUXOEGeCzXqZft38tZrG4VBUOQrTwE0i75wAjgNSOHXWWh9S3wQKSTK9qcSI3Hmai0UCHNtw6pvJ%7Ehoe796rs8MOI50oJbP62WU18M08JIYAFCboVJtUl18bv6sDXrmMKdOoCoq7tR3nvDkeCLqE5SYMNKHq0WmjltWfEjfYvdRb7BXOCjf1jw9b1dAdFBSv6M5imiYnR%7EXs3BBflMmcvTvW0Z-CCS9wF51MFmjlVzbbd3hoiHZqKCrvKnN29GCWliE%7EIregd70w__&Key-Pair-Id=K6UGZS9ZTDSZM
983b2fde039858475cc30617371dfc59
PDF Text
Text
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
Introduction/Problem
When the COVID-19 Pandemic began, obtaining essential supplies from existing supply chain channels
became an urgent challenge due to significant shortages in supplies. At the same time, there was an
influx of support from community volunteers and alternative manufacturers that needed and wanted to
pivot from their traditional products and apply a variety of technologies and skills to producing products in
response to COVID-19. The volume of innovations coming to the surface required a team and a process
to effectively catalogue, test, source, and ultimately add alternatively sourced products to supply chain for
purchasing.
Aim/Goal
The goal of this work was to alleviate the shortages of essential supplies that were in short supply during
the COVID-19 surges, and create processes to be more prepared with alternative supply changes for
subsequent pandemics or other major public health emergencies.
The Interventions
Coordinated BILH system-wide sourcing & testing of alternative PPE
Developed and implemented BILH evaluation algorithm for PPE sourcing
Provided business and legal guidance for alternative RT-PCR kit sourcing
Provided business and legal guidance for open source 3D printed swab project
Communicated BIDMC PPE needs to COVID-19 Massachusetts Manufacturing Emergency
Response Team (M-ERT)
Brought >20 alternatively sourced products into the BILH supply chain
Results/Progress to Date
The Team
Administrative Project Team
• Emilie Downing, BS; Director of Market Analytics & Intelligence, BILH
• Catherine Gill; Senior Research Administrator, BIDMC
• Andi Hernandez, BA; VP of Research Operations, BIDMC
• Olivia Potvin, PhD; Research Program Manager, BIDMC
• Gyongyi Szabo, MD, PhD; Chief Academic Officer, BIDMC and BILH
• Eleanor Torrey, MPH; Senior Project Manager, BIDMC
• Tod Woolf, PhD; Executive Director of Technology Ventures Office, BIDMC
Research, Clinical, and Administrative Contributors
• Ramy Arnaout, MD, DPhil; BIDMC
• Sana Ata, MD; Lahey Hospital
• Alana Dale, BA; BIDMC
• Abby Flam, MCP; BIDMC & Atrius Health
• Heung Bae Kim, MD; BCH
• James Kirby, MD; BIDMC
• Jeffrey Lamson, BS, RN; BIDMC
• Stanley Lewis, MD; BILH
• Chip McIntosh, NP, PhD; BILH
• Phillip Mears, MHA, JD; BILH
• Christopher Minette, MBA; BIDMC
• Peter Shorett, MPP; BILH
• Thomas Siepka, RPh, MS, FASHE; BIDMC
• James C. Weaver, PhD; Wyss
• Marten H. Wolckenhaar, MD; Lahey Hospital
• Sharon B. Wright, MD, MPH; BILH
• Mark Zeidel, MD; BIDMC
1. COVID -19 Innovation Hub. Alternative manufacturing and methods project categories:
1) PPE Products, 2) PPE Sterilization for Re-Use, 3) Ventilators (parts, repair and novel simplified
designs), 4) Assays (COVID PCR and serological assays), and 5) Therapeutics and Vaccines (discovery
research and clinical trials).
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
2. Community Support Overview.
3. BILH Evaluation Algorithm for PPE Sourcing. The BILH COVID-19 Innovation Hub 1) organized the
flow of PPE donations, and had the PPE evaluated for suitability, and 2) consolidated requests and
sources of PPE from pivoted manufacturers and tracked which items could be cleared for use at BILH.
4. Covid-19 Diagnostics. 1) James Kirby at BIDMC quickly developed a Q-PCR assay with a local
company that was used early in the pandemic and other area hospitals for clinical diagnosis of COVID-19
when CDC tests were unavailable (not shown here). 2) A multidisciplinary team of experts led by Ramy
Arnaout at BIDMC collaborated with 3D printing companies and other Medical Centers to develop open
source 3D printable swabs used for COVID-19 testing (above).
5. Alternative N-95 Elastomeric Respirator from BCH/Wyss/BIDMC. This alternative respirator was
developed with readily available locally sourced filter modules and a 3D printed adaptor. The product was
found to be effective, but was not deployed as it was not NIOSH approved.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
6. Massachusetts Manufacturing Emergency Response Team (M-ERT). Mark Zeidel and Tod Woolf
communicated BIDMC PPE needs on weekly M-ERT conference calls. Our work with the Covid-19 MERT had an impact in Massachusetts and beyond, and the M-ERT has been cited by government officials
as a model for innovative manufacturing responses to emergencies.
8. Summary. Our Innovation Hub reviewed over 156 alternatively sourced items, with >20 items passing
the evaluations and being approved to enter the BILH supply chain. We have established work flows for
evaluating novel supply chains during future emergencies.
Lessons Learned
7. Alternative Manufacturing of Disposable Face Shields from Lacerta. James Weaver from the Wyss
Institute led this project (https://wyss.harvard.edu/news/seven-million-face-shields-and-counting/). These
masks were produced at very large scale (millions) by local manufacturer of food packaging (Lacerta).
We coordinated with environmental health at BIDMC to have these evaluated and they were added to the
BIDMC supply chain.
We learned that making products which require governmental approval is quite challenging, and
requires input from regulatory agencies, engineers, environmental safety and end users. Some
items, like face shields and ethanol hand sanitizer, were relatively easy to find alternative sources,
but complicated items like the specialized materials used in N-95 masks was much more difficult and
time consuming to obtain from alternative manufacturers.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tod Woolf <a href="mailto:%20">woolf@bidmc.harvard.edu</a>
Project Team
Emilie Downing
Catherine Gill
Andi Hernandez
Olivia Potvin
Gyongyi Szabo
Eleanor Torrey
Tod Woolf
Ramy Arnaout
Sana Ata
Alana Dale
Abby Flam
Heung Bae Kim
James Kirby
Jeffrey Lamson
Stanley Lewis
Chip McIntosh
Phillip Mears
Christopher Minette
Peter Shorett
Thomas Siepka
James C. Weaver
Marten H. Wolckenhaar
Sharon B. Wright
Mark Zeidel
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Tech Ventures
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
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/46667bf0ba7d16a0b0ca4b7d3fc67105.pdf?Expires=1712793600&Signature=noGyre2cykO0STGoaegBNNtA6V8qGnl5aB3zHzic196o7KoAIYHJHF0LoV9ZPFiEvnmaMVyJjr3smHHD3hpVDR2F4efaL40FVVbs95AjjOlaLwrV8shUIc1VQTn6gqd80etnV0mpLmEmLYCc3rMy0k8uL6ptDQeh3lDymLvAVOWgokg2nGoIyMzLz1DUT2XMIIopXTc%7EOC7TBRgT14ZTZyypEnBCIoDoyyHO6JU99%7EKUFpg7TFRwdfwtKVt%7E5pFOeZogYhYHRjt95%7E1KTtgem6eQNL2rM0qsvk8NzeoiWMolav%7EZUnal1IO5KGheLNRQDop8FSPL60fgSLJyVqdqkQ__&Key-Pair-Id=K6UGZS9ZTDSZM
a73135d6dd6939caa6a88e1a94e37e3e
PDF Text
Text
COVID-19 Staff Vaccine Clinics
#Thisismyshot
Allison Wang, Lori DeCosta, Mo Ortega, Liz Haftel
Results
Background
•
•
•
•
As COVID-19 became a worldwide pandemic, urgency
for a vaccine became paramount as hospitals were
overwhelmed
The COVID-19 vaccines were the first brand new
vaccines to be granted an Emergency Use Authorization
(EUA) in the USA
In conjunction w/ EUA approval, we rapidly planned &
setup COVID-19 vaccine clinics for staff while dealing
with widespread supply/staffing shortages
Multi-disciplinary effort w/ coordination across ~15
departments (see next slide for team)
Planning & Implementation
Logistics
• Hospital Incident Command System (HICS) Structure
enabled rapid collaboration & streamlined decision
making and authority
• Space- Vaccination clinic location needs & considerations
(i.e. Social distancing, observation space etc.)
• Prioritization Scheme – based on federal/state /BILH
guidelines
• Day of Clinic - Designed new workflow
& simulated to increase efficiency
Planning & Implementation (cont.)
Figure 10
Figure 2
Nov
2020
Figure 6
Shapiro 10 Flow &
Signage Walkthrough
Figure 5
12/1 12/2 12/3 12/4 12/5 12/6 12/7 12/8 12/9 12/10 12/11 12/12 12/13 12/14 12/15 12/16
Pfizer
Submits EUA
Pfizer EUA/DPH
Approval
Moderna
Submits EUA
•11/30 –
Planning kickoff
Combined
Clinics 2/15
Pfizer Shapiro 10
Clinic Go-Live
•Prioritization sent to managers
•COVAX testing & schedule build
•Clinical protocols
Scheduling
Open to Phase 1
12/28
Moderna Shapiro
3 Clinic Go-Live
Clinic
Simulation
Figure 3
Design Session
Figure 9
Figure 7
Figure 4
Figure 11
* Refer to figure appendix on slide 3
Feb/Mar
2021
Moderna EUA/
DPH Approval
Figure 1
Supply
• State & BILH allocation management & strategy
• Vaccines –medication storage/delivery process/prep, etc.
• Medical and non-medical supplies
IT Processes
• COVAX - Scheduling System – how to integrate systems
that didn’t talk to each other
• Agility -EOHS
Jan
2021
Outcomes
Figure 8
Figure 12
Staffing
• SOPs/ Standing Orders/ Reactions & Contraindications
• Training - vaccinators/observers/front desk staff/
manager
• Innovative use of Labor Pool
Communications
• Signage and media relations
• Staff outreach & education
• Interpreter services (iPad & multi-language docs.)
Continuous Improvement
Managing a Variety of Challenges & Barriers
• Day-to-day supply instability (i.e. supply allocations,
Walgreens extra doses etc.)
• Sourcing proper equipment (i.e. Ultra cold storage, 1
ml syringes, research space usage etc.)
• Phased vaccine rollout troubleshooting
• Collaboration across BILH as a NEW hospital system
Check & Adjust
• Frequent reassessment of operations as new approvals
and guidance was released
• Strategies to reduce or limit vaccine waste
• Continuously adjusted capacity to increase
appointment access for staff
• Open 2nd clinic/Combined clinics
Sustainment
• Patient clinics & inpatient vaccinations
• Vaccine hesitancy work
• DEI campaigns
• Partnership w/ Red Sox for vaccine clinics
• Boosters
Created By: Allison Wang
Last Updated: 10/28/2021
�COVID-19 Staff Vaccine Clinics
#Thisismyshot
Allison Wang, Lori DeCosta, Mo Ortega, Liz Haftel
Team Members
The Teams Who Made This Happen!
The Clinics
Collaborators for Poster
•
Allison Wang & Jasmine Cline-Bailey (I2 - Improvement
and Innovation)
•
Lori DeCosta (Clinical Nutrition)
•
Mo Ortega (EM - Emergency Management)
•
Peggy Stephan, Liz Haftel, Julie Lanza (Pharmacy)
•
Matt Rabesa (Employee Health Management)
•
Dr. Mary LaSalvia (HMFP)
Additional Key Departments
Larry Markson, Carolyn Conti, Jim Arrington, Venkat
Jegadeesan & Team (IS)
• Jarrod Dore & Team (Facilities)
• Buzzy Abrha, Gordon Howard, Jinkyu Lee, & Vaccinators
(Pharmacy)
• Kyle Franko (Communications)
• Sarah Moravick & Kristin O’Reilly (I2)
• Declan Carbery (EM)
• Bridgid Joseph (Emergency Procedures)
• Brian Bertrand & Eric Acevedo (Distribution)
• Lori Cunningham & Team (Human Resources)
• Paula Stering (Clinical Advisor)
• Dr. Ed Ullman (Medical Director Fenway Clinics)
• PCS & Retired Nurses
• HMFP
• Vaccinators
• ID
• EVS
• Food Services
• BILH
And so many more….!
•
Created By: Allison Wang
Last Updated: 10/28/2021
�Figure Appendix
Figures (1-12):
1.
Draft of an iteration of the vaccine clinic flow
2.
Draft of the vaccine clinic setup
3.
Phasing from Gov. Charlie Baker’s Massachusetts vaccine distribution plan
4.
Brainstorming from the Design session on clinic throughput scenarios
5.
Staff Member getting vaccinated
6.
Pharmacy technicians prepping vaccines
7.
Acting out an emergent scenario during the simulation of the clinic prior to opening
8.
Simulation scenarios used to practice and work through issues prior to opening
9.
Construction of Shapiro 3 Moderna Clinic
10.
Color coding of Pfizer vs. Moderna syringes to prepare for combined clinic
11. Progression
12.
through BILH Phases (Sarah Moravick Leadership Presentation 1/25/21)
Stats (Sarah Moravick Leadership Presentation 1/25/21)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Allison Wang (<a href="mailto:aswang@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">aswang@bidmc.harvard.edu</a>)
Project Team
Allison Wang
Lori DeCosta
Mo Ortega
Liz Haftel
Peggy Stephan
Matt Rabesa
Jasmine Cline-Bailey
Julie Lanza
Mary LaSalvia
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Improvement and Innovation
Clinical Nutrition
Emergency Management
Pharmacy
Employee Health Management
HMFP
Information Systems
Facilities
Communications
Emergency Procedures
Distribution
Human Resources
Clinical Advisor
Fenway Clinics
Environmental Services
Food Services
BILH
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Staff Vaccine Clinics
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/81f2187ca92e086e0344033b61ff7daf.pdf?Expires=1712793600&Signature=obHg82pop0rrIx8WAZgIvMa5XIKWC9lZLRPtOQGYEekcypo4sz8M5W7xjJw6VYHJHaebw5yZweV9b0g3kxsxhqwV1nEdnU2ovJSQVGIvaHV2914vJPHGuTd3P0VlnOwU83GtpynugdgNXtbHnR6v4KGhuhsSOniAwwp0%7E302fId2IqotpTCzPbH1kk5CGjJLbPq1p6pzkyFxiLSplzlrGkDpb0zJi8CSux496RMT5AaQFzVprK1XYV8svhCRVOdau0p8%7EWgjVi01gnlS7LeF5Tm5dLWtgBZ3Cz-QS3XWYehUyOUbB59sfDEjfKsDX0uPeTAcon5hBZD9ck8ivjManA__&Key-Pair-Id=K6UGZS9ZTDSZM
e03ba8654f0aa704eba32c3fc03838b8
PDF Text
Text
Telehealth Consultations for Traumatic Brain Injury
Neurosurgery: Dr. Martina Stippler (Neurosurgeon and the Director of Neurotrauma at BIDMC, Senior Author) Dr. Ron Alterman (Chair Neurosurgery)
Emergency Medicine: Dr. Carlo Rosen (Executive Vice Chair BIDMC), Dr. Jonathan Anderson (Chief BID-Milton), Dr. Bryan Stenson (Associate Director BID-Needham), Dr. Kyle Trecartin (Associate Director BID-Plymouth)
Introduction/Problem
The Interventions
• Traumatic brain injury (TBI) leads to an estimated 2.5 million emergency department visits annually1.
• The majority of cases are mild (Glasgow Coma Scale, GCS, of 13-15)
• The increasing use of CT scan has identified increasing numbers of patients with mild TBI with
associated intracranial hemorrhage, known as complicated, mild TBI (cmTBI)
• An ED observation pathway was implemented at BIDMC to reduce admissions of cmTBI2
• 138 patients enrolled and analyzed
• 113/138 (81.9%) discharged home
• 91/111 (81.9%) transferred from outside hospitals subsequently discharged home
• Seven (5.1%) return visits to the ED within 7 days; three (2%) related to the cmTBI
• No patients required neurosurgical intervention
1) American College of Surgeons. ACS TQIP Best Practices in the Management of Traumatic Brain Injury.; 2015.
2) Singleton JM, Bilello LA, Greige T, et al. Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage. Am
J Emerg Med. 2020. doi:10.1016/j.ajem.2020.08.093
Aim/Goal
1) Implement Tele Brain Interprofessional Consult (TBIC) to triage patients with cmTBI at the Beth Israel
Deaconess Community Hospitals in order to triage patients for local care or transfer to BIDMC
2) Decrease the transfer rate for cmTBI from the Beth Israel Community Hospitals within 3 months of
implementation
The Team
Neurosurgery: Dr. Martina Stippler (Neurosurgeon and the Director of Neurotrauma at BIDMC,
Senior Author) Dr. Ron Alterman (Chair Neurosurgery)
Emergency Medicine: Dr. Carlo Rosen (Executive Vice Chair BIDMC), Dr. Jonathan Anderson (Chief
BID-Milton), Dr. Bryan Stenson (Associate Director BID-Needham), Dr. Kyle Trecartin (Associate
Director BID-Plymouth)
A. Inclusion Criteria
–
GCS 15 (14 if intoxicated)
–
Minor CT findings of traumatic head injury:
•
Traumatic SAH
•
SDH < 1 cm
•
Contusion without midline shift or mass effect
•
Skull fracture without associated ICH
B. Indications for Transfer
–
ED attending or neurosurgeon discretion
–
Any focal or lateralizing neurologic deficit
–
Epidural hematoma
–
Skull fracture with ICH
–
Post-traumatic seizure
–
Any anticoagulation or anti-platelet agent (excluding aspirin)
–
Signs of basilar skull fracture with CSF leak
C. Responsibilities of the telehealth neurosurgeon
–
Telephone consultation initiated by ED attending with neurosurgery attending
–
Discussion of history and neurologic exam findings
–
Neurosurgical attending reviews images
–
Neurosurgical attending writes a note in Meditech
D. Medical treatment then provided, as necessary, at the Beth Israel Community Hospital
For more information, contact:
Kyle Trecartin, MD, Associate Chief of Emergency Medicine Beth Israel Plymouth, ktrecart@bidmc.Harvard.edu
�Telehealth Consultations for Traumatic Brain Injury
Neurosurgery: Dr. Martina Stippler (Neurosurgeon and the Director of Neurotrauma at BIDMC, Senior Author) Dr. Ron Alterman (Chair Neurosurgery)
Emergency Medicine: Dr. Carlo Rosen (Executive Vice Chair BIDMC), Dr. Jonathan Anderson (Chief BID-Milton), Dr. Bryan Stenson (Associate Director BID-Needham), Dr. Kyle Trecartin (Associate Director BID-Plymouth)
Results/Progress to Date
Table 1. Descriptive Statistics
Total Cases
19
Age
71 (Mean)
Female
12
Chief Complaint
Fall
14
Motor Vehicle Collision
2
Syncope
2
Assault
1
CT Findings
Subdural Hematoma
9
Subarachnoid Hemorrhage
8
Intraparenchymal
2
23-98 (Range)
63.2%
73.7%
10.5%
10.5%
5.3%
47.4%
42.1%
10.5%
Figure 1. Disposition
21%
Home
Skilled Nursing Facility
11%
68%
•
•
•
•
•
•
No patients required transfer to BIDMC
Only 1 patient on aspirin
All patients that were admitted were admitted for a non-TBI related reason
No patients were readmitted within 30 days
No patients died within 30 days
No patients needed neurosurgical intervention within 30 days
Lessons Learned
Telehealth consultations for cmTBI are safe and effectively avoid transfer to a tertiary care center
Consults were successfully carried out by inpatient teams as well (ex. fall while in the hospital)
Different EMR platforms within the network creates challenges for documentation and scan review
Credentialing of the neurosurgical consultant at each site was the most significant hurdle
Next Steps
Advocate for universal credentialing system across BILH
Ensure billing supports a sustainable system
Expand to all hospitals in the BID Network
Expand to include other neurosurgical issues (ex. non-traumatic hemorrhage, spine pathology etc.)
Expand to other specialties
Admitted to Community Hospital
For more information, contact:
Kyle Trecartin, MD, Associate Chief of Emergency Medicine Beth Israel Plymouth, ktrecart@bidmc.Harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kyle Trecartin (<a href="mailto:ktrecart@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ktrecart@bidmc.harvard.edu</a>)
Project Team
Martina Stippler
Ron Alterman
Carlo Rosen
Jonathan Anderson
Bryan Stenson
Kyle Trecartin
Department
Any departments listed on the poster or identified in the spreadsheet.
Emergency Medicine
Neurosurgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID-Milton
BID-Needham
BID-Plymouth
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Telehealth Consultations for Traumatic Brain Injury
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/9cade9f5bfe0cb9f6780971a605e5d00.pdf?Expires=1712793600&Signature=B6rXqw6RU%7E9WcuebyzZYT0pHHiHFR5SwsVBpiuvAD0Rf3CeDl86LfqAk5O5CtVwXZjsiqivrp9T%7EjB17com60MXS3vHoba3xir%7EogdO3sPOYQMtlBz%7E1PLKS7WER7wF7T93i6ExCX-coz%7EYSmpEfJT6oN-Puocv7JQuKqBvJyJ6OKvjhwoHb61ESa8ivckmhauNLamnJMDBpSUyXLE7Niwb6QCUqqscOb-4ij7eRQTEN-T1h-7fMbeX34xefbs9KG1f6gJMXhXJdg1EJYNH7g8ai-GhO8ApcC9lPRO93bgXmj-79FxraB6OO3c1iYT-hj1Uu7qW5B8gl7hUyn9FKhw__&Key-Pair-Id=K6UGZS9ZTDSZM
fb6ce74aade0da53c16e9fc2257df6df
PDF Text
Text
Measuring Economic Gains for Telehealth for Primary Care Patients, Providers, & Hospitals
Catherine M. Ternes, Senior Project Manager, BIDMC-Healthcare Associates
Introduction/Problem
The Interventions
Out of necessity, HCA went from 0% to 90% telehealth in one weekend in March 2020. Now that we are
emerging from the pandemic, there are critical learnings for our practice and the broader
BIDMC/HFMP/BILH system we should heed moving forward.
Estimates of the annual economic loss of in person care for patients, providers, and the hospital were
calculated using a combination of primary, secondary, and tertiary sources. The data were pulled from the
real-life experiences of the patients and providers of HCA between 2019-2021, and validated using
external scientific articles and reporting on the impact of telehealth on primary care, before and after the
COVID-19 pandemic.
Telehealth represents the greatest opportunity for radical redesign in health care since electronic health
records. Primary care is particularly well-positioned to benefit from widespread telehealth utilization due
to diversity in cases and increasing focus on chronic care management, behavioral health, which can be
done remotely However, there are two primary weaknesses in BIDMC/HCA’s current approach to
telehealth: 1) Insufficient investment has led to inefficiencies which make telehealth more time-consuming
for providers than in person care and 2) A gap in proactive outreach, education, and customization means
the most vulnerable patients, who are also most likely to benefit from telehealth and whose lack of care
continuity and/or access to primary care contribute significantly to inefficiencies in the system, are at risk
of underutilizing it or not using it at all.
Aim/Goal
The aim of this research was two-fold: First, we wanted to better understand the realities of telehealth at
HCA during the COVID-19 pandemic. We wanted to get some quantitative data and qualitative analysis
around how the system was performing and what some of the barriers were for patients and providers.
The second goal of the research was to begin to develop a basic method for estimating the financial cost
of not having telehealth for patients, providers, and the hospital.
Results/Progress to Date
Process map of in
person care experience
showing MassHealth
patients (10% of HCA)
spend an additional 261
minutes (4.4h), more
than double the time
spent by nonMassHealth patients
(90% of HCA), who
spend 130 minutes
(2.1h)
The Team
Catherine M. Ternes, Principal Investigator, General Medicine, BIDMC-Healthcare Associates
Marc L. Cohen, MD, Senior Sponsor, General Medicine, BIDMC-Healthcare Associates
Kayla Tremblay, MBA, PMP, Senior Sponsor, General Medicine, BIDMC-Healthcare Associates
Ravi Shankar Chaturvedi, MIB, MBA, PhD, Advisor, Tufts University, Fletcher School of Law & Diplomacy
Process map of virtual care experience
showing all HCA patients spend an
additional 10m for a 20m telehealth
appointment
For more information, contact:
Catherine M. Ternes, Senior Project Manager, cternes@bidmc.harvard.edu
�Measuring Economic Gains for Telehealth for Primary Care Patients, Providers, & Hospitals
Catherine M. Ternes, Senior Project Manager, BIDMC-Healthcare Associates
More Results/Progress to Date
HCA providers spend an additional 22m for a 20m in person visit compared to 28m for a 20m telehealth visit. With
investment in telehealth technology and support staff integration, providers could reduce time spent to just 20m.
Analysis of five common post-COVID scenarios regarding availability of in person vs. virtual care
and associated economic impact on patients, providers, hospital, and state economy.
Lessons Learned
-
Financial impact is an important metric to capture but one which is not as readily available as other
measures
Process maps are powerful visualizations and conversation starters
There are subsequent opportunities for research (publication) and improvement (Linde, CRICO grant)
Private companies, from startups to major institutions, are pivoting towards virtual primary care.
BILH/BIDMC needs to decide whether to collaborate or compete.
Recommendations
-
Calculation of savings to patients, providers, hospital, and state economy by going from 0%
telehealth (pre-COVID environment) to 25% telehealth (Most likely post-COVID environment).
Formally embed telehealth as a pillar of care
Pursue collaborations with public and private partners
Invest further to reduce provider inefficiencies
Better telehealth experience will enable us to not only operate more efficiently but also offer a way to
care for more of the most vulnerable patients.
For more information, contact:
Catherine M. Ternes, Senior Project Manager, cternes@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Catherine M. Ternes (<a href="mailto:cternes@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cternes@bidmc.harvard.edu</a>)
Project Team
Catherine M. Ternes,
Marc L. Cohen
Kayla Tremblay
Ravi Shankar Chaturvedi
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Healthcare Associates
Tufts University, Fletcher School of Law & Diplomacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Measuring Economic Gains for Telehealth for Primary Care Patients, Providers, & Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c7a2573acfc20a9ed3efa005c41687c7.pdf?Expires=1712793600&Signature=WCFbWsn%7E5gRdjXeWHTZKQSSwYlJ%7EnYp8OIXd7QonoiT7Edx3kx3Lsfk3AtyHNv6Ns57jBNvkIUhCQEM0-6TqjEfTWwD5xVQh4Q4btblVfo-0ffNI0N0sFEhI5HX4Wu1bEE64GKCBesLBh951d-UQ8WZ1yw%7EUc3PPdMSTzGUZB%7EjbZlH0O73IIpWrHqOXltUF171obXTkFRWHpWxjRpurgNq7UwDBRkycceK14VuseaYZ7ypXbYPvMgMlAz8DezQXvHh1Yb3tMJaCWjB79LQgRGCDWMSBCe7updoxXt-asX5-xjeHH4jNyngOsrKBjacGt73bErPaX4qi6baKgmg1Bg__&Key-Pair-Id=K6UGZS9ZTDSZM
c8481cdd573f037f539b955c8e8808b1
PDF Text
Text
Rapid Cycle Implementation and Retrospective Evaluation
of a SARS-CoV-2 Checklist in Labor and Delivery
L Zucco, N Levy, Y Li, T Golen, S Shainker, P Hess, C Stewart, S Nabel, SK Ramachandran
RESULTS
INTRODUCTION
• The redesign and implementation of a perioperative workflow for obstetric patients was necessary in preparation for
a COVID-19 outbreak.
• L&D units are unique perioperative areas as they are designed to create a shared experience for family members.
Labor rooms, nursing stations and ORs are often within close proximity, resulting in overlapping foot traffic.
A single COVID-19 parturient presenting for care would pose significant risk of viral exposure and spread, especially
if emergency cesarean delivery was required.
• The Consolidated Framework for Implementation Research (CFIR) is often used post-implementation of an
innovation to retrospectively assess factors influencing implementation successes and failures. However, there are
few studies on factors influencing implementation outcome in the setting of rapid change to manage pandemic
spread within hospital units.
• Analysis of factors influencing implementation using CFIR
revealed domains of process and innovation characteristics as
overwhelming facilitators for success.
• Constructs within the outer setting, inner setting, and
characteristics of individuals (external pressures, baseline culture,
and personal attributes) were perceived to act as early barriers.
Facilitators of Implementation of L&D Workflow
8%
Process
31%
34%
Innovation characteristics
Inner setting
Characteristics of individuals
• Constructs such as communication culture and learning climate
shifted in terms of their influence over time.
27%
CFIR Domains Influencing Implementation of L&D Workflow
STUDY AIM: Identify factors that influenced implementation of perioperative workflow for care of COVID-19 parturient
by performing a retrospective analysis using The Consolidated Framework for Implementation Research (CFIR)
Charcteristics of Individuals
60%
40%
Outer Setting
METHODS
Inner Setting
64%
13%
Process
7%
88%
10%
0%
• Rapid cycles of real time testing, focused debriefing, and
on-site walkthroughs were carried out over a two week
period with obstetric, anesthesia and perinatal team
members, to identify areas of optimization (Fig 1).
25%
29%
Innovation Characteristics
• A novel checklist was created for use in real-time as a
cognitive aid for the perioperative care of a COVID-19
parturient.
80%
10%
20%
Barrier
30%
40%
Facilitator
50%
10%
60%
70%
80%
90%
100%
No Effect
DISCUSSION
• To identify factors influencing implementation, retrospective
analysis was done using the Consolidated Framework for
Implementation Research (CFIR). CFIR classifies intervention
characteristics defined by operational domain, that have
been shown to influence implementation success.
• Assessment of the implementation experience was ranked
by a panel of 6 experts from the departments of Obstetrics,
Anesthesia and Quality and Safety. A group deliberation
approach was used because of the extensive history of
collaborative work that existed in the L&D unit.
75%
• Process implementation and innovation characteristics were overwhelming facilitators of implementation. We
believe that transparency in the development and implementation plan along with the design and content of the tool
were significant influencers.
• Constructs within the inner setting like implementation climate and readiness for implementation likely acted to
support the time pressure. We believe that clarity in the prioritization and readiness of senior leadership to support
this innovation facilitated its rapid change implementation.
Figure 1. CFIR Consolidated Framework for Implementation Research
• Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into
facilitators once a perceived benefit was experienced by healthcare teams.
• These key factors provide important information for the implementation of rapid change during a time of crisis.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Catriona Stewart (<a href="mailto:cstewar8@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cstewar8@bidmc.harvard.edu</a>)
Project Team
L Zucco
Nadav Levy
Yunping Li
Toni Golen
Scott Shainker
Philip Hess
Catriona Stewart
Sarah Nabel
Satya Krishna Ramachandran
Department
Any departments listed on the poster or identified in the spreadsheet.
Labor and Delivery
Anesthesia
Healthcare Quality and Patient Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0777f7d7eba4f50ffd56929296e54324.pdf?Expires=1712793600&Signature=hPJ06UbDLtMw1Iqz0fgncBQ-Df9CzHPgiGxUm7trJAd9F-D9nNzzuAEXkSnjHinqzxGv6P5TaQAOv5rk5D00RuN-CmubPU8KJvt9RK-7C-Tt2%7EMmxxNTbxGx6UaKVt9MqVZNqu%7Eb4UotvqNufj%7EiYsZNoJ3YziwUS8NyBPBx02Tgq5r0OFRpzxiz2V%7E1jfV85Ppoz-tw5qdS2oWbmfgjEbSP6ANP5oBKKehtB2Ab%7EbPUBsv1PyJEYMhHxnmv6QSqmvbqxjsEs9K8GhRhvZliD7Cdj4hFfhDe32f25kiBTSuyqhlbYQyFoiVWUnuz2GVHtN1QYPtSB5Aa%7ECXzsrejXw__&Key-Pair-Id=K6UGZS9ZTDSZM
17be930de2a04b14b812b000962ab16c
PDF Text
Text
Basic Research Response during the COVID-19 Pandemic
Andi Hernandez, Vice President, Tanya Santos, Director, and Kim Chun, Project Manager, Research Operations
Beth Israel Deaconess Medical Center
Introduction
In March 2020, the City of Boston declared COVID-19 a public health emergency.
Research Operations was tasked with safely shutting down basic and translational research labs
by instituting new operational protocols and best practices. Only essential research and
maintenance staff were allowed on-site and all non-essential research work was transitioned to
remote. In facilitating the Research shutdown, we recognized the potential in improving our
operational and communications plan for reopening the Research labs in June 2020.
Goal
Our overall goal was to effectively shut down and reopen basic and translational research labs
while ensuring the safety of all Research Employees and animals and regularly communicating
progress with the Research Community.
The Team
Leadership
Gyongyi Szabo, MD, PhD; Chief Academic
Officer, BIDMC and BILH
Andi Hernandez, Vice President, Research
Operations
Research Operations
Tanya Santos, Director, ResOps
Kim Chun, Project Manager, ResOps
Barbara Garibaldi, Director, ARF
Denise Glass, Assoc. Director, ARF
Mark Varhol, Lead Project Manager, ResFac
Lucero Vega, Sr. Project Manager, ResFac
Kim Tablante, Research Administration
Chris Botte, Academic Research Computing
Environmental Health & Safety
Kristin Piticco, Interim Director
Peter Schooling, Safety Officer
Rob Griffin, Biosafety Officer
Research Reopening Planning Committee
Al Charest, PhD, Research Safety
Committee Chair
Steven Balk, MD, PhD – Professor of
Medicine
Jack Lawler, PhD, Professor of Pathology
Leo Otterbein, PhD, Professor of Medicine,
IACUC Chair
Evan Rosen, MD, PhD, Principal Investigator
The Interventions
Interventions in preparation for Research Shutdown
Generated Lab Ramp-Down Checklist, Remote Access to Systems tools for Research Community
Work from Home Assessment/Staffing Survey distributed
Managed the process for research lab donations for Clinical Supply shortages
Managed Redeployment to COVID-19 clinical efforts
Delayed New Hires/Visa Processing
Kept abreast of changing NIH Grant Management guidelines
Continued on-site management/maintenance of labs by Research Facilities
Converted research lab space to Clinical COVID-19 testing and PPE reprocessing facilities
Interventions in preparation for Phased Research Reopening
Hosted Town Hall meetings regularly (2x per month from April 2020 to July 2020) to update Research
Community
Organized a Research Reopening Planning Committee comprised of members of leadership,
Research Operations, EH&S, and Research Community leaders
Discussed and Coordinated timing of Reopening with: BIDMC COVID-19 Command Center, Harvard
University Committee of Research Laboratory Re-Entry, Conference of Boston Teaching Hospitals
group & AAMC Dean’s group
Created a Reopening Survey for completion by the Research Community to obtain feedback about
their safety concerns with returning to the lab
Implemented the Section Chiefs Program to assist in COVID-19 Safety efforts during Reopening
Created the Research Reopening Resources Page on the BIDMC Portal
Created and implemented myPATH Return to Research Training for all returning staff and new
incoming staff during Phase I and Phase II
Produced Research tools: example: checklists, signage, and put engineering controls in place for
social distancing
Opened a direct e-mail line for Return-specific questions: researchreturn@bidmc.harvard.edu
For more information, contact:
Tanya Santos, Director, Research Operations: msantos3@bidmc.harvard.edu
�Basic Research Response during the COVID-19 Pandemic
Andi Hernandez, Vice President, Tanya Santos, Director, and Kim Chun, Project Manager, Research Operations
Beth Israel Deaconess Medical Center
Basic Research Shutdown Timeline
March 15
(Sunday)
Communication
from CAO re:
Shutdown
Preparations for
Shutdown
March 16
(Monday)
• COVID-19
Redeployment
• Animal Welfare
• Essential
Staffing
March 17
(Tuesday)
Guidelines and
Safety Protocols
created and
provided to
Research
Community
March 18
Wednesday
Results
• Staffing Survey Completed
• Remote Work Assess
Guidelines Distributed
•
~118 Labs Shutdown
by 5pm in 3 Research
Buildings
1. Basic Research labs and core facilities were shut down by 5:00pm on March 18, 2020. As shown by
the graphic above, Research was successful in shutting down labs within a 3-day period.
Basic Research Reopening Phased Approach
55 out of 99 Research
employees redeployed
Due to supply shortages,
Laboratory supplies/PPE
donated for clinical needs
Lab Spaces were made available for
COVID-Testing and Masking
Stations while not in use
3. During the Research shutdown, the Research Community contributed to BIDMC’s overall COVID-19
management effort by diverting personnel assistance, supplies, and lab spaces.
Section Chiefs have been identified for larger
open lab units on each floor/section. They are
responsible for coordinating and creating
schedules for shared equipment use and
common areas for eating/breaks as well as
addressing issues and concerns with COVID19 prevention processes.
COVID-19 Safety Officers are responsible for
reporting any concerns with processes within
the lab or shared spaces to Section Chiefs,
appropriately coordinating with the PI
2. Our phased reopening model for Research enables us to adjust on-site research/population density
phase by phase easily with as little disruption as possible. In June 2020, we entered Status Yellow
(Phase I) and after one month, we ramped up to Status Blue (Phase II). The triggers for our gradual
ramp up/down are guided by BIDMC and state and local response to any COVID-19 trends.
4. The Section Chiefs program (~35 individuals) significantly supported and contributed to the Research
Operations team’s effort to safely reopen basic research labs. The Section Chiefs were our “eyes” on the
research floors. They aided in enforcing safety best practices and communicating guidelines to
Researchers.
For more information, contact:
Tanya Santos, Director, Research Operations: msantos3@bidmc.harvard.edu
�Basic Research Response during the COVID-19 Pandemic
Andi Hernandez, Vice President, Tanya Santos, Director, and Kim Chun, Project Manager, Research Operations
Beth Israel Deaconess Medical Center
More Results
5. Throughout the shutdown and reopening period, Research Operations communicated regularly with
the Research Community via virtual Research Town Halls and by re-distributing BIDMC-wide e-mails to
the Research Community highlighting Research-specific instructions/relevance. Town Halls were
recorded and made available on the Portal to ensure everyone had access to the updates. Over the
course of this period, we also generated a number of tools and resources for our Researchers.
Lessons Learned
Researchers want to be heard and are willing to provide feedback
Efforts need to be coordinated with all key stakeholders in order for implementation of new guidelines
to be successful and met with little resistance
Research now has an emergency management contingency plan and a catalogue of tools available
that can be tailored to based on the severity of the situation
Research Operations opened more direct lines of communication & reach to our Research
Community through the implementation of the Section Chiefs program (in addition to our existing Lab
Safety Officer Program)
Next Steps
Continue to monitor/evaluate emergency management contingency plan
Improve tools and resources already available and connect these to the appropriate contingency
levels (See Results #2)
Re-enforce awareness of the available tools and resources contingency plans
Better utilize available resources to strengthen communications with Research Community (Portal,
use of pre-existing templates, distribution lists)
For more information, contact:
Tanya Santos, Director, Research Operations: msantos3@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tanya Santos (<a href="mailto:msantos3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">msantos3@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Gyongyi Szabo
Andi Hernandez
Tanya Santos
Kim Chun
Barbara Garibaldi
Denise Glass
Mark Varhol
Lucero Vega
Kim Tablante
Chris Botte
Kristin Piticco
Peter Schooling
Rob Griffin
Al Charest
Steven Balk
Jack Lawler
Leo Otterbein
Evan Rosen
Department
Any departments listed on the poster or identified in the spreadsheet.
Leadership
Research Operations
Environmental Health & Safety
Research Reopening
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
Basic Research Response During the COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d1101a8db809d083100a9e78481b5cc5.pdf?Expires=1712793600&Signature=ndiBrq0XOQ02dCHpz9SYsHrZ8EiWl%7EBXKuBEVA0nNbaeHBFFpelnsBLwbmzVmj9Dubr6SwnAbMuy34gRUTpDKbAF2vLmmqHzYrvkMTHbykXPsR3GZUC4kxBlzGBk8q49-ELvp1xUOf5NYK-wYAgSIji9Svy5ACzuvjKSVcT1FvDWqLayRhfhynQ6ZPeR3TZ98eyrqKUU%7E18F2DaIwp3ipIEsBUNDIAFeYP64WZA2fVEZsSkDBLG%7ES9JBJIq1rl7NoBu-0IgvH49WPoQOv7txeeMIq1x--lYt1qV9jkGqM1KDDUJeyIydOCFBIhzPCRQPkCA3KSAoupQ1wNWeujJBmw__&Key-Pair-Id=K6UGZS9ZTDSZM
37f1a16237a76043e971634f7a6c911a
PDF Text
Text
Providing Organized Knowledge in Chaotic Times:
Creating a Virtual Exam Room Drawer for HCA
Daniel Z. Sands, MD, MPH
Harvard Medical School, Division of General Medicine, HealthCare Associates
Background
•
•
•
•
•
•
HCA is a large complex primary care practice at BIDMC
40,000+ patients with ~100,000 visits/year by 60+ MDs
and NPs and 100+ residents with embedded mental health
and support services
Most resources printed and available only on-site (Fig. 1)
In March 2020 in-person visit volume dropped rapidly as
clinicians stayed home and the practice transitioned to
virtual visits → no access to printed info or colleagues
Rapidly evolving policies, procedures, and protocols
related to new care models and COVID distributed via email, some available (with delay) on the BIDMC portal,
HMFP website, BILH website, BIDMC’s public website, or
elsewhere
As a result, needed info not available (Fig. 2)
Approach
Results
Author created a web portal for internal use, HCAportal.net (Fig. 3)
Quick, easy, not password-protected, easily usable on mobile devices and off-site
Search functionality to make it easy to rapidly find resources
Uniform look and feel throughout
Rapidly and easily updates from any location
Platform initially WordPress with Google for document management
Content:
• Internal documents and databases and some links to external
• Created database of personal fax numbers that was user-updated
• COVID-related documents
• Telehealth education
• No PHI or other confidential information permitted (no password protection)
• Editing and curation:
• Initially by one person (poster author), which proved inefficient and burdensome
• Later created federated authoring/editing using Google Apps, so key stakeholders could control content
and organization for designated sections of portal (Fig. 4)
• Author (exec editor) responsible for educating and onboarding, as well as promulgating style standards
• Platform evolution:
• Wanted simpler editor, search function, and platform
consolidation, so migrated to Google Sites
• Content evolution:
• Many other resource needs identified
• Added many useful resources from exam rooms
transitioned to digital formats
• Expanded to include new tools and resources, including
directories, referral guidelines, billing resources, and
conference handouts
• Editorial/curation evolution:
• Single editor proved inefficient and burdensome
• Created federated authoring/editing, so key
stakeholders could control content and organization of
sections of portal (Fig. 4)
• Author responsible for educating and onboarding, as
well as promulgating style standards
• Onboarding starts with “Helping” page on portal
• ~500 website uses per week at peak
•
•
•
•
•
•
•
Figure 1: Printed Info in HCA Exam Rooms
Rapidly
changing
information
No casual
interactions
Clinicians
not in
practice
Info not
available
when and
where it's
needed
Discussion
Webmaster &
Executive
Editor
Administrative
Editor
Multiple
distribution
channels
Info pwprotected or
not mobilefriendly
Figure 2: Factors leading to info gaps
Section Editor
1
Figure 3: HCAportal.net
Search function
Editor identified on each page
Info and training for editors
Section Editor
2
Section Editor
3
Figure 4: Federated Authorship Model
• Pandemic highlighted inefficiencies in access to info
resources in HCA à encouraged innovation
• Although started with COVID and remote-care related
resources, through faculty feedback we identified many
other needs
• Federated authorship model key to sustainability
• Online resources make it possible to practice virtually
• The portal has allowed us to think differently about tools
and resources we use in HCA
• The portal remains in heavy use and continues to expand
in scope
• HCA Portal can serve as a model for other clinical divisions
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Daniel Z. Sands (<a href="mailto:dsands@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dsands@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Division of Medicine
Healthcare Associates
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Daniel Z. Sands
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
Providing Organized Knowledge in Chaotic Times: Creating a Virtual Exam Room Drawer for HCA
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/93c5a805a2c7d409d11fce186a16266a.pdf?Expires=1712793600&Signature=opX%7EGD--KmTMFGy8e4%7EsuQTNsRLtA27sT1CgIMXpCEHemBteh8c7NrGjspjCdyO%7EQQ6Z%7E8ufxfKw9BYTLUI5PfguUUl5SQh5QV-ud633dPuwk%7E9T5K-Lxf%7ErAoY5vMBZKayObcDLir9xQuiM8Wzolx6W35enaHoA-%7E1SLH2bzyzvfJwLrtIgcaDLFQt-zHsKqMwHm%7E2SoYclgEQdvGoJR8j%7EtdqsmDHxcInR-yKHlfGVNjaehUnvbu5Xuyvl9-jMyWTNCsBlB9%7EHn-gHKOCUw74HZYHwjVf%7E0BjVe--%7EQf8IjV8tGeV%7EDOwd4fMuAPEkiNs9clIz7wGWKUJrqgAV-w__&Key-Pair-Id=K6UGZS9ZTDSZM
45e2b6b7b407e27bbd58b2e7b8c8b5c2
PDF Text
Text
CLOSED: Closing Loops by Operationalizing Systems Engineering and Design
Talya Salant1, James Benneyan2, Nicole Nehls2, Mark Aronson3, Scot Sternberg3, Gordon Schiff4,5, Russell Phillips3,5, Maria Rivera, DeeDee O’Brian, Meghan Dreilak
1
Bowdoin Street Health Center, Beth Israel Deaconess Medical Center, 2Healthcare Systems Engineering Institute, Northeastern University, 3Division of General Medicine, Beth Israel Deaconess Medical Center,
4
Center for Patient Safety, Brigham and Women’s Hospital, 5Center for Primary Care, Harvard Medical School
Motivation
Objective
• Diagnostic errors in primary care are costly and often are due to failures to follow
up (“close the loop”) on diagnostic tests, referrals, and symptoms
(1) Diagnostic tests and referrals often are not completed
(2) Tests and referral results often are not communicated to patients and PCPs
(3) PCPs frequently are not informed when symptoms evolve, altering diagnosis
• Methodical systems approach to closing loops on diagnostic processes will
measurably improve timely completion from approximately 70% to 90%
Aim to reduce diagnostic errors using systems engineering methods to 1) redesign diagnostic processes (diagnostic testing, specialist
referrals, and symptom monitoring) in primary care and 2) develop highly reliable and generalizable, “closed loop” systems
•
•
•
•
•
•
Conceptual Framework of Project
•
•
•
•
•
•
2021
Problem Understanding
2022
Solution Design & Testing
2024
2023
Solution Implementation
Impact Evaluation
Results
Methods
Problem Understanding
Data analysis of loop closure rates,
timeliness, and disparities
Statistical process control charts to
evaluate stability of process performance
Process mapping using Lean, human
factors, and reliability concepts
Failure Modes Effect Analysis (FMEA) and
Fault Tree Analysis (FTA)
Chart reviews and patient interviews
Simulation modeling of “loop of loops”
2020
Solution Design & Testing
Structural Analysis Design Technique for
design and ideation
Participatory patient-centered design
Quality improvement and health services
research approaches
Process improvement and redesign
Pilot testing and prototyping using
reliability design science concepts
Simulation modeling to evaluate
interventions and impact
•
•
•
•
Loop closure rates and timeliness of loop closure varies significantly based on the department and test site
Process maps highlighted areas most susceptible to failures and in most need of intervention and extra support
Failure analyses emphasized the severity and frequency of the failures identified in the process mapping stage
Structural analysis design technique diagrams and reliability design science concepts helped facilitate process redesign brainstorming
and new thinking which resulted informed potential solutions and pilot tests
SPC Charts
Process map
Rapid cycle pilot testing
Reliability Science Design Pyramid
High reliability
Low reliability
SADT Diagram
For more information, contact:
�CLOSED: Closing Loops by Operationalizing Systems Engineering and Design
Talya Salant1, James Benneyan2, Nicole Nehls2, Mark Aronson3, Scot Sternberg3, Gordon Schiff4,5, Russell Phillips3,5, Maria Rivera, DeeDee O’Brien, Meghan Dreilak
1
Bowdoin Street Health Center, Beth Israel Deaconess Medical Center, 2Healthcare Systems Engineering Institute, Northeastern University, 3Division of General Medicine, Beth Israel Deaconess Medical Center,
4
Center for Patient Safety, Brigham and Women’s Hospital, 5Center for Primary Care, Harvard Medical School
Lessons Learned
•
•
•
•
•
General
Systems engineering approaches have proven to be useful to study complex problems in
healthcare and improve and redesign care processes and outcomes
Improvement of loop closure rates in clinical domains that were heavily impacted by COVID will
have direct clinical and cost benefits
Incorporated equity as a key dimension of quality within our systems engineering will optimize
the generalizability and universality of our proposed systems redesign
Our model of collaboration, which integrates the perspectives of patient advisors, staff, and
experts from disciplinary fields both within and outside clinical care prompts us to be more
innovative and pragmatic
Our multidisciplinary approach to patient safety and quality may serve as a model for future
work in systems redesign
•
•
•
•
•
•
•
•
Solution Design & Testing
Need to consider patient diagnostic and care journey through the loop of loops
Need to find right balance of effort vs reward: Is the juice worth the squeeze?
Higher reward with focusing efforts on upstream processes (efficient, timely scheduling and patient
education) rather than further downstream (rescheduling after DNKAs)
Important to have primary processes that prevent failures for majority (~80%) of patients and
secondary processes to detect failures
Need reliable mechanisms and processes to detect and mitigate for patients with loops not closed
Processes and solutions should put emphasis on patients that providers are actually concerned about
(to reduce staff burden and information overload)
Need to generate more “out of the box” ideas that are still practical given constraints and priorities of
system
Need to operationalize and align sense of urgency between providers and patients
Publications
Benneyan J, White T, Nehls N, Yap T, Aronson M, Sternberg S, Anderson T, Goyal K,
Lindenberg K, Kim H, Cohen M, Phillips R, Schiff G (2020). Systems analysis of a dedicated
ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19
symptoms, Journal of Ambulatory Care Management, in publication. ID: NIHMS1714749
Nehls N, Yap T, Salant T, Aronson M, Schiff G, Olbricht S, Reddy S, Sternberg S, Anderson T,
Phillips R, Benneyan J (2021), Systems Engineering Analysis of Diagnostic Referral Closed
Loop Processes, under review
•Radiology paper under review
What is Systems Engineering?
•
Systems engineering is a structured approach and set of methods to methodically analyze,
design, and optimize effective processes that perform robustly and with high reliability
•
Different and complementary to traditional quality improvement and strongly advocated by the
Institute of Medicine, NIH, and others.
Includes human factors, process and failure analysis, design concept generation, rapid
prototyping, process design, reliability engineering, computer modeling, and systems
integration methods.
AHRQ’s Patient Safety Learning Labs grants are funded to integrate systems engineering in
patient safety initiatives.
For more information or assistance with systems engineering: www.hsye.org
•
•
•
For more information, contact:
Talya Salant, MD, Medical Director Bowdoin Street Health Center, tsalant@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tayla Salant (<a href="mailto:tsalant@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">tsalant@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Community Health Center
Project Team
Talya Salant
James Benneyan
Nicole Nehls
Mark Aronson
Scot Sternberg
Gordon Schiff
Russell Phillips
Maria Rivera
DeeDee O’Brian
Meghan Dreilak
Department
Any departments listed on the poster or identified in the spreadsheet.
<p>Bowdoin Street Health Center, Beth Israel Deaconess Medical Center</p>
<p>Healthcare Systems Engineering Institute, Northeastern University</p>
<p>Division of General Medicine, Beth Israel Deaconess Medical Center</p>
<p>Center for Patient Safety, Brigham and Women’s Hospital</p>
<p>Center for Primary Care, Harvard Medical School</p>
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
CLOSED: Closing Loops by Operationalizing Systems Engineering and Design
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5883bcb04f1dcd626ff8b9172e55989f.pdf?Expires=1712793600&Signature=jS0BLvDiOrwUewEtSvSi-JSzqmpowE-DIApB6VXGhpESXjv8ATV9vrn4TdkM%7EHUr4IzCY-C3SZfKfFRhiY66ZQ6SdqscejEhhWJMncylzf9%7EJAJ9kq8jheaTH4WDwBomRHHOfm2s3jFMDupSscjvsw9D0MgPn4P5FlzFGVpoO5AxdeGS0LR3VZCUcD6efSGyLSM4qOFkFTzyR7WohPeoiwPDd2xmx98RIDQP6kWuFjddPEHkCG101RYfwjIY7LZmC9jX-pixQdaFOUc7TQelYUNFMsNHyJDA%7EM2G4Y3JcCM3ryKPrX64QfGkCXpIXzV7I7rS3j3WevdnxktiMiZn6Q__&Key-Pair-Id=K6UGZS9ZTDSZM
2a5d2341b474e6d90f263bcb78f8c782
PDF Text
Text
Addressing the Gap in NAFLD Screening
Nathan Sairam, MD1; Eddy Leung, MD1; Hirsh Trivedi, MD2, Jonathan Li, MD3; Michelle Lai, MD2
Department of Medicine1, Liver Center2, Health Care Associates3
Beth Israel Deaconess Medical Center
Introduction / Problem
Methods
● Non alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease that causes steatosis of the
liver in the absence of alcohol consumption.
● 50% of cases of advanced fibrosis from NAFLD are not discovered until they present with
decompensated cirrhosis, which has an 85% 5 year mortality without transplant.
● The incidence of NAFLD is projected to increase significantly by 2030 and will cause increased
incidence of NASH cirrhosis, HCC, and associated complications.
● NAFLD currently leads to $103 billion dollar in medical expenses annually.
● Diabetics have very high rates of NAFLD, with some studies showing 71% of diabetics having NAFLD.
● 23.1% of diabetic patients have F3-F4 fibrosis, which would warrant HCC and variceal screening.
● The American Diabetes Association currently recommends screening patients with diabetes for NAFLD
with yearly LFTs.
● 50% of diabetics with NAFLD and 56% of diabetics with NASH actually have normal LFTs.
● Fibroscan screening has the potential to identify patients with F3/F4 fibrosis with higher sensitivity
allowing for more early identification of HCC and varices.
● Using Arcadia, we generated a list of 101 diabetic patients seen at HCA clinic by three of our study
members.
● All patients were manually chart reviewed to determine whether or not they were getting yearly LFT
screening. Any patients with a 2 year or greater gap with no LFTs starting from the time of their
diabetes diagnosis was considered to not be getting yearly LFTs.
● All patients were chart reviewed to determine if they ever had persistently abnormal LFTs on at least 2
consecutive checks at any point in time.
● We reviewed prior imaging to determine if patients ever had incidental findings of steatosis of the liver.
Results
37% of patients with
diabetes were not being
screened yearly with LFTs
Aim / Goal
● Identify patients with F3/F4 fibrosis prior to presentation with decompensated cirrhosis and enroll
these patients into HCC and variceal screening pathways.
● Retrospectively review a cohort of patients with diabetes in the primary care setting to determine how
well we are currently adhering to the ADA’s current guideline of yearly LFT screening.
● Determine how often fibroscans are ordered for patients with abnormal LFTs or steatosis on imaging.
● Determine feasibility of direct to fibroscam screening strategy.
59% of patients with
diabetes had past or present
abnormal LFTs or imaging
showing steatosis but had
never received fibroscan
Conclusions / Next Steps
At HCA clinic, there is poor adherence to the current ADA guideline recommendation for yearly LFTs to
screen for NAFLD among diabetic patients. Furthermore, the majority of diabetic patients have had
abnormal LFTs or incidental steatosis of the liver on imaging at some point in their care but have not been
ordered for fibroscan to follow this up. Offering one-time fibroscan may therefore be a superior screening
strategy. We developed a call outreach effort to offer fibroscan to these patients. The outreach effort and
our results are described on the following slide.
For more information, contact:
Nathan Sairam (nsairam@bidmc.harvard.edu)
�Patient Perceptions about NAFLD and its Screening
Eddy Leung, MD1; Nathan Sairam, MD1; Hirsh Trivedi, MD2, Jonathan Li, MD3; Michelle Lai, MD2
Department of Medicine1, Liver Center2, Health Care Associates3
Beth Israel Deaconess Medical Center
Aim/Goal
Results continued
• Ascertain patient-related barriers to NAFLD screening by gauaging knowledge and interest in NAFLD
screening in patients by outreach calls
• Implement a direct-to-fibroscan approach to NAFLD screening for those patients who agree to be
screened with this approach
Methods
79%
A subset of patients were identified
through Arcadia and sorted with
exclusion criteria. The remaining
patients were contacted with outreach
calls using a standardized script
Number of Responses
Results
Number of Responses
What Patients had to say:
● “My liver numbers (liver function tests) are excellent. What else would
justify doing it (fibroscan)?”
● “Do my [diabetes specialists] know about this? None of them mentioned
anything about fatty liver disease.”
● “I have an appointment with my primary care doctor tomorrow. I want to
talk to [them] about it instead.”
● Patient was afraid the call meant she had fatty liver disease because nobody
had mentioned it to her before.
● Patient stated she was nervous about the [fibroscan] results because she
knows diabetes is bad and it “puts you at risk for everything.”
Conclusions
• Knowledge and awareness about NAFLD are low among patients with T2DM. For many, it had not
been discussed by their primary care doctors or specialists.
• Most patients intuitively believe that fatty liver disease is serious and warrants screening.
• Patient hesitancy regarding NAFLD screening may be improved by discussions initiated by the primary
care doctor as part of healthcare maintenance.
• Outreach calls using a standardized script may be an effective method in improving rates of NAFLD
screening in patients with T2DM.
Next Steps
1-10 scale where 1 is not serious at all and 10 is among the most serious
medical conditions
• Follow up on fibroscan completions rates in three months from the time they were ordered to
determine adherence
• Follow the results of fibroscans ordered. This may inform whether a direct-to-fibroscan approach
identifies advanced fibrosis in those who otherwise would not have been screened according to
guidelines that recommend liver function testing.
For more information, contact:
Eddy Leung (eleung3@bidmc.harvard.edu)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Nathan Sairam (<a href="mailto:nsairam@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">nsairam@bidmc.harvard.edu</a>)<br />Eddy Leung (<a href="mailto:eleung3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">eleung3@bidmc.harvard.edu</a>)
Project Team
Nathan Sairam
Eddy Leung
Hirsh Trivedi
Jonathan Li
Michelle Lai
Department
Any departments listed on the poster or identified in the spreadsheet.
Department of Medicine
Liver Center
Health Care Associates
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Addressing the Gap in NAFLD Screening
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/454c8ff73b353ebf0755efd0213246e8.pdf?Expires=1712793600&Signature=VjcXlrBHS82kf0SvgHE3%7ESOeB3xtDVfcVQAlC1MnfZxoJCHQExfYHQSzfRuIJ2l2-lKXGNMytGOTXLc-hA3sw0vG4%7E3Vly6cphC-ptjF0K58caDlf0Wu7Tt9g5VjaESURUVQO7FoMQ913SUQm1jmD3nDw4NTjbnOLXasNG4pKs%7EwYB6Ys8Rhp6qHmmRKmMuyDw2%7EHDgJi5bP3dqHbb8ALuqTx1gw-jmb8sRadaAzRTyi-xKumjX5Sxg7sc1qi38jUB8YXCUnq80yUBz0hGmVtBmWwd8twLmnce34wB3jQZiurzzKdR2U5v1LV%7EyezDsK08XHCJMPWZSi%7EpaCErwjbw__&Key-Pair-Id=K6UGZS9ZTDSZM
75752262bdb033bcbea59d0776080417
PDF Text
Text
Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Pre-Intervention Survey
Effective Use of Time (Offgoing)
Post-Intervention Survey
Effective Use of Time (Offgoing)
Strongly disagree
(11%)
Disagree (49%)
Strongly disagree
(8%)
Disagree (15%)
Neither agree nor
disagree (4%)
Agree (32%)
Neither agree nor
disagree (0%)
Agree (39%)
Strongly agree (4%)
Strongly agree (39%)
Effective Use of Time (Oncoming)
Strongly disagree
(0%)
Disagree (10%)
Neither agree nor
disagree (17%)
Agree (62%)
Neither agree nor
disagree (0%)
Agree (50%)
Strongly agree (8%)
Strongly agree (40%)
A lot less (23%)
Neither agree nor
disagree (11%)
Agree (43%)
About the same
(8%)
More (15%)
Figures 1-3. Survey responses regarding preexisting signout process. N=47.
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
Opportunities
Likely to Contribute ___ to Burnout
Strongly disagree
(2%)
Disagree (9%)
Strongly agree
(36%)
•
Effective Use of Time (Oncoming)
Strongly disagree
(2%)
Disagree (11%)
Contributes to Personal Burnout
Key Results
Less (54%)
A lot more (0%)
Figures 4-6. Survey responses regarding
piloted signout process. N=10-13.
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
Next Steps
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Pre-Intervention Survey
Post-Intervention Survey
Average 37 Minutes per Patient
Average 25 Minutes per Patient
>60 (20%)
>60 (15%)
50-60 (7%)
50-60 (0%)
40-50 (4%)
40-50 (8%)
30-40 (26%)
30-40 (15%)
20-30 (30%)
20-30 (31%)
10-20 (13%)
10-20 (23%)
0-10 (0%)
0-10 (8%)
0
5
10
Key Results
15
0
1
2
3
4
5
Figure 7. Estimated time per patient completing entire
signout process. N=47. Typical census of 8 patients = 5
hours.
Figure 8. Estimated time per patient completing entire
signout process. N=13. Typical census of 8 patients = 3.5
hours.
Things Fall Between the Cracks
Important Missed Information
FREQUENTLY (9%)
•
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
NO (50%)
Opportunities
SOMETIMES (47%)
NOT SURE (30%)
INFREQUENTLY (45%)
YES (20%)
0
5
10
15
20
Figure 9. Estimated frequency of missed
information with pre-existing signout process.
N=47.
25
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
Next Steps
0
2
4
Figure 10. Oncoming providers’ report of later
discovered important information not covered
with modified signout. N=10.
6
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Provider Preparedness and Preferences
Key Results
Felt Prepared to Start on Service
Strongly disagree
(0%)
Disagree (10%)
Neither agree nor
disagree (0%)
Agree (40%)
•
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
Prefer Verbal Signout (Offgoing)
Strongly agree (50%)
Figure 11. Oncoming providers’ perceived
preparedness after receiving modified signout. N=10.
Yes (69%)
Not Sure (8%)
Prefer Verbal Signout
(Oncoming)
Yes (70%)
Not Sure (20%)
No (23%)
Figure 13. Offgoing providers’ preferences for or
against modified signout. N=13.
Opportunities
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
No (10%)
Figure 12. Oncoming providers’ preferences for or
against modified signout. N=10.
Next Steps
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Warm Handoff Guidelines
SHOULD
SHOULD NOT
Focus on the most complex patients
Simply repeat information already written
Express uncertainty: what’s unknown
and/or undifferentiated
Explain deviation from standard of care
Read directly from abbreviated written
signout without adding context
Require the receiver to take notes
Include questions and clarifications
Be a one-way or lopsided conversation
Mention nuanced social issues
Be rushed or inconveniently timed
Ideally occur with medical record in view
Last more than an hour in most cases
Identify follow up communication needed
�
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
Handoff Redesign to Reconnect and Reduce Burnout
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
PDF
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mitchell Ross (<a href="mailto:mwross@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mwross@bidmc.harvard.edu</a>)
Project Team
Mitchell Ross
Susan McGirr
Justine Blum
Rachel Hensel
Alicia Clark
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Hospital Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Handoff Redesign to Reconnect and Reduce Burnout
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3bc8747e8f1f74802138a0f1d0095d26.pdf?Expires=1712793600&Signature=XQ0YfZSU6SHMOH5m7xDwvwK1v01Ck-zkWpR9F6IDXR9-TmM8B8-0-Hod3wJ9RgHcnmCBtjCpe8SXBQKcpJtyvx78eoceTU1MCGCEPwH1m-NMqYWO-LMpS-51MfQRUxNfE%7ECMwGvuOlKLhSY2lnSP2qjFdacLIoYGjmUjBQD2ZmA2XuYkNyaxxj%7EE9Rg0iMBvyU0a8GXlzBrtxXCSSilF31xpNcX2vX7dFZ2kpGIS0ZmAOlCRqc2kBfQ7hCXgk14iuHANVn%7EduZttLgvGVoJQ40cvAed4WUAtfrxxRrq-18tdINYEgNUJQscmBfPkfBrmnXnZN9ZKJsc48fp3UPdeFA__&Key-Pair-Id=K6UGZS9ZTDSZM
7b4e46f599997aab95ba2cd140ac7392
PDF Text
Text
Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube
Placement Improves the Confidence of Decision-Making
Liubauskas R. MD, Litmanovich D.E. MD, Chakrala N.L. MBBS, Oren-Grinberg A. MD, Eisenberg R.E. MD
INTRODUCTION
•
•
•
•
Following intubation, a frontal chest
radiograph (CXR) is obtained to
assess endotracheal tube (ETT)
position by measuring the ETT tip to
carina distance1
ETT tip location changes with neck
position, but it can be determined by
assessing the position of the mandible2
Since the mandible usually cannot be
visualized on standard CXR, we
developed a new protocol where the
mandible is seen in the CXR
We compared the confidence of
decision-making using new and
standard protocols for post-intubation
CXR to assess ETT position
WHY CARE?
•
•
An excessively distal ETT position
could lead to endobronchial intubation,
which may result in serious
complications such as3,4:
• Atelectasis of the
non-ventilated lung
• Hypoxemia, hyperinflation,
and barotrauma of the
ventilated lung with possible
development of pneumothorax
A too proximal ETT position may lead
to its displacement – caudal migration
and even self-extubation5, the
development of vocal cord injury,
resulting in permanent hoarseness and
significant airway obstruction3 and
ETT-related tracheal rupture resulting
from an overinflated ETT cuff
METHODOLOGY
Retrospective and prospective, single-center, IRBapproved study, which consisted of patients
undergoing CXR following intubation to assess the
position of the ETT-tip relative to the carina.
Two parts of the study:
• Part I- retrospectively assessed images obtained
with the standard protocol. Patients underwent a
routine supine AP post-intubation CXR for the
assessment of ETT position, in which the upper
margin of the image typically was in the lower neck
• Part II– prospectively included all consecutive CXRs
acquired using the new post-intubation protocol.
The radiology technologists palpated the mandible
to ensure that 1-2 cm of this bone would be
included within the upper margin of the image
What the heck is with the neck?
The position of the ETT depends on the
position of the neck2:
• If the neck is extended, the ETT ascends
• If the neck is flexed, the ETT descends
• Potential movement of the ETT tip can be up to
3.8 cm in cases where neck position changes
from flexed to extended or vice versa
• If the neck changes position between flexed
and neutral, or between neutral-extended, the
potential movement of the ETT tip is ~1.9 cm
In the study2,6:
• The neck is considered extended if the
mandible projects over C4 or higher
• The neck is considered neutral if the mandible
projects over C5 or C6
• The neck is considered flexed if the mandible
projects over C7 or lower
Where do we want the ETT to be?
The desired position of the ETT depending on the neck position6 (Figure 1; A, B, C):
• With the neck flexed – the ideal position of the ETT tip is 3 ± 2 cm above the carina
• With the neck neutral – the ideal position of the ETT tip is 5 ± 2 cm above the carina
• With the neck extended – the ideal position of the ETT tip is 7 ± 2 cm above the carina
We can be uncertain sometimes
We established “gray-zone” values (Figure 1) at which the
CXR are difficult to assess whether the ETT is in a satisfactory
position if the mandible is not visible:
• If the ETT tip-carina distance is >9 cm, then the ETT is too
high, regardless of the neck position
• If the ETT tip-carina distance is <1 cm, then the ETT is too
low, regardless of neck position
• If the ETT tip-carina distance is 6.0–9.0 cm, then the ETT is in
a high gray-zone position
• Rationale: if the neck is extended at the time the CXR was
obtained, the ETT is positioned appropriately. If the neck is
flexed, the ETT may move upwards with the neck in a neutral
or extended position, resulting in a too high ETT position
• If the ETT tip-carina distance is 1.0-4.0 cm - the ETT is in a
low gray-zone value
• Rationale: if the neck is flexed at the time the CXR was
obtained, the ETT would be positioned appropriately. If the
neck is extended or neutral, the ETT may potentially move
Fig. 2 – Algorithm to assess the ETT position downward, resulting in a too low position of the ETT
Making a confident decision
Algorithm for assessing the ETT position (Fig. 2):
Step 1 – is the mandible is visible on the CXR?
• If so, the position of the neck, and therefore
the ETT position, can be confidently
assessed. No additional steps
• If the mandible is not visible, go to step 2
Step 2 – is the tip of the ETT is in one of the
clear-zones?
• If so, the ETT position can be confidently
assessed regardless of the neck position
• If not, the ETT position cannot be
confidently assessed
Other times we’re sure
• Based on the “gray zones” - only when the
ETT tip-carina distance is 4.0-6.0 cm, can the
reader be confident that the ETT position is
satisfactory regardless of the neck position
• When the ETT tip-carina distance is either
>9.0 cm or <1.0 cm, the reader can be
confident that the ETT position is
unsatisfactory regardless of neck
• We established these ranges (<1.0, 4.0-6.0,
>9.0 cm) as “clear-zone” values, because
the reader can confidently recommend
moving or leaving the ETT in the current
position
Fig. 1 – Summary of different ranges of the ETT tip – carina
A – appropriate range of ETT tip when neck extended (5-9 cm)
B – appropriate range of ETT tip when neck flexed (1-5 cm)
C – appropriate range of ETT tip when neck neutral (3-7 cm)
X – Gray zone of the ETT being potentially too high (6-9 cm)
Y – Gray zone of the ETT being potentially too low (1-4 cm)
Z – Clear zone regardless of the neck position (4-6 cm)
Which zone is what now?
“GRAY ZONE” – ETT tip–carina distance, at which
it is difficult to assess whether the ETT is in a
satisfactory position if the mandible is not visible
“CLEAR ZONE” - ETT tip–carina distance, at which
the reader can confidently recommend retracting,
advancing or leaving the ETT in the current position
NB! - clear zone does not mean that the ETT position is
satisfactory, but that the reader can distinctly determine
whether the position is satisfactory or requires adjustment.
�Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube
Placement Improves the Confidence of Decision-Making
Liubauskas R. MD, Litmanovich D.E. MD, Chakrala N.L. MBBS, Oren-Grinberg A. MD, Eisenberg R.E. MD
RESULTS
•
•
•
•
There were 308 patients in the study with post-intubation CXR –
155 using the standard technique and 153 using the new protocol
Based on the mandible position, the neck was in neutral (45%;
78/173), extended (45%; 77/173) or flexed (10%;18/173) positions
There was a significant increase (p<0.001) in visualization of the
mandible on post-intubation CXR obtained with the new protocol
(92%; 141/153) compared to those with the standard technique
(21%; 32/155).
The distribution of mandible visibility and zones is summarized in
table 1 and figure 3.
ETT*
position
Certain
Standard
Protocol
32 (21%)
New
Protocol
141 (92%)
Mandible
Visible
Mandible
Clear zone 48 (31%)
7 (5%)
Not Visible Gray zone 75 (48%)
5 (3%)
Total
155 (100%) 153 (100%)
EXAMPLES FROM YOUR PRACTICE TODAY!
RESULTS
•
There were two acceptable ways to determine whether
the ETT was is in the appropriate position: by visualizing
the mandible, or by observing the ETT in the clear zone.
Combining both
measures, we
have estimated
that a confident
decision can be
made in 96.7% of
cases using the
new protocol,
compared to
51.6% of cases
using the standard
protocol (p<.001)
(Figure 4).
Table 1 Overview of
the study
results
Fig. 4 - Decision confidence rate when assessing
ETT position (new vs standard protocol)
CONCLUSION
Figure 3 - Using the standard protocol, there was an unconfident
decision rate of 48%, compared with only 3% using the new protocol.
•
When the mandible was visualized, it most commonly projected
over the C5 (32%; 56/173) or C4 (25%; 44/173) vertebral body,
with a range of C1-T2, suggesting that the neck is usually in a
neutral or slightly extended position (Figures 5 and 6).
Figure. 5 – Inaccurate interpretation of the ETT
position based on shape and angle of the
mandible. 55-year-old woman following
intubation with ETT tip 2.1 cm above the carina.
Recommendation to retract the ETT was not
made. Based solely on the shape of the
mandible, the neck may appear flexed.
Assessing by the relationship of the vertebral
body to the mandible, neck may be extended
(mandible projects over C4), introducing the risk
of ETT descending by approximately 2-4 cm
depending on neck movements, and possibly
intubating the right bronchus.
Fig. 6 – Inaccurate interpretation due to failure to
assess the relationship of the mandible to the
vertebral bodies. In this 66-year-old man following
intubation with ETT* tip 7.0 cm above the carina, it
was recommended to advance the ETT. However, in
assessing the relationship of the mandible to the
vertebral bodies, the neck appears to be in an
extended position (mandible projects over C3-C4),
making the position of the ETT appropriate, as it may
descend 2-4 cm depending on neck movements
To our knowledge, this study is the first study to
demonstrate that mandible inclusion on post-intubation
CXR is a simple and cost-effective method to ensure
proper assessment of the ETT position, sparing the
patients from unnecessary additional imaging and
almost doubling the level of certainty of the decisions
made by the radiologist.
REFERENCES
1.
2.
3.
4.
5.
6.
Godoy MC, Leitman BS, de Groot PM, Vlahos I, Naidich DP. Chest radiography in the ICU: Part 1, Evaluation of
airway, enteric, and pleural tubes. AJR Am J Roentgenol. 2012;198(3):563-71.
Conrardy P, Goodman L, Lainge F, Singer M. Alteration of endotracheal tube position. Flexion and extension of
the neck. Crit Care Med. 1976;4(1):8-12.
Mathew R, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Lines, tubes, non-cardiac
medical devices and materials. SA J Radiol. 2019;23(1):1729.
Owen RL, Cheney FW. Endobronchial intubation: a preventable complication. Anesthesiology. 1987;67(2):225-7.
Kearl RA, Hooper RG. Massive airway leaks: an analysis of the role of endotracheal tubes. Crit Care Med.
1993;21(4):518-21.
6. Goodman L, Conrardy P, Laing F, Singer M. Radiographic evaluation of endotracheal tube position. AJR Am J
Roentgenol. 1976;127(3):433-4.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Rokas Liubauskas (<a href="mailto:rliubaus@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">rliubaus@bidmc.harvard.edu</a>)
Project Team
Rokas Liubauskas
Diana Litmanovich
Nahara Chakrala
Achikam Oren-Grinberg
Ronald Eisenberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
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
Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube Placement Improves the Confidence of Decision-Making
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3ef6f52c68111d35033bb010b8e189c3.pdf?Expires=1712793600&Signature=AvLsU5rC%7E6FRL%7EoRoiqdf99DPZdgeZOVZdkLdpDYMRYlnxfGdgU9WEVv4-RXvuv2ecH2i8xH5QO-wgvVyQ74GaXGeTkHZrrv-GZ7GAsVdodk3ZLo%7EEWzahfYGF2H5cJ1Pup1Sb8qzbIVWvpUgBksJOYYCIlRKDpXkvpngqIensa2Usf0Ov5uHcKbwUuLVZ4GwZz8FVobkeZoSdCNw-qKp-nLLPoxG6%7EuisRCgC%7EJh5tlqbmk2PWCe8PScw1sowHKkVZ1fTbUepM5u5lSVs09HofjogTNQhwYjhDvcFJ8-2i6xkWla6Oqe0mG472neOaCVmIRGQkgwdYGZ6awR15nVQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ef8016f83c23c61c81d3f3c0b98ddffe
PDF Text
Text
"I Got the Shot: The Story of COVID Vaccine Clinics in the Community"
Ellen Volpe, Kristin O’Reilly, Katelyn Rick, Jordan Ellis, Jaime Levash, Jasmine Cline-Bailey
BIDMC
Results/Progress to Date
Introduction/Problem
Total Doses given by BIDMC
47672
Axis Title
In December of 2020, nearly one year into a global pandemic that had killed over
300,000 Americans the world was looking for something to be hopeful about. On
December 13, 2020 Pfizer Biotech received the initial EUA approval for a two
dose COVID-19 Vaccine that had promising results in clinical trials. Shortly
thereafter Moderna and J&J were also approved and BIDMC’s mission shifted to a
widespread vaccination campaign.
31109
Aim/Goal
The goal of this work was to provide access to life saving vaccines to as many
patients as possible and focus our efforts on the communities where our patients
were disproportionately impacted by the pandemic.
14926
The Interventions
Reviewed data that showed where the highest concentration of COVID cases were by zip
code
Worked with facilities to identify potential clinic locations in those areas: Dorchester, Chelsea,
Boston
Our IT team developed a worklist of our patients based on eligibility criteria
We used that email/ text patients directly to schedule their appointment
Outlined a process for how the clinic would flow: outreach, scheduling, perform check in,
documentation, and future scheduling
Outlined safety protocols for vaccine sites with multiple vaccine types
Created staffing and throughput models to maximize capacity
Recruit, train, and staff each location
Strategized to ensure we used an equitable approach to outreach, scheduling, booking, and
administering of vaccines
Engaged with Interpreter Services to ensure we were adequately serving our LEP patients
CHELSEA
DORCHESTER
TEMPLE ISRAEL
Total Doses
In total, BIDMC’s site administered 93,707 doses of COVID-19 Vaccine. This accounts for 28% of all doses
administered through BILH. BILH administered 338,457 doses.
We collected data on patient experience throughout the clinics being open which helped us to gain
some good insight into what could have improved the experience for patients.
Vaccine Site
Chelsea
Chelsea
Dorchester
Dorchester
Chelsea
Patient Response to what could have been better
This was so easy, clean, and well organized. So much better than I
expected.
Your Chelsea Team deserves a patient care award.
Could not have been any easier or better than what I experienced
to today all was 100%
3-Mar-21
3-Mar-21
2-Mar-21
Someone playing the piano in the fellowship room would be lovely 3-Mar-21
The directions to the location should of been more clear because
the whole plaza is 1100 revere Beach parkway in Chelsea and it
For
more
brings you to a buffet when put
in the
gps information, contact:
2-Mar-21
Katelyn Rick, MSN, RN Manager, Improvement and Innovation krick@bidmc.Harvard.edu
�“I Got the Shot: The Story of COVID Vaccine Clinics in the Community"
Ellen Volpe, Kristin O’Reilly, Katelyn Rick, Jordan Ellis, Jaime Levash, Jasmine Cline-Bailey
BIDMC
More Results/Progress to Date
The Team
Ellen Volpe, Vice President - Ambulatory Services
Mary LaSalvia, Associate CMO, Infectious Diseases MD
Peggy Stephen, Chief Pharmacy Officer
Jarrod Dore, Director of Capital Facilities
Mo Ortega, Project Manager, Emergency Management
Sherry Calderon, Director, Ambulatory Services
Shari Gold-Gomez, Director, Interpreter Services
John Casavant, Manager, Telecommunications
Katelyn Rick, Project Manager for Chelsea
Kristin O’Reilly, Director Improvement and Innovation
Bridgid Joseph, Program Director ECC & Training Center Coordinator
Barbra Blair, Infectious Disease MD, Medical Director of Vaccines
Kyle Franko, Internal Communications Manager
Elise Porter, Site Director for Chelsea
Kerry Falvey, Site Director for Dorchester
Sandi Leitao, Site Director for Temple Israel
Larry Markson, Vice President of Information Systems
Divya Narayan, Project Manager IS
Jordan Ellis, Project Manager for Temple Israel
Jaime Levash, Project Manager for Dorchester
Jasmine Cline-Bailey, Project Manager
Sarah Moravick, Vice President- Organizational Planning
Julie Lanza, Pharmacy Compliance Specialist
Katie Scalzulli, Project Manager, Vaccine Staffing
Kerry Carnavale, CNS Nursing Educations for Vaccine Clinics
Kate Willetts, Nursing Educator
Paula Sterling, APP for Vaccine
Lessons Learned
The team learned to be flexible and pivot quickly when vaccine supply changed or was reallocated.
Leveraging relationships the clinics (Bowdoin, Chelsea internal medicine) have with their patients
proved to be an effective strategy to broaden our outreach and work through vaccine hesitancy.
We worked with IT to include patient language data and message a second time to all patients in their
primary language.
The BIDMC team created a “playbook” for how to open a vaccine site that was given to the BILH
system for the future.
Next Steps
The team is working towards rolling out a booster clinic for 3rd dose Moderna and 2nd dose J&J
For more information, contact:
Katelyn Rick, MSN, RN Manager, Improvement and Innovation krick@bidmc.Harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Katelyn Rick (<a href="mailto:krick@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">krick@bidmc.harvard.edu</a>)
Project Team
Ellen Volpe
Mary LaSalvia
Peggy Stephen
Jarrod Dore
Mo Ortega
Sherry Calderon
Shari Gold-Gomez
John Casavant
Katelyn Rick
Kristin O’Reilly
Bridgid Joseph
Barbra Blair
Kyle Franko
Elise Porter
Kerry Falvey
Sandi Leitao
Larry Markson
Divya Narayan
Jordan Ellis
Jaime Levash
Jasmine Cline-Bailey
Sarah Moravick
Julie Lanza
Katie Scalzulli
Kerry Carnavale
Kate Willetts
Paula Sterling
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID Healthcare - Chelsea
Community Health Center
Department
Any departments listed on the poster or identified in the spreadsheet.
Improvement and Innovation
Infectious Diseases
Ambulatory Services
Pharmacy
Information Systems
Organizational Planning
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
"I Got the Shot": The Story of COVID Vaccine Clinics in the Community
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/be1f907a04c91c807fc1ce39f85eef92.pdf?Expires=1712793600&Signature=Be2PZ1s0osXruxhnEenGxDoKIsqbT32MMffl3mpWf6To2cshxEiYdf44J%7E591O%7E%7ERq8jScq3Pb2X7m0SZRECpJWQARuKhr0YEN-CHKsxeflAhisA2zcErjZSXNwNQrXClK7477f5eFoEKItzTOHwzCdAy9gKtoFQ-p%7EpzbLx1KBWIvEhAnocsmDy3WbB6X-0hm5uloMUVWJBfcb7KIrdPc1TFFyYshMCNvpzXOPuia14%7EQW6PRHwKbJ7NVLyvDJ7r9hWvuXH6ueoenQLeorziZSzQL4xce5%7ExsCL1odICmY0L3bpT34maXlS8B6SaIhDLpJr97Xn%7EfaoE%7EUTosVbcg__&Key-Pair-Id=K6UGZS9ZTDSZM
794912fc492e34746e80144908a715f2
PDF Text
Text
Facing the Unknown with Data:
Strategies to Maximize Care Capacity for Resurgence of COVID-19
Aya Sato-DiLorenzo, RN, BSN, OCN, BMTCN; Jo Underhill, RN, BSN, OCN; Christine Flanagan, RN, MSN;
Matthew Weinstock, MD; Mary Linton Peters, MD; and Meghan Shea, MD
Ambulatory Hematology & Medical Oncology
Introduction
Hematology/Oncology Respiratory
Evaluation Emergency Extension Site
(Hem/Onc REEES) was established
in March 2020 with the following
goals:
•
To care for hematology and
oncology patients with respiratory
or other symptoms associated
with COVID-19.
•
To minimize delay in oncology
care delivery due to COVID-19.
•
To minimize unnecessary patient
visits to the emergency
department.
Problem
As we prepared for the winter of 20202021, the prevalence of COVID-19 was
expected to increase. With expected
patient influx at Hem/Onc REEES, there
was an urgent need to understand our
practice patterns and identify
improvement strategies to maximize our
care capacity.
Methodology
April 2020 Data
This project was conducted in the fall of 2020. We reviewed the unit log
from April 2020. It represented a period of high clinical acuity along with
the first wave of COVID-19 in our state.
Nursing interventions were identified by reviewing the billing data.
Furthermore, we analyzed appointment scheduling and duration on
selected days.
Based on the April 2020 data, we implemented Interventions likely to
promote high-quality, efficient care.
Structure
• Revised orientation plans
for deployed nurses with
focus on commonly given
interventions
• Planned to book 2-3
hours for patients
requiring urgent symptom
evaluations
• Lead-RN to oversee daily
unit operation and patient
flow
• A weekly “chemotherapy
day” with chemotherapy
competent nurses on site
• Weekly huddle between
clinic nurses and
leadership
Based on the Donabedian Framework
Results – January 2021
Total Clinic Encounters = 114
Average Visit Duration = 2hrs 32 min
Common Nursing Interventions:
• Nasopharyngeal specimen collection (n=100)
• Lab evaluation (n=52)
• Intravenous fluid administration (n=16)
• Blood products administration (n=2)
Many visits were added on the same day for
urgent patient evaluation.
Process
• Nursing processes as
per hospital policy
• Fidelity to REEES unit
SOPs
• Communication and
teamwork
Outcome
•
•
•
•
Maximize care capacity
Minimize care delay
Evidence-based care
Minimize nursing
burnout
Total Clinic Encounters = 95
Nursing Interventions Provided:
• Nasopharyngeal specimen collection
(n=76)*
• Lab evaluation (n=63)
• Chemotherapy/immunotherapy
administration (n=16)
• Intravenous fluid administration
(n=10)
• Injections including Leuprolide
Acetate, Octreotide, Cyanocobalamin,
& Pegfilgrastim (n=9)
• Blood products administration (n=9)
• tPA instillation (n=3)
• Non-chemotherapy IV therapeutics
including Belatacept, Ferumoxytol, &
Eculizumab (n=3)
• PK/PD draw for clinical trial (n=1)
* Decrease in the specimen collection at
Hem/Onc REEES was a result of more
patients using BIDMC drive thru testing
sites.
Winter 2020-2021: Unanticipated Challenges
Many other departments continued to operate for patient care.
• A smaller space available for the Hem/Onc REEES clinic.
• A fewer number of nursing staff who were deployed from other departments.
• No dedicated nursing assistants or administrative support on site.
• Patients with complex medical histories including those who had stem cell
transplant & chimeric antigen receptor T-cell therapy and those on clinical trials.
Conclusion
We were successful at expanding the
scope of Hem/Onc REEES. The clinic
utilization data showed the provision of
more complex, oncology-specific care
in January 2021 despite the smaller
physical space and a smaller number of
nursing staff.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Project Team
Aya Sato-DiLorenzo
Jo Underhill
Christine Flanagan
Matthew Weinstock
Mary Linton Peters
Meghan Shea
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Aya Sato-DiLorenzo <a href="mailto:%20">asato@bidmc.harvard.edu</a>
Department
Any departments listed on the poster or identified in the spreadsheet.
Ambulatory Hematology
Medical Oncology
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/.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Title
A name given to the resource
Facing the Unknown with Data: Strategies to Maximize Care Capacity for Resurgence of COVID-19
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/01403eec0838fe9903bc585d2a4c7396.pdf?Expires=1712793600&Signature=LLSfmX4VPISy4PD7iZ7NNpiS8TR2BelMom3EVeUgNCWaQh-UHocOC9dAighq%7Ep7mS4iMp-hPJGEJG%7EIm3xKi1fgO5SgE%7EgZxfoM46Ya9O6XWNnAT3DBmIhoknYXFNE8ZQLxgzYtd6flGzQL%7EIPMYIMduzMnKi2z68m0a5m47U-Voc%7EudC7do1szDJaemWkpTjilALO8Tw78UqS61%7E0mLiFKWmWbG0ATpqLfj1XpOFy3bU1CDGHa0FZXugqgofyojamO3MFlM4qBLEzyGV3H1i7%7E0PPUxMgt1sGIa8Jo7TgiTfQKtNys4488B%7Efl5x7zeKhGwmo9PGQ3zE1zOkLO5hw__&Key-Pair-Id=K6UGZS9ZTDSZM
3162c576e41aefead167bc2f78bf9a19
PDF Text
Text
Hematology/Oncology Admissions
Tara Meekins RN and Tonia Valeri RN
Ambulatory Units: Shapiro 7, Gryzmish 7
Introduction
Our project is geared towards
Hematology/Oncology clinic
patients who have scheduled
clinic visits with same day
admission for chemotherapy. Our
clinic volume has increased with
higher levels of acuity as well as
the added burden of social
distancing during the Covid
pandemic which has made it
difficult to accommodate patients
waiting in clinic purely for an
available admission bed which
can take many hours. In order to
provide treatment for our
scheduled treatment patients
safely and without excessive
delay, we needed to alter our
planned admission process.
Method
The change of practice adopted is to schedule the patients
for planned chemotherapy admissions to clinic 24 hours
before their planned admission. The clinic visit entails a
pre-admission Covid swab, labs, any schedules test (i.e.
EKG/PFT/CXR) and physician exam that will authorize next
day admission. This also allows for high cost drugs (ie
Rituxan) to be administered on the day prior to admission.
t
Conclusion
Changing our planned admission
method to having our patients come to
clinic 24 hours in advance to their
planned admission (as opposed to
same day) has increased patient and
health care team satisfaction.
This has resulted in a quicker clinic
visit for the patient and allowed the
patient to wait in the comfort of their
home the next day to await for a
hospital bed for their planned in-patient
chemotherapy regimen.
This increases patient safety as it
allows time for a Covid swab to result
and helps support social distancing by
reducing crowding in the clinic.
This has also helped healthcare
team members, giving adequate time
to analyze lab results and organize
appropriate oncology intervention with
appropriate bed placement (ie shared
or private room).
�Hematology/Oncology Admissions
Tara Meekins RN and Tonia Valeri RN
Proposal for Planned
Admissions
1. Moving forward, all planned
admissions will have Clinic visit
(MD/NP appointment) with labs
and Covid swab done the day prior
to planned admission. Along with
labs and covid swab, the
practitioner will verify with 7F or
11R that the planned admission is
in the book and that the patient is
cleared to be called from home the
following day to come in when bed
is ready. MD will place and sign
future Chemotherapy order.
Day -1
2. Patients will be called at home by
the admitting floor the following day
when room is available to come
into the hospital for planned
admission.
Day 0
Ambulatory Units: Shapiro 7, Gryzmish 7
Advantages of next day Planned Admits
Increased patient satisfaction, allowing them to wait comfortably at home for
an available bed as opposed to in a busy clinic lobby for prolonged time.
This will also help increase safety, ensuring a covid swab is done with a
reliable result time for that covid swab before admission.
Next day admission allowed a quicker clinic visit which reduced waiting for a
bed in a crowded lobby.
Allows clinician to verify that patient is in the book for planned admission to
ensure a bed will be available the next day.
Limited bed holds for patients that may not be eligible for the planned admit
due to abnormal lab results. This results in better utilization of limited
in-patient beds.
Fiscally, this allows providers to charge for a clinic visit as it won’t be on
same day as admission.
This also allows us to charge for any RN intervention or treatments such as
administration of Rituxan as it is separate from admission day. We can’t
credit a charge on the same day as admission from the clinic.
Resource Nurse can now focus on supporting nursing care to the scheduled
patient treatments in the clinic and focus on unplanned admissions as
opposed to acting as a liaison to the same day admission process (checking
bed status and providing updates and then transportation for patient to get
to floor).
Advantages of next day
Planned Admits
This allows physicians time to fully
review lab results along with
patient evaluation to determine
safety of planned admission for
chemotherapy.
This also allows time to write the
chemotherapy regimen in advance
(Day -1), ensuring it is signed and
ready to be verified on admission
(Day 0).
This gives time for all the
healthcare team members to
prepare for the admission,
including nursing and pharmacy.
Ultimately this reduces delays,
increases safety and satisfaction
for the patient being admitted.
�Hematology/Oncology Admissions
Tara Meekins RN and Tonia Valeri RN
Ambulatory Units: Shapiro 7, Gryzmish 7
Nursing Professional
Governance
Allowing nurses the time to evaluate
practice and work environment to find
areas of improvement and
empowering them to help implement
changes to these areas help improve
patient satisfaction and outcomes
along with increased workplace
satisfaction.
Disadvantages of Same Day Admissions
● Patients voice frustration and dissatisfaction with the long wait time before
their bed is available for them. They voice feeling “forgotten about” when
they are left in an exam room or in a busy lobby.
● As the clinic volume has increased with higher levels of acuity, it is
becoming very difficult to accommodate patients waiting in clinic purely for
an available admission bed. We have limited spaces to provide scheduled
treatments and have increasingly had a waiting list for patients to come
back to treatment area due to no beds or chairs available. This results in a
very full lobby and delays in care.
● It becomes harder to provide safe environment with social distancing with
clinic volume increasing.
● It is and will continue to be important to have a covid swab result to
determine treatment and bed placement, there are times when same day
admissions have not had their covid swab done or resulted in time.
● There are instances when planned admissions were not communicated
correctly and the floor has no bed reserved, resulting in a scramble to find a
bed, sometimes after 6pm which delays onset of planned treatment to the
next day.
● Treatments or interventions done in clinic can not be billed if patient is
admitted on same day. Hospital does not get reimbursed for high cost drugs
like Rituxan administered in clinic if patient is admitted the same day.
Changing Disadvantages to
Advantages
Shapiro 7 - Gryzmish 7 - Feldberg 7
This change was initiated by the
nurses in the ambulatory setting to
help with our admission process.
Oncology is increasingly moving to
the outpatient setting which has
resulted in large clinic patient
volumes. This is a challenge to our
limited physical space and limited
time in the clinic day. The Covid
pandemic has added to this, having
to ensure proper patient symptom
screening and maintaining social
distancing.
Our planned admission process
was one area we focused on to help
reduce crowding in the clinic. We
worked in collaboration with the
physicians, admitting floors and
pharmacy to ensure the proposed
changes were safely implemented.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tara Meekins (<a href="mailto:tmeekins@harvard.bidmc.edu" target="_blank" rel="noreferrer noopener">tmeekins@harvard.bidmc.edu</a>)
Project Team
Tara Meekins
Tonia Valeri
Brendan Sendrowski
Caroline Meijas
Sarah Marcinowicsz
Jo Underhill
Matthew Weinstock
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Hematology and Oncology
Ambulatory Units Shapiro 7
Ambulatory Units Gryzmish 7
Pharmacy
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hematology/Oncology Admissions
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness