3
20
773
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46f9f7ea4236d717d373402da1fbf85c
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Text
Integrating and Improving Access to Mental Health in Primary Care: Quick-Response Consultation
The Problem
Primary care provider (PCP) visits frequently address multiple health concerns,
usually within a 20-30 minute visit. While mental health needs are frequently
identified, limitations of what can be addressed within a visit plus limited access
to mental health services usually result in needs being unmet.
Unless it is a psychiatric emergency, PCP’s are frequently left to give their
patients a phone number to either schedule an intake appointment about 8-10
weeks out or are referred to external mental health services.
Social Workers at HealthCare Associates (HCA), a large academic primary care
practice, are expected to provide 7000 billable visits annually. Last year, HCA
Social Work instituted improvements to the intake process and started QuickResponse therapy groups.
To meet productivity requirements, HCA social workers are scheduling patients
for mental health treatment 90% of their time and emergency on-call is provided
concurrently. However, there is very limited availability and access for patients
not already in therapy.
Quick Response Consultation Pilot is intended to test how primary care providers
can provide the right care, at the right time, and in the right way.
Productivity standards were temporarily relaxed to allow for staffing quickresponse coverage during the 4 week pilot.
The Results/Progress to Date
Over a 4-week pilot period, there were 133 patients seen (on average, 7
patients a day) and 51 provider consultations (on average, 2-3 provider
consultations a day).
Aim/Goal
Implement pilot for quick-response mental health consultation at time of primary
care visit to address needs and connect patients to services, as appropriate.
Improve patient and provider access and satisfaction
Assess practice need and sustainability of model.
The Team
Stephen O’Neill, LICSW, Lynda Seletsky, LICSW, Ann Koplow, LICSW,
Adebayo Oshin, MPH, Medicine QI, Scot B. Sternberg, MS, Medicine QI
The Context and Interventions
BIDMC’s HealthCare Associates (HCA), a large hospital based adult primary
care practice (42,000 patients), has an integrated social work team to provide
mental and behavioral health services. However, the growing demand has
outpaced the capacity of available HCA social work resources:
Identified a social worker to be available on-call and provide quick-response
consultation for each clinical session for 4-week pilot and implemented pilot.
Identified data points for tracking, including type of encounter, reason,
disposition, and developed a database.
Developed 3 questions to measure patient experience and provider experience,
including satisfaction.
Over 90% of patients receiving a Quick-Response consultation indicated it
gave them with what they needed at that time and they left with a workable
plan, as opposed to being given a telephone number to call.
Primary Care Provider satisfaction:
98% indicated that they felt this Quick Response Social Work Consultation
helped to deliver better care to their patient that day.
91% indicated this Quick Response Social Work Consultation saved time
that day or in the overall care of their Patient
Lessons Learned
Both patients and providers valued the Quick-Response social work consultation
and expressed that it helped improve care, as compared to standard practice.
Many patients reported that they were more likely to follow-up with plan than if
they had simply been given telephone number to call without seeing the social
worker at the time of primary care visit.
Next Steps
Develop sustainable model to continue quick-response social work consultation
in practice.
For more information, contact:
Stephen O’Neill, LICSW : soneill2@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Stephen O'Neill (<a href="mailto:soneill2@bidmc.harvard.edu">soneill2@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Stephen O’Neill<br />Lynda Seletsky<br />Ann Koplow<br />Adebayo Oshin<br />Scot B. Sternberg
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Title
A name given to the resource
Integrating and Improving Access to Mental Health in Primary Care: Quick-Response Consultation
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
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003754747cc790dd93303342fb62311d
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Job Safety Behavioral Observation (JSBO) Team
IV. Solutions
I. Background
A Job Safety Behavioral
Observation (JSBO) program can
proactively prevent incidents and
injuries through the peerobservation/ hazard mitigation
follow-up in addition to
monitoring, trending, and
management of safe vs. unsafe
behaviors. This team developed
the JSBO process for Beth Israel
Deaconess Medical Center and
launched it in the East OR where
the highest number of injuries
occur.
Rick Caswell
Micha Deshaies
Barbara DiTullio (Co‐Leader )
Lisa Foster (Co‐Leader )
Rod McArdle
Dan McCarthy
Customized observation form used in manufacturing to meet
our needs in the hospital (i.e. added a sharps section):
OR Employee Incidents ‐ Feb 1 2012 Through Feb 1 2013
Pareto Analysis
45
40
35
30
25
20
Site
Date
Department
Building
Observers
Med Students
2
Residents
10
Task
OR Employees
S= Safe Behavior, AR = At Risk Behavior
1.0
19
0
2
3
6
Sharp
Muscular
Skeletal
Trips & Falls
3
Splash
2
Concussion
Other
Project Team
Sponsor ‐ Elena Canacari
Matthew Rabesa
Oscar Rojas
Janet Rowe
Emp 1
Emp 2
2.0
People
Emp 1
Emp 2
Arm
Body
Eye/Face
Foot
Hand/Arm
Head
Hearing
Respiratory
Availability of PPE
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
2.1
2.2
2.3
2.4
2.5
2.7
2.8
Caught in/on/between
Chemical exposure
Contacting hot surfaces
Eyes on path / hands
Fall exposure
Rushing
Struck Against, by
S
S
S
S
S
S
S
S
S
S
S
S
S
S
3.0
16
5
PPE
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
15
10
□ Outside □ Both
Specific Location
(Room/Floor)
Attending Surgeons
7
□ Inside
Identified OR‐specific hazards to consider when performing
an observation:
Hazard
Lifting heavy items (kits,
equipment, bed)
Wet floors
Heavy doors ‐ Cysto
Debris from saw/drill
# Of People Observed
General Location
Attending Anesthesiologists
3
BIDMC, Boston
Ergonomics
Emp 1
Emp 2
4.0
Emp 2
Awkward Postures
Forceful Exertions
Static Postures
Wrist deviation
S
S
S
S
S
S
S
S
S
S
S
S
S
S
4.1
4.2
4.3
4.4
4.5
4.6
Sharps
Needle box
Recapping
Safe sharps passing
Safety device in use
Use of Safe Zone
Emp 1
3.1
3.2
3.3
3.4
3.5
3.6
3.7
S
S
S
S
S
S
S
S
S
S
S
S
S
S
Environment
Emp 1
Emp 2
6.0
Job Planning, Procedures
Emp 1
S
S
S
S
S
S
S
S
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
6.10
JSA Adequate
JSA Established
JSA Followed
JSA Known
JSA Usage
Non-routine Pre-Job Plan
Access to equipment
Permits in Place
S&H Procedure Usage
Safety of others
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
II. Goals – All achieved
1. Develop a JSBO process for BIDMC and launch it in the East OR
2. Train all JSBO Team members on the observation process to start and then consider others outside of this team including
those who work in the OR as well as others who work outside of the OR
3. Achieve a rate of 3-4 observations/week
4. To establish a baseline of employee awareness of safety as a priority (as well as subsequent increased awareness),
develop and implement a survey.
III. Analysis
Slips & Falls
Muscular‐skeletal
Respiratory, blood & body
fluids
BBF
Muscular‐skeletal
Muscular‐skeletal
Concussion
Muscular‐skeletal
Muscular‐skeletal
Emp 2
S
S
S
S
S
S
S
S
5.0
Ross Simon (Facilitator)
Dr. Chunbai Zhang
Sharps
Moving pt
O2 Tank
Monitors above head
Trash/linen bags
Wearing/carrying lead
gowns
Fumes/cement ‐ Ortho
Potential Injury
Muscular‐skeletal
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
Lift/Bend/Twist
Over reaching
Rep. Motions
Housekeeping
Chemical Use/Storage
Flammable storage
Slip/Trip Potential
Barriers/barricades
Stored Energy
Temperature Extreme
Noise Extreme
Biological
Electrical
Radiation
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
/
/
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
AR
AR
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
Respiratory
AR
AR
AR
AR
AR
AR
AR
AR
AR
AR
7.0
Plant Vehicle Use
Emp 1
Emp 2
7.1
7.2
7.3
7.4
7.5
7.6
Daily Inspection
Horn Used
Looking indirection of travel
Safe Driving Speed
Seat Belt Use
Unobstructed Driving View
S
S
S
S
S
S
S
S
S
S
S
S
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
/
/
/
/
/
/
AR
AR
AR
AR
AR
AR
V. Hazards Mitigated
Muscular-Skeletal
75-pounds less lifting in CPD & OR per
total joint procedure
Light-weight leg extension
Trash can lid hand injuries
Carpel tunnel injury – COW keyboard
wrist rests
Now
Trip & Falls
Use this form to complete your analysis of each specific job/task.
Job or Task Title/Description: Cysto Case
Prepared By/Date: Janet Rowe / 4‐10‐13
Basic Job Step
Potential Hazards
Recommended Safe Procedures
Orderly cleans surfaces & empties Muscular skeletal injuries (MSI) r/t Explore using smaller linen bags
rash & laundry
lifting heavy linen bags
Orderly mops floor
Slips & falls on wet floor
Planned change to microfiber mop
Cysto lead door swings in front of
monitor
Maneuvering stretcher through
door into cysto
Hanging 3‐liter IV bags
hroughout the case
Heavy lead worn for most cases
Assist anesthesia at extubation
Moving pt to stretcher post
procedure
Hitting staff at monitor & lead
door
MSI straining neck. back & arm
MSI, straining neck, back & arms
Contract planning/maintenance r/t
door configuration change
Explore changing the type of door
handle
Explore automated IV pole
MSI strains bending & stretching in
lead
MSI r/t decreased ability to secure
pt on wide table
MSI r/t pushing, stretching on
wide table
Don & remove lead immediately pre
& post procedure
Have 2 staff available to assist
anesthesia
Max assist for transfers (4 staff); make
it a priority for orderlies to respond
Cord covers
Room set-up standards to
prevent trips, falls and concussions
Slippery floors from wet back tables
Repetitive Motion, Other
Drifting MIS lights
Aerosolized enzymatic solution
Before
VI. Next Steps
Spread use of JSBO to other parts of the medical center,
where appropriate, and the understanding that all injuries
are preventable. Employee safety is as important as patient
safety.
For More Information Contact
Barbara Ditullio, bditulli@bidmc.harvard.edu
Lisa Foster, lafoster@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Barbara DiTullio (<a href="mailto:bdutilli@bidmc.harvard.edu">bdutilli@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Occupational Health
Employee Health & Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Rick Caswell <br />Lisa Foster<br />Matthew Rabesa <br />Ross Simon<br />Micha Deshaies <br />Rod McArdle <br />Oscar Rojas Dr. <br />Chunbai Zhang <br />Barbara DiTullio<br /> Dan McCarthy <br />Janet Rowe
Dublin Core
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Title
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Job Safety Behavioral Observation (JSBO) Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d37540c143244babb86960dadf263336.pdf?Expires=1712793600&Signature=W95IE6WDpn-TTp4VAq1RW7%7E1G6x4XA04MkIdg7jZ-z5NkrtIdGqMGGFEgvHYZom-DlBAuseqJHAKfoq7NXc518YWT3gfpUMD4K2oJDJjKwXfthObyTCNhM6K96wWKxrnB2UwKXoFiUXPz%7EDbKNOxLAZlee9%7ESAsc3SkdP68wfX5cN67upezLyf-xmoRO%7Ee-LGr3jhpkRAtoOkxu-XyfdzSG1soHymuWsNuBKvwuNLEq3IOGHeHNdE9zVvy1pL%7EnN0G-NLsfHVcPzCuBgI%7E75N8uonBzvTfK3tAGvsW8a%7EKXJR1P4QOS3JpqCHLUmM2vwRSGEyLX5RjBUqsQfUEl2mA__&Key-Pair-Id=K6UGZS9ZTDSZM
2a3c84442c2a8210c0d46418ec9e0777
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Text
Managing Repackaged Medications, Smarter not Harder
The Problem
The Results/Progress to Date
In order to support eMAR with BCMA, pharmacy needed to ensure that over 350,000
oral dosage forms per year get repackaged with a unique barcode on them.
The pharmacy formulary also had several hundred line items that have to be
repackaged that had a low annual usage <100 doses/year on the East Campus.
Number of doses repackaged
40000
Average # of doses
repackaged per
month has
decreased 28%
35000
20000
15000
l
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ay
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4
Centralize repackaging to the West Campus.
Decrease # repackaged doses by 30% per year.
Decrease quantity on hand of these medications by 50%.
Have par levels driven by patient usage, not manufacturer package size.
Rollout
Phase
25000
Ju
Aim/Goal
# doses
30000
month
The Team
Jean Beach, CPhT
Cristina Dischino, CPhT
John Hrenko, RPh
David Mangan, RPh
Steve Maynard, CPhT
Sonia Najdzien, CPhT
Total number of doses on hand
in the main pharmacy of
medications now centrally
repackaged and shared,
decreased by 53.8%.
The Interventions
Identified 321 line items on formulary that require repackaging that
could be shared between campuses.
Obtain actual usage data to inform par levels, not manufacturer
package size.
Re-deploy a repackaging machine that would provide medications in
preferred package for nurses.
Create a workflow that would enable sharing of inventory across
multiple pharmacy locations.
Resultant time saved by East Campus staff would be redirected to
checking in barcodes of commercially unit dosed products to support
BCMA.
Lessons Learned
Approximately 100,000 doses per year will no longer need to be
repackaged at BIDMC.
By centralizing repackaging, $149,648 of pharmaceuticals could come off
the shelf
Workflow improvements were made by staff delegated to open the area.
An additional >30,000 doses per year could be split in advance by
pharmacy, improving nursing workflow at the bedside.
Next Steps/What Should Happen Next
Determine change in waste to assign a valuation of workflow change.
Identify additional line items (Average Monthly Usage less than 0.25 Units
of purchase per month) that could benefit from sharing inventory.
For more information, contact:
David Mangan, PharmD, RPh, Manager of Pharmacy Operations
dmangan@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Dave Mangan (<a href="mailto:dmangan@bidmc.harvard.edu">dmangan@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jean Beach
Cristina Dischino
John Hrenko
David Mangan
Steve Maynard
Sonia Najdzien
Dublin Core
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Title
A name given to the resource
Managing Repackaged Medications, Smarter Not Harder
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/da373399426c060519291e5335bb5f9a.pdf?Expires=1712793600&Signature=B9k8BuIBa6pebsKPfoNf8ykUH8ZHGEHeKj%7EOd8lof1LXEl2B6r1rhvYYcdSr%7E761TEcgCkvcNjva2pGJWASCRK3R65sgLMMA263tGd2mJhFDuhMXuKIbLXUNlUvp2ipoJyV0Ur2UkUklxZkOb0EKcqN-Jryxa87nbmknGEovU5loa5v6O6VRHg6yKo%7EAc2pwFtO4wVCAK17HnX09PeWohPXBwiUdCQSkL3YznfjEd7Xzo002wsJMLjInHlI%7EMX4k2DHEU3iZcdH6YJ3CrlB41RgqYrPwLQqZqbU3eTh9do9uvtN3pwbxDWhlNPzCRHEQkmoDiFkR02ayOb0-4hvACA__&Key-Pair-Id=K6UGZS9ZTDSZM
dbba8bc9c5d323af2f483bf83e7f557f
PDF Text
Text
Medication Prior-Authorization Requests Psychiatry
The Results/Progress to Date
The Problem
Health plans often require a Prior Authorization (PA) before a psychiatrist can
prescribe certain medications. Submitting PAs currently requires the
psychiatrist to perform several time-consuming administrative steps,
including:
Identify the correct pharmacy contact line associated with the patient’s
health plan
Call the pharmacy contact line to request the PA form, which often
entails multiple automated phone prompts, long hold times, and delays
when selecting the incorrect prompts
Complete the demographic portion of the PA, including items that the
psychiatrist may not know (i.e., patient health insurance ID number)
Fax the completed PA
Track whether it has been approved or denied
Aim/Goal
To minimize time spent by physicians on administrative tasks, allowing
them more time to focus on clinical issues
To eliminate the need to search for pharmacy contact information
To eliminate delays in health plan responses to PAs due to the
submission of incorrect demographic information
Lessons Learned
The Team
The Interventions
Sandi Leitao, CAO
Sherene Blake, Practice Administrator
Jounathan Paulsaint, Referral Specialist
Pam Peck, PsyD., Clinic Director
The Referral Specialist (RS) receives requests for PAs from psychiatrists
by e-mail or in RS’s mailbox. Patient and pharmacy requests for PAs are
transferred from the front desk staff or psychiatrist to RS.
An Excel Spreadsheet is used to enter data about each PA, including the
psychiatrist requesting PA, patient name and MRN, medication name
and dosage, health plan, pharmacy vendor, pharmacy contact line, and
weblinks to PA forms.
The Referral Specialist uses the spreadsheet to track the number of
requests by health plan, medication, and psychiatrist.
An insurance company may have multiple health plans, each with a
different vendor, making it more difficult to identify the correct
pharmacy contact line when requesting and submitting PAs
When a patient’s pharmacy requests a PA to fill a medication they
often do not provide the correct number to the psychiatrist or RS to
obtain the PA form
The psychiatrists appreciate the administrative support that allows
them to focus on their clinical tasks
Next Steps/What Should Happen Next
Create a Microsoft Access database to collect data on PA requests
and submissions, including information to track approval periods,
denials and reasons for denials, and appeals; and to identify
proactively when PAs need to be re-submitted
Identify more effective and efficient ways to track and update the
requesting psychiatrist on PA submission, approval, denial and
appeals
Maintain a database of direct pharmacy contact lines, which often
result in faster authorization, especially for urgent patient requests
For more information, contact:
Jounathan Paulsaint, Referral Specialist
jpaulsai@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jounathan Paulsaint (<a href="mailto:jpaulsai@bidmc.harvard.edu">jpaulsai@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Sandi Leitao<br />Sherene Blake<br />Jounathan Paulsaint<br />Pam Peck
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Title
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Medication Prior-Authorization Requests Psychiatry
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4eb21cddf6385bef31ad21116e482342.pdf?Expires=1712793600&Signature=WbcJfpXEaqLB5g1qIti7LZ5ih5AaVSNIMSn8SIjTiIARsizmylmb0yCVQxdxfpVQ%7ElzE-J-jWZcgBxRgLGm4GOMDeAem07ZGo7M-jMUCNpwjkXNaDmy0lzgjk1mfzlIGrz9DhXfgjR5E5j5OG7peKwxRItz5tMjVsDRdlpvHE5NHk7Doc%7EldOuOJUvLQQuWjrvz1rblHuNEU5q7ZX1oqr1FFket-pPH13TLkU9mAOfyXAGEQQB%7EA%7EvMXxd9JRibMBZ%7ELj6-Oecp9N8G3BxLNbkTg46xyyKfgSMjhE5m6xS9en4ETeMxvTdlr5ldOUMcncUc4YQXGAysocH2IdzEZhQ__&Key-Pair-Id=K6UGZS9ZTDSZM
872b32933957961bc448e3d9554ab538
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Text
Minimizing CAUTI Risk Through Implementation of a
Team-generated Nurse-directed Protocol
The Problem
The classification criteria and algorithm are implemented daily for every catheter:
Catheter-associated urinary tract infections (CAUTIs) are the most common
healthcare-associated infection.
Patients with an indwelling urinary catheter (IUC) have a 5-7% risk of acquiring
CAUTI each day the catheter is in place.
At BIDMC, CAUTI rates and the IUC device utilization ratio (DUR, a measure of
how frequently IUCs are used) in intensive care units (ICUs) are both worse than
national benchmarks, despite interventions to date.
Interventions have included: education regarding aseptic catheter insertion;
evaluation of appropriate catheter maintenance; and daily order for IUCs.
A reduction in DUR would be expected to result in a reduction in CAUTIs.
Aim/Goal
In the selected intervention ICU, we aim to achieve a 25% reduction in the current
DUR of above 0.8 catheter-days per patient-day, within the first two fiscal quarters of
protocol implementation.
The Team
ICU RN Local Champions: Christine Joyce, Lisa Mirabella, Susan Kitchen, Lauren
Schmitz
ICU Clinical RN Specialists/Managers: Sharon O’Donoghue, Marjorie Serrano
MDs (multidisciplinary): Peter Steinberg, Andrew Hale, Deborah Nagle, James Levine
Infection Control/Hospital Epidemiology: Robin Kalaidjian, Payal Patel
Critical Care Quality: Kristin O’Reilly, Christina Cain, Michael Cocchi
Center for Resuscitation Science: Michael Donnino, Parth Patel, Mary MacDonald
Co-Investigators: Susan Holland, Peter Clardy, Sharon Wright, Graham Snyder
And many other nurses and physicians providing input and oversight.
The Results/Progress to Date
The Interventions
Intervention: Employ a team-generated, nurse-directed protocol to reduce the
duration of IUCs, specifically through facilitating prompt removal of IUCs.
Lessons Learned
Develop Classification Criteria to Determine IUC Justification:
a contraindication or likely complication if catheter is removed, or
HIGH
a condition for which the catheter is part of evidence-based care
a relative contraindication or possible complication if catheter is
INTERMEDIATE removed, or
a condition for which the catheter may be indicated
no contraindication or likely complication if catheter is removed, and
no current or anticipated compelling clinical indication for catheter
LOW
use
The classification criteria are approaching completion and entering testing.
Anticipating implementation efforts have included staff education.
Data collection (retrospective) is underway.
The time to develop algorithm and consensus has taken longer than planned.
Multidisciplinary team effort has contributed value to the design process.
Many ancillary ideas and issues have arisen, such as identifying the appropriate
indications for urine output monitoring.
Next Steps/What Should Happen Next
Trial implementation of the classification criteria and algorithm.
A staff survey is being developed to understand perceptions regarding catheter
use and removal.
Analyze the effect of the algorithm on DUR and CAUTI rates before and after the
intervention.
For more information, contact:
Graham Snyder, M.D. S.M, Infection Control / Hospital Epidemiology
gsnyder@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
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Graham Snyder (<a href="mailto:gsnyder@bidmc.harvard.edu">gsnyder@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Heath Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Christine Joyce<br />Lisa Mirabella<br />Susan Kitchen<br />Lauren Schmitz<br />Sharon O’Donoghue<br />Marjorie Serrano <br />Peter Steinberg<br />Andrew Hale<br />Deborah Nagle<br />James Levine<br />Robin Kalaidjian<br />Payal Patel <br />Kristin O’Reilly<br />Christina Cain<br />Michael Cocchi <br />Michael Donnino<br />Parth Patel<br />Mary MacDonald<br />Susan Holland<br />Peter Clardy<br />Sharon Wright<br />Graham Snyder
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Minimizing CAUTI Risk Through Implementation of a Team-Generated Nurse-Directed Protocol (2014)
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
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pdf
Effectiveness
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-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f495eadc4ab030ebc053b8e3a7a42b75.pdf?Expires=1712793600&Signature=isCCPFrD6RzUyeeG8fb9E81F5E35cGeXJJAlUe8KVoWfX4rkkJfuG3IGP2MLgsB5qT8Ywpvl7b7yKinCsL5Al-EclyHIiy1nFUGuzuROIUJ4bWFeQ1jZ5G8Bg99QsGYGTtlHdhyBt-YotN9uNLriLcZNlUQcB4FpyQo1f4NinPTXu9xofa3h3LrDNM4EHnk7CUoSK492YdUaqVOsf%7EdLz6UDWTU6IZgTCCOwrSi59QfSHRBqelALD4LEzWdOlW6YPpxpteAWId5aPfeSyay%7ESqLv7tNcyUDm9ED5y9kAXE0hcJep4ocmo0lFmgv7D2M%7EHGahHUmeCpWLeK98fSEsSw__&Key-Pair-Id=K6UGZS9ZTDSZM
6516475b10b48c2c44bf6cf467cfa50e
PDF Text
Text
Monitored Anesthesia Care (MAC) Anesthesia
Recovery Outside the PACU
The Problem
The Interventions
There has been a gradual increase in the number of procedures performed outside the
operating room. Currently around 13% of the anesthetic volume is accounted for by
cases done outside the operating room. Additionally with the changing healthcare
model, higher acuity patients are being preferentially treated in major teaching
hospitals. Unfortunately ICU capacity has not commensurately increased, thus leading
to the Post Anesthesia Care Unit (PACU) being utilized as a temporary ICU. This practice
of boarding ICU patients has consumed valuable space and resources in the PACU. The
problem of resources was most acute on the West campus where the Electrophysiology
(EP) lab was a major contributor of patients to the PACU who needed recovery following
a MAC anesthetic. All of these changes have led to serious capacity issues in the PACU.
An educational module was developed regarding MAC anesthesia that focused on the
recovery characteristics and common side effects of commonly used intravenous
anesthetics. Nurses also reviewed the BIDMC Moderate Sedation policy that covers
commonly used drugs including fentanyl and midazolam. Initially a small group of cath lab
holding area/recovery nurses attended a half a day session where they watched PACU
nurses recover patients from MAC anesthesia in Phase II. However this practice was
subsequently abandoned, as explained below. All cath lab holding area/recovery nurses
attended a policy review session with the PACU educational resource nurse. This session
was regarded to be very useful as it allowed nurses to raise specific questions and concerns
regarding the BIDMC policy surrounding MAC recovery. All cath lab holding/recovery nurses
underwent a post test and were credentialed by their peers who had undergone the
process previously.
Aim/Goal
Nurses at the Gastrointestinal Unit (GI Unit) have been recovering patients from MAC
anesthetics for a few years now with great efficiency and safety. The aim of this project
was to replicate this successful model in other areas where interventional procedures
under MAC anesthesia were being performed.
This aim required EP holding area/recovery nurses to study an educational module
about recovery from MAC anesthesia, complete a post study test, observe MAC
recoveries in Phase II of the PACU, and finally to undergo real time evaluation by nurses
already competent with this skill. The outcome of this project will be to eliminate the
need of patients recovering from interventional procedures performed under MAC
anesthesia in the PACU.
The Results
100% of EP nurses have completed the online module that is available on MyPortal, 100% of
them have attended the policy review. A formal roll out date is being awaited to allow EP
nurses to begin recovering patients from MAC anesthetics within their perspective holding
areas.
Lessons Learned
Sending EP nurses to observe MAC recovery in Phase II of the PACU proved to be unhelpful.
The observing nurses benefited little from this process as they already had experience
administering moderate sedation, recovering patients, and managing simple
ventilation/oxygenation and hemodynamics issues. On the other hand, small group sessions
with the PACU educational coordinator proved to be more useful.
The Team
Irina Fishman M.D. Resident Dept. of Anesthesia
Mary Grzybinski BSN, RN. Clinical Advisor West PACU
Marianne McAuliffe MSN, RN. Unit based educator. PAT and PACU
Mary Ellis BSN, RN Clinical Advisor East PACU
Jane Noonan BSN, RN East PACU
Susan Dorion MSN, RN Nurse Manager PAT and PACU
Lisa Hird BSN, RN Nurse Manager Cardiac Cath Lab
John Whitlock MS, RN Clinical Nurse Specialist, Invasive Cardiology
Sheila Barnett. MD Interventional Procedures Committee Chair.
Eswar Sundar MD Director of PACU
Next Steps
This training and credentialing program will be used to train nurses in other procedural
areas like radiology, ECT, and also to re‐credential GI nurses.
For more information, contact:
Eswar Sundar MD. Director of PACU
esundar@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Irina Fishman (<a href="mailto:ifishman@bidmc.harvard.edu">ifishman@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Preadmission Testing
PACU
Cardiac Cath Lab Nursing
Invasive Cardiology Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Irina Fishman <br />Mary Grzybinski <br />Marianne McAuliffe <br />Mary Ellis <br />Jane Noonan<br />Susan Dorion<br /> Lisa Hird <br />John Whitlock<br /> Sheila Barnett<br />Eswar Sundar
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Title
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Monitored Anesthesia Care ( MAC) Anesthesia Recovery Outside the PACU
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/76aee3370eedffb9b5a2260aaf50e609.pdf?Expires=1712793600&Signature=SgosXeR6okGu5yNiLje0DPf371xjwKeawdJ70XP%7EVIrZZn7w5fWy2gZPqZa99WhSA6ucupKXLnbkk2kxG2--sE347WFFeUIFjsFGqvDfZxHdVQffWvDUw5iOqvuF%7ESEFdpxlJm2y7xoMWLVSE9O2Bs7EvBMCit5748s4fhNjspvh2mN3VpKoWbDxWXjbvbIhMVp3MHl0fnDREkV5WO%7EeBgnN8Tz9s0ZgxRZSvUQXF%7Edzwaxi3sR7owogJwFzaTrqwFjwUILEZntWSNy5RWVfb3Oz1EILQiuwFQRIWK2cOLhE0ZB7HK3tDmUf8tiKxx2XI26o7-WIzGH9QAQWLZg8uQ__&Key-Pair-Id=K6UGZS9ZTDSZM
f7309984a5a44cb645686e192d161781
PDF Text
Text
Monitoring Missing and Unsigned Notes in Ambulatory Psychiatry
The Problem
The Results/Progress to Date
Timely and complete documentation facilitates patient care and strengthens
decision- making. In June 2013, BIDMC updated its ambulatory
documentation policy requiring all notes be completed and signed within 7
calendar days after the outpatient visit. Although the Psychiatry Department
currently runs regular reports to identify unsigned and missing notes, these
reports are run separately making it difficult to track whether notes are
completed and signed in a timely fashion.
Aim/Goal
Our goals for this project were to
Create a system to integrate both missing and unsigned ambulatory visit
notes
Automate that report
Decrease the number of ambulatory notes designated missing or
unsigned more than 7 calendar days after the date of service.
The Team
Denise Doucette, Finance Manager
Rohn Friedman, MD, Vice Chair
Stephenie Loux, MS, Quality Improvement Data Analyst
Pamela Peck, PsyD, Clinical Director
Lessons Learned
While the majority of providers have few notes >7 days, a small number
of providers have high numbers of incomplete notes. The Clinical
Director is working to identify the causes to help staff eliminate the
backlog of missing and unsigned notes.
Notes awaiting co-signature do not show up in the current reports
The Interventions
Run weekly CCC OMRVN report for Psychiatry’s HMFP and Training
Clinics
Create automated summary and individual provider reports with
missing/unsigned notes categorized as <7, 7 to 13, and 14 or more days
after visit
Distribute individual reports to clinicians and summary report to Clinical
Director
Provide clinicians with assistance in resolving errors in missing notes
report
Monthly data summary for Departmental Management Report
Contact those with missing/unsigned notes > 14 days past due and
schedule an appointment with Chief of Psychiatry as per BIDMC policy
Next Steps/What Should Happen Next
Develop individual plans with providers who have high numbers of
missing and unsigned notes > 7 calendar days past the date of service.
Examine the feasibility of adding notes awaiting attending cosignature
For more information, contact:
Pamela Peck, PsyD, Clinical Director
ppeck@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Pamela Peck ( <a href="mailto:ppeck@bidmc.harvard.edu">ppeck@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Denise Doucette<br />Rohn Friedman<br />Stephenie Loux<br />Pamela Peck
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Monitoring Missing and Unsigned Notes in Ambulatory Psychiatry
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
Efficiency
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-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/b2d35d98d4b71b6510944ce06a2c401e.pdf?Expires=1712793600&Signature=dQHdlLsu4AHHQMo%7E83nFqTFg2OUAIhuOBsf5GHyjdhn-9ysy3wyk2WgVDsHl-DKlXPm6Fusi1YQdVJ2BpJo7zMsjDmNjlLl2KYCEGkwOGKK8GrevSKHSAMAHzP0PtQYHOQCVOOFJU-MtX5Wns7hHyk80H0OL-PQzS23VJovJIETKYDz%7EbfkwV%7EV0Yl2run349AZ-0qrQnz2ylFHeyCFqvVl-SrqNClvMioXvGrkRK%7EMDSlLc9Sl3Qc3q-ili7wWST-5cLNitpcVR6bu9MGFC1hEq5%7ETbYSnW8xRtz2EMfESLZDry3EaX31Yg7sZS9yBOT7e8cQj0l%7ErwbmGl65g%7E6g__&Key-Pair-Id=K6UGZS9ZTDSZM
4a1da951d825048b2ec91d69d22891f3
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Text
Music Genre May Not Hinder Surgical Performance
The Problem
The Results/Progress to Date (Cont.)
We specifically asked about subjective assessment of whether their most and
least preferred music affected their surgical task performance. Subjects rated
their feedback on a 5 point Likert Scale (1=not at all, 5=very much). In this
study, performance was not substantially affected by:
the most preferred music (median = 1) OR
the least preferred music (median = 2)
Music in the operating room is now commonplace
Several studies have characterized how music may affect surgeon
performance (1,2,3)
Aim/Goal
We seek to measure surgical performance in the presence of distractors such as
music. In order to safely conduct this study without possibility of harm to human
subjects during an operation, we do this in a second generation virtual reality
environment. The purpose of this study is to determine whether the selection of music
genre affects surgeon performance.
The Team
BIDMC: Robert Sung, MD, Hussna Wakily, MD, Daniel Jones, MD
Rensselaer Polytechnic Institute: Ganesh Sankaranarayanan, PhD, Baichun Li,
MS, Suvranu De, Sc.D
Cambridge Health Alliance: Amie Miller, MD, Kelly Manser, BSc, Steven
Schwaitzberg, MD
The Interventions
Exemplars of various genres of music were selected. Surgeons were asked to rank
each genre from most preferred to least preferred. Surgeons were then asked to
perform a virtual reality peg transfer task similar to that found in the Fundamentals of
Laparoscopic Surgery (FLS) exam. Musical distractors (most preferred and least
preferred) were played during the peg transfer task. Along with music, two
interruptions (fogging of the camera view and tool malfunction) were also presented
to the subjects. Task performance was scored according to the standardized FLS
methodology.
The Results/Progress to Date
9 subjects (7 attendings and 2 medical students)
participated in this study held at the American
Society for Metabolic & Bariatric Surgery
(ASMBS) Obesity Week conference in
November 2013. A Wilcoxon Signed Rank test
was used to test the difference in peg transfer
task performance of subjects while subjected to
their most and least preferred music. This
showed no significant difference (p = 0.136).
Lessons Learned
Virtual reality allows surgical performance assessment outside of the operating room
in a safe environment. In this study, surgical performance did not degrade in the
presence of musical distractors and interruptions. Specifically, music genre did not
affect surgical performance. Therefore, our data suggests that any team member in
the operating room can select music without hindering surgeon performance.
Next Steps/What Should Happen Next
A peg transfer tasks may be too simplistic to challenge an experienced surgeon, even
in the setting of musical distraction. Further studies are necessary to examine effect
of surgical task complexity as well as variations in music rhythm, volume, and tempo.
References
1. Allen K, Blascovich J. Effects of music on cardiovascular reactivity among
surgeons. JAMA. 1994 Sep 21;272(11):882-4.
2. George S, Ahmed S, Mammen KJ, John GM. Influence of music on operation
theatre staff. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):354-7.
3. Conrad C, Konuk Y, Werner P, Coa C, Warshaw A, Rattner D, Jones DB, Gee D.
The effect of defined auditory conditions versus mental loading on the laparoscopic
motor skill performance of experts. Surg Endosc 2010, 24:1347-52
For more information, contact:
Robert Sung, MD, MIS/Bariatric Surgery Fellow,
rsung@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Robert Sung (<a href="mailto:rsung@bidmc.harvard.edu">rsung@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Robert Sung<br />Hussna Wakily<br />Daniel Jones<br />Ganesh Sankaranarayanan<br />Baichun Li<br /> Amie Miller<br />Kelly Manser<br /> Steven Schwaitzberg
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Title
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Music Genre May Not Hinder Surgical Performance
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ceb97a47790a13224384f7def34b3563.pdf?Expires=1712793600&Signature=c6xpS7HQbSNQ57F52rw73%7EdbxsIhHQEMxQi2VO94Tvbd6TWYcCmPvw-kdCH6eP9X7C22mVd7G5nHvmTyfxEYlcW%7EV2QA8OCOSZ-UgddleAtYSuY290L30duMZnX7c0dAKLGceRnaqxECoacHx1uBBhVYPKpAeDub%7Ei2ValFMFHUpo0ptOu2DsyAvB3lYFWspziHbuL7I0C7th9LC4F5X26sUoMHxhd3jP9Xd9DIobg68sq3uK6A0P9hc9U5RaU0Ey70UaiC7VgJQYiW-PBFKZc0iNbV0lA8-PlcRtee2MbBG%7EEq5iX1yRP4YVonrTVioNmRo3jFdcW7zoW7DQuYHgQ__&Key-Pair-Id=K6UGZS9ZTDSZM
6af720334aecd442dca93f03a78d1e98
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Text
Neonatal Continuous Improvement System (NCIS): 1 Year Update
Few mechanisms for translating bedside challenges identified
Limited involvement of front-line staff in the identification and
implementation of improvement opportunities;
Absence of mechanisms to ensure improvement projects are
completed in a timely fashion; and
Absence of integrated communication systems resulting in
Jane Smallcomb, Perinatal Director
Munish Gupta, QI Director
Susan Young, CNS
Kathy Tolland, Nurse Manager
Pam Dunleavy, Practice Administrator
Dave Miedema, Data Engineer
Results / Progress to Date through January 31, 2014
Submitted and Completed Improvement Opportunities (Fig 1)
457 improvement opportunities submitted
Submission rate fairly consistent: 15-30 per month
352 (77%) have been completed
Submissions by Discipline (Fig 2)
Submitted by all disciplines
66% by RNs
Prioritization Category (Fig 3)
228 (50%) assigned to “Just Do It”
36 (8%) to “Holding” or “No Action”
Impact Category: all represented (Fig 4)
Median Days to Completion (Fig 5)
For all completed items: 18 days
> than target for Just Do It and Short Term
Figure 1: Submitted and Completed Improvement Opportunities
70
450
400
50
redundant and uncoordinated work efforts.
250
30
200
150
20
100
10
50
0
0
Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13
Submitted
Aim / Goal
On November 1, 2012, we launched the Neonatal Continuous Improvement System (NCIS), a new platform
for coordinating improvement efforts in the NICU. Here we describe our experience with NCIS after 1 year.
NCIS is built around a project board that
organizes ongoing and completed
improvement efforts.
Daily rounds by NICU staff and leadership
are conducted to review new and ongoing improvement opportunities (IOs).
Board has undergone several revisions
over first year, including adjustment of
section sizes, addition of “Key” defining
categories, and addition of plastic card
holders in several areas.
Improvement Opportunity (IO) Cards
Completed by any NICU staff member at any time
New IOs reviewed daily: assigned owner, prioritization category
Categories: Just Do It (target completion < 7 days), Short-term
(< 30 days), Long-term (< 90 days), Holding, No Action
Microsoft Access Database
During NCIS rounds, new IOs entered and existing IOs updated
Reports sent to submitters after initial entry and each update
Owner reports with outstanding IOs sent weekly by email
Cumulative summary of completed IOs posted weekly on board
Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14
Submitted Cumulative
Completed Cumulative
Figure 3: Improvement Opportunities by Prioritization Category
250
302
12
200
Not Completed
150
25
63
8
30
4
2
Completed
150
216
100
7
1
20
17
2
0
108
200
38
Just do it
70
122
100
Care Quality Efficiency
13
No Action
80
203
172
150
Patient
Safety
23
Holding
Figure 5: Median Days to Completion by Prioritization Category
222
180
Long Term
0
Figure 4: Improvement Opportunities by Impact Category
250
22
Short term
50
42
5
0
Project board
Jul-13
200
50
Interventions
Completed
Figure 2: Improvement Opportunities by Staff Category
250
50
300
40
350
100
350
352
300
DeWayne Pursley, Chief
500
457
60
60
50
40
70
30
20
40
10
9
0
Waste
Family
Staff
Staff Safety
Satisfaction Satisfaction
Just do it
Short term
Long Term
Examples of Improvements Resulting from NCIS:
Enabled central monitoring of third bed space in
Adjusted virus scan to avoid previously seen
unit-wide nightly computer slowdown
all rooms
Instituted family identification badge system
Developed visual system for cleaning and stocking eye exam kits to ensure availability
Updated nitric oxide guideline to match new
standards of care
Initiated Last Name / Last Four patient ID system
Lessons Learned / Next Steps
Key Features
After 1 year, staff involvement remains consistent, with 1530 new submissions per month from all disciplines
Daily review of items critical for maintaining momentum,
encouraging action, and completing items
Periodic improvements to process, project board, and database increase NCIS impact and ease of use
Challenges
Ownership of items still almost exclusively NICU leadership (87% are owned by six individuals)
Time investment for daily NCIS rounds and improvement work remains substantial, although less time
needed in other committee and group meetings
Next Steps
Repeat culture of safety survey to measure impact of NCIS (baseline conducted in January 2013)
Extend system to newborn nurseries, post-partum units, and BID-Plymouth Continuing Care Nursery
For More Information:
Jane Smallcomb (jsmallco@bidmc.harvard.edu)
DeWayne Pursley (dpursley@bidmc.harvard.edu)
Cumulative
by clinical staff into improvement activities;
The Team
Median Days to Completion
Our improvement efforts often have difficult challenges, including:
Opportunities per Month
The Problem
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Munish Gupta (<a title="mgupta@bidmc.harvard.edu" href="mailto:mgupta@bidmc.harvard.edu">mgupta@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Neonatology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jane Smallcomb<br />Munish Gupta<br />Susan Young<br />Kathy Tolland<br />Nurse Manager<br />Pam Dunleavy<br />Dave Miedema<br /> DeWayne Pursley
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Title
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Neonatal Continuous Improvement System (NCIS): 1 Year Update
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
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Timeliness
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/64ad7939694ba2152b67feb16c8d3c59.pdf?Expires=1712793600&Signature=URUZEP59C48fHNXe1lShbk6MDszS%7EzbZ0BREqy9DpCdRMJbD1BfpkAtLxjKr3PbzOrfqWi1HlMy18jciA3mQT48ja1Ol9vPax1KMVQgMtFIj0aQbeARio%7EwJY6QOswDdpyANdTN5vJVaHADrZpvnlnmULjocVkO6bhP8O%7Eur-On5py1HturDtLJCs0Wzdj5IhBuTtqB-PQ%7EfiaJLRHj%7ERB2Ix0lHwUvYkouvF24doy9l-aOSFJeM9XEwEtwyjAcpQxhpj4D4qcigBR21IwIqfEEA5FvQ4c7JzBXVCZMraW0T2G3LD-mizIei2-3PUo3NWZswKwav-NnoII89nYgG6Q__&Key-Pair-Id=K6UGZS9ZTDSZM
3ee4882577824c7bc9390307d4fcf6cf
PDF Text
Text
NICU Discharge Medication and Supply Program
The Opportunity
Discharge for NICU infants can often be stressful for the parents. NICU infants may be
discharged on special formulas, prescription medications that require compounding, and
over‐the‐counter (OTC) supplements.
Parents have verbalized their problems with discharge preparations:
Formulas can be difficult to find
OTC supplements can be difficult to locate in the correct concentration
This adds more stress to an anxiety producing process.
RN and Pharmacy staff verbalized their concerns:
Delays in bringing in any medication, OTC or prescription, leads to delays with
discharge teaching
Because medications might not be compounded correctly by community
pharmacies, and OTC items such as vitamin D might not be the correct
concentration, oversight is key to safe discharge
Using the discharge medication program successfully deployed on the adult floors as a
model, the NICU set out to work with Walgreens to tailor a program that would meet the
needs of NICU families.
The Program Goal
Establish an in‐unit discharge medication
and supply program that would meet the
unique discharge needs of NICU infants
and families.
The Team
Gregory Dumas RPh
Karen Poliskey PharmD
Susan Young RNC, MS
The Work
Can OTC supplements such as multivitamins, iron, and vitamin D be supplied with the
appropriate concentrations? Yes
Could specialty formulas be obtained? Yes
Are compounded medications available? Yes
Design an order sheet specific to the NICU orders
Develop a process for phone contact with families
who may not be present when Walgreens is on unit
Establish NICU med and supply fulfillment routine which
often requires delivery days prior to discharge for teaching
Add an informational flyer to the Discharge Packet so families
would be aware of the program
Evaluation of program after one month to assess the process
o
o
Order form was redesigned
On‐unit form storage was revamped with input from Walgreens and NICU staff
The Results
The program was introduced on September 24, 2013.
Since that date 26 families have participated.
Order Type
Number
Formula
8 Enfacare, Enfamil
OTC
42 Iron, Vitamin D, Multivitamins, Acetaminophen
Prescriptions
Breakdown
Other
3 AquADEKs, Furosemide, Potassium Chloride
2 Vaseline, Glucometer
There were only 3 prescription medications obtained through Walgreens. In general,
NICU infants aren’t discharged with many prescription medications.
The majority of the items obtained from the Walgreens program were OTC supplies,
which parents had stated they had difficulty obtaining.
Parents were queried during post discharge follow‐up phone calls about their knowledge
of the availability of the program and whether they found it helpful if they did use it.
Parents questioned during follow‐up phone calls: 41
‐ 22 parents did not use the Discharge Program
o 13 of these families didn’t know about the program
Of the remainder, several families didn’t require medications or formula, or discharge
occurred on the weekend
‐ 19 parents used the program
18 families commented that the program was ‘helpful’, ‘quick and easy’, ‘fast and
efficient’, ‘great’; and ‘saved us time’.
Lessons Learned
Families were not always aware of the program
The program added additional work for the bedside RN
Preplanning is important for compounded meds, and weekends and holidays
when the program is not open
OTC supplies were the most frequently purchased items, not meds
Next Steps
The program was modified to use for newborns on the Mother / Baby Units
Post information about the Discharge Medication and Supply program on
the NICU information slide screen to increase awareness
Schedule follow‐up meeting for March 2014 to discuss issues
Complete a review of our most common discharge medications and send
Walgreens an updated list with NDC numbers
For more information, contact: Susan Young RNC‐NIC, MS
NICU Clinical Nurse Specialist
syoung1@bidmc.harvard.edu
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Susan Young (<a title="syoung1@bidmc.harvard.edu" href="mailto:syoung1@bidmc.harvard.edu">syoung1@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
NICU
Pharmacy
Walgreens
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Gregory Dumas <br />Karen Poliskey<br />Susan Young
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Title
A name given to the resource
NICU Discharge Medication and Supply Program
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Patient and Family-Centeredness
-
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0fce8561db8582822b0d37b1e3cc987e
PDF Text
Text
Nursing time spent before and after the
implementation of eMAR/bedside barcoding
The Problem
The implementation of bedside barcoding and eMAR (Electronic Medication
Administration Record) have been shown to improve patient safety by
reducing certain types of medication administration errors
Starting in 2013, BIDMC began a hospital‐wide implementation of these two
practices
It is unknown what effect (if any) the implementation of these processes
would have on how nurses spend their day
o On medication‐related tasks
o Overall patient care
o Time spent in the patient’s room
The Results/Progress to Date
Before eMAR
After eMAR
(per 8 hour
shift)
(per 8 hour
shift)
Non-medication
patient care
65 minutes
63 minutes
MAR interaction
25 minutes
32 minutes
Administering
Medications
37 minutes
35 minutes
26 minutes
The Team
Non Medication
34 minutes
transport (includes
searching)
Rachel Hutchinson, RN – 5 Stoneman Mary Ellen Gunning, RN ‐ 5 Stoneman
Cynthia Phelan, RN
John Marshall, PharmD – Pharmacy
Samantha Moore – Pharmacy Nicholas Demosthenes
Total time spent in
patient room
196 minutes
The Interventions
Lessons Learned
Aim/Goal
The aim of this project was to quantify how nurses spent their time before
bedside barcoding/eMAR implementation to how they spent their time
after bedside barcoding/eMAR were implemented.
A time in motion study was created with bedside nursing input to define the
tasks that a nurse performs throughout their shift
The studies were conducted using Workstudy+ software using an iPAD mini.
Data was then downloaded and analyzed using Microsoft Excel.
The baseline study was conducted for 5 shifts (4 day/1 evening) on the 5
Stoneman unit prior to eMAR implementation
The same time study was then conducted roughly 6 months after the
implementation of eMAR implementation for 5 shifts (4 day/1 evening) on
the 5 Stoneman unit.
166 minutes
Overall nursing time spent performing tasks was not different when
comparing pre/post eMAR implementation
Medication‐related administration time remained the same, despite
the requirement for bedside barcoding
Less nursing time spent walking around the unit (no need to search
for med books)
Time spent in patients’ rooms increased by 30 minutes per shift
Next Steps
Continue to implement eMAR/bedside barcoding throughout BIDMC
For more information, contact:
John Marshall, PharmD, Clinical Coordinator – Pharmacy
jmarshal@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
John Marshall (<a title="jmarshal@bidmc.harvard.edu" href="mailto:jmarshal@bidmc.harvard.edu">jmarshal@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Rachel Hutchinson
Mary-Ellen Gunning
Cynthia Phelan
John Marshall
Samantha Moore
Nicholas Demosthenes
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Title
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Nursing Time Spent Before and After the Implementation of eMAR/Bedside Barcoding
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Environmental Sustainability
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/031da116229ade158f44cab922d287a9.pdf?Expires=1712793600&Signature=wBZ-pd9mupXLJZGQu1igdkYajZicLK6zMYXAAEXKSjzYnDtZ9ut70J%7EJR3jZfrKelSNH7cBvU7GkkeEIr7k2Vt7gRNI4xj%7E-3Mg9gThe%7Elc2OfkZpFrIQDtOY6ST%7EjBr14HWp%7En-SJMmj9lV4-QKFX0HIow%7EuYBhtccLqZC7mpsLDaASW2kg9ILVp2TAPMF51yi3iVG9XJTL1Om3vta-ND4jf1HxiIGjXlcylvFKUM9DwOEpJW4oCxrWanXtMSxhoSDeoL7l92vxBjiMbnlOs0Azva1Et8fk7U8hwiws0WiZHImwa9mTea8kx6IvJpMNZ5hUIiJx7of7Dpbx2z5EIg__&Key-Pair-Id=K6UGZS9ZTDSZM
d54195dd33c1efbb22d9c59c69ada325
PDF Text
Text
Margie Reilly, PharmD, Project Manager: OMS Project Manager
Patricia DiGiacomo-MacDonald RN., OMS Oder Set Coordinator
Loi Nguyen RPH, OMS Order Set Coordinator
Oncology Management System (OMS)
Expansion of Downtime Process
PD
A S
1. Reason for Action
5. Target Condition
During a short downtime in 5/2013, the newly formed OMS team
discovered a specific gap in the computer downtime operations of OMS.
OMS created approved templated electronic copies of OMS order sets
which conformed to Medical Records/Forms Committee standards. Final
documents in PDF format for MD ordering. The templated orders would
be used by the Hem‐Onc MD in the event of an extended computer
downtime. Forms would be loaded and stored on the OMS Shared drive.
A copy of the files would be available on secured USB drives which would
allow access in the event of network downtime. The OMS team is
responsible for updating the documents. The USB drive would allow
printing from an individual PC or printer with a USB option for printing.
OMS team to guide MD’s on the use and filling out of downtime order‐
sets.
2. Current Condition
In May of 2013, OMS had 314 active regimens available for MD
ordering. While an electronic backup (print out of orders) is performed
nightly on patients who are scheduled to receive chemotherapy in the
Hem‐Onc Clinic the next day, a gap existed for any new patients/orders
or those being rescheduled. No paper or electronic back up for paper
existed for these particular scenarios.
Problem Statement:
P
If the OMS system were to go down, physicians would not have
templated chemotherapy orders available when entering initial orders or
when renewing a previous cycle.
D
O 6. Countermeasure Implementation Plan
1. Discuss need with multidisciplinary committee/ nurse manager (5/13)
2. Discuss gap and need with medical records (8/13)
3. Obtain template from Medical Records (8/13/13)
4. Develop a sampling of templated orders for approval by Forms
Committee (7/13)
5 . Discuss process / implementation for use with Multidisciplinary Team
(8/13)
6. Implement updated process ((9/30/13)
L
A
N
3. Measure of Improvement
Design and implement a backup plan for OMS orders during downtime
to allow for MD ‘s to order chemotherapy when initiating new therapy
or renewing a prior cycle. Make 314 orders available in a templated
form to be used by MD’s during OMS downtime.
4. Analysis
The chance of a computer downtime of a significant time period (>2 hrs)
is unlikely, but given the high risk of error and implications for
incomplete documentation, the OMS team felt it important to have a
plan. Considerations when designing the downtime process:
• Approval of paper forms by Forms Committee
• Ease of use by MD, RN’s, and Pharmacy
• Ease of documentation of recovery
• Storage and upkeep
8. Standardize and
Spread Processes
7. Monitor both
Results & Processes
S
T
U
D
Y
All 314 orders have been
converted and are available with
new Regimens being added as
new orders undergo sign off
procedures. Since the
implementation of the new
process only 2 short downtimes
have occurred neither required
the use of these backup orders.
A
D
J
U
S
T
Departments should periodically
review downtime procedures to
identify possible gaps and apply
lessons learned from previous
downtime experiences.
For example, considering
essential forms or
documentation that are needed
for downtime and creating a
recovery process if needed to
meet the departmental /legal
standards.
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Margaret Reilly (<a title="mdreilly@bidmc.harvard.edu" href="mailto:mdreilly@bidmc.harvard.edu">mdreilly@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Cancer Center
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Margie Reilly<br />Patricia DiGiacomo-MacDonald <br /> Loi Nguyen
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Title
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Oncology Management System (OMS) Expansion of Downtime Process
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
Timeliness
-
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35192092d3049f3466e7eebd5ccc949d
PDF Text
Text
Optimizing Clinical MD Documentation
The Problem
Documentation is an essential part of medical care and is the core of any process
improvement intervention. However documentation is becoming increasingly cumbersome
andredundant. Furthermore, the current state of note writing is inefficient and underutilizes
existing electronic systems to optimize efficiency, accuracy, education, and compliance.
Aim/Goal
As part of the Department of Medicine’s Stoneman Quality improvement elective, the team
of residents designed a project that would highlight the state of current MD documentation
and provide a roadmap for the characteristics of an ideal inpatient clinical note. We sought to
provide suggestions that might be incorporated to optimize clinical documentation.
The Team
Haider Javed Warraich, MD, PGY‐3, Department of Medicine
Kristin Burke, MD, PGY‐3, Department of Medicine
James Brush, MD, PGY‐3, Department of Medicine
Kudakwashe Maloney, MD, PGY‐5, Med‐Derm
Sarah Moravick, QI Project Manager, Health Care Quality
Alex Carbo, MD, QI Director, Department of Medicine
The Current State of the Clinical Note
Areas Identified for Improvement
Efficiency:
•
Similar information is collected separately by different providers
•
Data cannot be viewed and entered on one screen
•
No good way to import data from OMR
•
Lack of review of prior information (alerts regarding prior precautions e.g.
aspiration precautions, prior dietary information)
Accuracy:
•
Over‐reliance on copy pasting increases chances of errors being carried over
•
Essential information is not available digitally to be imported e.g. medication
administration, vital signs, leaving room for error and/or redundancy
•
Inability to view information and trends reduces ability to discern clinical trends
•
Over‐reliance on free text increases variability in quality of notes
Compliance:
•
No support to indicate compliance requirements
•
No integration with ICD‐based billing codes
•
No differentiation between inpatient and observation documentation
Education:
•
Lack of decision support in current notes system
– Hyperlinks to standardized protocols, decision support
– Automatic problem list generation could curate required information
•
Lack of patient safety pop‐ups (e.g. if some comes with falls, is he on fall
precautions etc.)
•
No platform for robust data‐viewing or trend generation
The Future: Suggested Improvements
To optimise physician clinical documentation, notes of the future should:
Collect and store recurring information (medication recononciliation,
social/family history etc) in one electronic location viewable by all
providers, allowing for editing to be incoporated into notes
Auto‐populate physician‐selected vitals, relevant lab data, medications,
and prior treatment history into notes
Provide links for decision support
Incorporate a smart problem list which automatically populates relevant
clinical information (e.g for sepsis: microbiology data, antibiotics, need for
PICC line etc. could be imported)
Allow data‐viewing and vital sign/lab data graph creation on the same
screen as the note platform to enhance decision making
Incoporate more patient safety prompts (e.g if patient has aspiration
pneumonia, need for aspiration precautions could be imported)
Electronic medical administration data can be incorporated and
automatically imported
For more information, contact:
HaiderJaved Warraich, MD, PGY-3, Medicine,
hwarraic@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.
Haider Warraich (<a title="hwarraic@bidmc.harvard.edu" href="mailto:hwarraic@bidmc.harvard.edu">hwarraic@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Health Care Quality
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Haider Javed Warraich<br /> Kristin Burke<br /> James Brush<br />Kudakwashe Maloney<br /> Sarah Moravick<br />Alex Carbo
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
Optimizing Clinical MD Documentation
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
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5c7c56e4cff4c416ac48b470d28fed3b
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Patient Care Supply Project
The Problem
Excessive waste of Patient Care Supplies results in higher costs and environmental
impact:
A “pink basin” full of supplies brought to the bedside in preparation for an
admission
Estimated cost of unused items $121,000 annually
Unused supplies at the bedside add to clutter and reduce the appearance of
cleanliness
Lack of an efficient, effective system to determine what patient needs
Sample of one inpatient med-surg unit:
Past State 2012: Cost per Patient Admission $9.96
Aim/Goal
Reduce the waste of unused supplies as demonstrated by achieving a cost savings of
$48,000 in FY 13
The Team
The members of the PCT Council
Donna Clarke RN- Farr 7; Kathleen Clark Hussain RN-Farr 11
Chip McIntosh APN- CQVA; Amy Lipman- Environmental Sustainability
Current State 2014: Cost per Patient Admission $1.68
The Interventions
CQVA provided annual cost and expected savings goal
PCT council brainstormed on ways to reduce supplies being brought to the
bedside
Nurse Managers, Clinical Nurse Specialists, Unit Based Educators in
collaboration with RNs and PCT developed and posted unit specific lists of the
minimum supplies to be brought to the patient upon admission
Process changed from bringing “pink basin” full of supplies to asking the
patient what supplies they actually needed
The Results/Progress to Date
Patient care item use and expense continues to drop despite similar census
during the last two fiscal years
Lessons Learned
Improvement in communication between RNs and PCTs could further reduce
wasted supplies. Information regarding discharge, planned OR, supplies go with
patient when transferred to another care area
PCTs are closest to the work and are key drivers of patient supply use
Small changes in processes can effect big change
Savings per patient: $8.28
Estimated savings at 50 admissions per day: $414.00 per day
Next Steps/What Should Happen Next
Meet with areas who have not implanted floor specific lists
Ongoing agenda item at PCT council and CQVA
For more information, contact:
Kathleen Clark Hussain MHA RN Nurse Manager Farr 11
khussain@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kathleen Clark Hussain (<a href="mailto:khussain@bidmc.harvard.edu">khussain@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
Med- Surg Units
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Donna Clarke <br />Kathleen Clark Hussain <br />Chip McIntosh <br />Amy Lipman
Dublin Core
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Title
A name given to the resource
Patient Care Supply Project
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Environmental Sustainability
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/7d320d11765dc7e1c772b3fa1c72e2fd.pdf?Expires=1712793600&Signature=nc-gApAoZxT7%7EIFDee6XDwJ65rGuxgNfuKptzI9FnYJaiKaSmA87J9zivGXA0FvmQH5Bz4QGFo5ocSSd0kLpn6iIWIiAZdLH-F2IGL6y0qEFzgWiyZc7Q4Qv2OKEP0q7LS6dGXdS1Kz2qMdxoipnZRUwXbIrx0ofPX0g1-P6sWCSN2b-awgg1BA7fB1l03m3m%7EFZwoBpm5YkOuURlMTkU4HAbzXhgTLq76RaaJi1nZtq2adBnqMtpdvYlTkZs7qqOYFR8l2Q5ykLzwAHIPBwTvt7BVHu%7EOq31E7cRbUPq2Rs%7Ex4vy9pbdU7vYSJeDG9Q5ONCiBVVBnBQKHwzg-lyjQ__&Key-Pair-Id=K6UGZS9ZTDSZM
03b79954274e4d01a0179fb3e8c2c17a
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Patient On-line Registration
The Problem
The Results/Progress to Date
BIDMC patients were mostly limited to the telephone to provide updates to their
registration information.
The existing registration model was confined to business hours and weekday
access
Web based access wasn’t available for patients to use
There was no convenient way outside of a phone call to update insurance
information
Aim/Goal
The data collected over the 1st five months show:
Over 10,000 online updates have been completed since implementation
Registration call volume indicates a downward trend since implementation*
Almost 75% of registrations updated on-line occurred without manual intervention
Manual corrections are higher than expected but a review identified accurate
entries were flagged for review because system and payer related limitations
Usage is tied to patient communication and reminders
* January spike reflects higher number of insurance changes that occur in the first month of the year
(open enrollment)
The goal was to facilitate patient convenience, reduce call volume and wait time both
on the phone and at the time of scheduling and check-in. Implementing a web based
application with increased flexibility and expediency would lead to a more patient
centered approach and improved patient satisfaction.
The Team
The Team : Beth O’Toole – Senior Director Revenue Cycle Operations, Elekcia
Pimentel – Project Lead, Kristen McKenney – Director Patient Access Services,
Charles Messinger – Training & QA Manager, Amy Goldman – Director
Ambulatory Systems & Training, Charmaine Massey – Education and Systems
Specialist
Project Sponsors: Jayne Sheehan - SVP Ambulatory/Emergency Services,
Steve Fischer – SVP, CFO
IS Partners: Lawrence Markson – Vice President – Clinical Information
Systems, Caryn Franklin – Manager Information Systems, Paul Panza – IS
Application Developer, Margaret Jeddry – IS Applications Analyst, Qiang Wang
- Manager of IS Web Services
The Interventions
Form a multi-disciplinary team to map the breadth and the approach of the
project, and present to sponsors for feedback and implementation approval
Organize the current registration flow in such a way as to make it easy to
use for the patients online
Identify and categorize all fields, registration, insurance, payers, and all
possible entries
Link to real time eligibity and create a patient friendly display
Create workflows for exceptions
Seek and incorporate feedback
Build a secure patient friendly application that would interface with our
internal system
Collaborate with Patient Site team to implement and promote patient usage
through coordinated communications and reminders
*
Lessons Learned
Patient notifications and registration reminders need to be tied to expired
registrations and upcoming scheduled appointments
The final straight forward design was the result of input from various
perspectives, technical, personal, and professional experience
Medicare patients represented a higher than expected percentage of the on-line
registrations
Percentage of registrations updated requiring interventions is tied to the
integration with companion systems
Next Steps/What Should Happen Next
The actions that the Team will be taking:
Improve the integration of inside and outside companion systems to reduce the
number updates requiring manual intervention or review
Track metrics related to patient satisfaction, i.e. continued reduction in call
volume, wait times, and check in registrations
Generate patient registration reminders by targeting expired registrations and
upcoming appointments
Set up automatic notification reminders based on open enrollment dates
Begin Phase II and roll out for use by patients in clinics
For more information, contact:
Beth O’Toole, Senior Director Revenue Cycle,
botoole@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Beth O'Toole (<a href="mailto:botoole@bidmc.harvard.edu">botoole@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Revenue Cycle Operations
Ambulatory Emergency
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Beth O’Toole <br />Elekcia Pimentel <br />Kristen McKenney <br />Charles Messinger<br />Amy Goldman<br />Charmaine Massey<br />Jayne Sheehan <br />Steve Fischer<br />Lawrence Markson <br />Caryn Franklin<br />Paul Panza <br />Margaret Jeddry<br />Qiang Wang
Dublin Core
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Title
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Patient On-Line Registration
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3a0ff723a91e5f0b212e941094d32a59.pdf?Expires=1712793600&Signature=WyGHgrFpJJTqrajGRlh-UFMNUde%7EUll5MyljfKc4ikIl4YI2gBIYf3CChTjSussCpNO8dYYyM1HHFAdmhxvKkvPFStUPOgoi%7ExrSgxE2uZjYFuLl-H8V3epH2C2Y917Yjygm5rvveCoqo1%7EVlPZvxXUZhFYJYhNNyAd6Ffpukhd1l0dokO2YM5JDc%7E4DCCnudlhC60QiodTGPoaiXp1NaHVGlOCbPhBtMIyBBB1%7EL6OEZNnJSb6SdjryxKcKdzStooDCHfEMV3LPyyFGuHWz6p5pCJalOr7YGzdNCUAh%7E5YrBDxx3uPFSCMaclN6RfkAl1Q01v1UAI3g6iPHrCdBMQ__&Key-Pair-Id=K6UGZS9ZTDSZM
72c3fbb7fa74f7053e8c9087fee3d619
PDF Text
Text
Patient Rounding Technology
The Problem
The Results/Progress to Date
After reviewing research, best practices and previous Silverman submission, a direct
positive correlation between patient rounding visits and increased patient satisfaction
(Press Ganey) scores was determined. As a result, the quantity of patient rounding
was increased. The method by which rounding data was collected and documented
was inefficient with the increase in volume, created a need for more streamlined
technical way of reporting data.
Aim/Goal
Create a streamlined data collection tool using mobile technology to decrease the
administrative time and allow for more rounds to occur and enhance the patient
experience through personal attention. The goal was to increase Press Ganey points
by 5% in six months. Overall the aim was to implement an effective and sustainable
program, utilizing real-time information, to improve patient satisfaction and adjust
operational behavior.
The Team
Patient Ambassadors – Lindsay Johnson, RD, LDN, Julia Sementelli Kelsey
Whalen, Shana Sporman, MS, RD, LDN
Executive Chefs - Michael Hanley, Akeisha Hayde
Food Service Operations – Kathryn Giere, RD, LDN
Mieka Martin, Maude Meade ,Roda Somera, RD, Nora Blake
Clinical Nutrition Director - Patricia Samour, MS RD
The Interventions
Formed focus groups with AR Sawyer and Food Service to discuss appropriate
technology and functionality for an efficient database to be used for patient
rounding visits.
Trialed the tool on mobile devices (iPad) and made improvements to streamline
the data entry and reports.
Continued to collect a high volume of patient rounding visits in order to collect
sufficient data to test the effectiveness of the tool.
Utilize “assign action” function and “Reports” section as communication to the
appropriate manager (i.e. Quality concerns assigned to Executive chef; Courtesy
concerns assigned to Patient Services Manger)
Discuss problems and action plans in weekly Food Service Management
meetings.
Lessons Learned
The Ambassador Tool provided a more consistent and accurate method of collecting and
documenting patient data. It has given the Food Service Managers/ Patient
Ambassadors a common mode of communication in order to evaluate department issues
to then form corrective action plans. In finding this tool to be beneficial in the realm of
patient satisfaction, we hope to expand its usage to all other improvement activities (i.e.
safety audits, Sodexo Gold Checks).
Currently the Ambassador Tool lacks the permission to sync with the hospital patient
information dashboard, causing some inefficiency with the system. In gaining access to
the patient dashboard, we will be able to keep continuous files on patients whether they
are staying long term or return with frequent readmissions. This will also reduce time
waste as patient comments will be entered with the click of button, as opposed to the
ambassador entering name and MRN number.
Next Steps/What Should Happen Next
Continue to round with patients as frequently as possible (with a goal of at least 25%
of patient population)
With 96% predictability, we are able to forecast Press Ganey based on rounding,
nd
therefore if we increase usage of Recovery Rounds function with 2 level manager
provided service recovery to patients flagged as high concern we should increase
Press Ganey Scores and achieve our goal.
For More Information Contact
Lindsay Johnson, RD Sodexo Food Service Patient Ambassador
lkjohnso@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Lindsay Johnson (<a href="mailto:lkjohnso@bidmc.harvard.edu">lkjohnso@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Food Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Lindsay Johnson<br />Julia Sementelli <br />Kelsey Whalen<br />Michael Hanley<br />Akeisha Hayde<br />Kathryn Giere<br /> Patricia Samour<br />Shana Sporman<br />Mieka Martin<br />Maude Meade<br />Roda Somera<br />Nora Blake
Dublin Core
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Title
A name given to the resource
Patient Rounding Technology
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/7c4901733463762c02dfb13570d38c7f.pdf?Expires=1712793600&Signature=dS0216iLv4rOikAUDOM5WagzSftZX54O%7EJvye440Zdz5RMmrseTR80TmClMk90VfficpTrvJEmghPKrgf2l1R2ntnpZdzqLzU8gNCeOGqeWRj1B3YPs8ox4PQN74gn5KJEXmfR1dZDKIjpD9REIX8BNS3DJOg3bfJI9PvhBGlfIoyv65UjKrNg2NbtK4KI81tuL40O576%7E01m7ksc-60Ocwrm5mhbTy2CXoPIUOBV63wxBoRR5Yh0VfkTJ0qgVsxnmjrZdRCgwfp6k1Sm9f1mS422oJkHpSgCo6aCELv4uwF2A5l9-kkxGGPHCIO7kZkkcBtrZqc-owCpikR2vPZsg__&Key-Pair-Id=K6UGZS9ZTDSZM
5fce229836f75e305746e4a07e12c642
PDF Text
Text
Percutaneous Coronary Intervention (PCI) Same-Day Discharge
The Problem
Progress to Date
Includes all Elective PCI Patients
The literature shows that same-day discharge after PCI is a safe and cost effective
practice. Furthermore, with increased demands for PCI and the limited bed resources,
it is prudent to develop a protocol for selecting patients who are eligible for outpatient
or same-day discharge procedures. BIDMC established a multidisciplinary team to
develop and evaluate a same-day discharge program that will allow more efficient use
of limited hospital beds.
Aim/Goal
Develop patient inclusion and exclusion criteria using evidence-based practice
Decrease the LOS of interventional cardiology patients
Reduce number of outpatients in a bed on Farr 3
The Team
Donald Cutlip, MD Director of Cardiac Catheterization Laboratory
Kalon Ho, MD Cardiovascular Quality Director
Lisa Hird RN, BSN Nurse Manager of Cardiac Catheterization Laboratory
Cindy Phelan, RN MS Associate Chief Nurse
Pam Browall, RN MSN Nurse Manager CCU/Farr 3
Patricia Clark, RN BSN
Debra Jones, RN BSN
Cheryl Esposito, RN BSN
Eric Harrington, RN BSN Cardiac Catheterization Educator
Mary Jane Devine, MSN, NP-C
Marie Bosak, MSN, NP-C
Lorraine Britting, MSN, NP-C
David Mangan, Pharm-D
Tricia Bourie, RN, MS
Brianna Soper, MA
Q1 FY13 N=92
Q1 FY14 N=104
30 Day MACE N=0 Cardiac Readmissions N=0
Exclusion Criteria FY13 Compared to FY14
The Steps Taken for Practice Change
Establish oversight team to develop protocols and evaluate the project
Nurse Practitioners extended work hours to accommodate later discharges
Review and revise discharge instruction sheets
Develop tracking sheets for inclusion and exclusion criteria
Follow-up all SDD patients at 24 hours and 30 days post procedure
Next Steps/What Should Happen Next
Collect discharge data for review at quarterly team meetings
Extend discharge times to 10 pm
Expand inclusion criteria
Revise cath lab scheduling system and electronic whiteboard
Go live with POE in the cath lab holding area
Provide 24 hours of medications for patients discharged late in evening
For More Information Contact
Donald Cutlip, MD dcutlip@bidmc.harvard.edu
Lisa Hird, RN lhird@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Lisa Hird (<a href="mailto:lhird@bidmc.harvard.edu">lhird@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Invasive Cardiology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Donald Cutlip<br /> Kalon Ho<br />Lisa Hird <br />Cindy Phelan<br />Pam Browall<br />Patricia Clark<br />Debra Jones<br />Cheryl Esposito<br />Eric Harrington<br /> Mary Jane Devine<br />Marie Bosak<br />Lorraine Britting<br />David Mangan<br />Tricia Bourie<br />Brianna Soper
Dublin Core
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Title
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Percutaneous Coronary Intervention (PCI) Same Day Discharge
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/58c9b04c013e1499d27662fc093ae13b.pdf?Expires=1712793600&Signature=ZvrbGomBs5gyO8CsgSe0%7E-OvRSAPBPGxu2KZmOmh00Yb0YEcRDccMEJ39rIhDeIpBiXq0CkjO8SdFmE7X08%7ER9kFG9HCZPL-n0cl%7E8E8L1lBwXcXc3IHE7oK5wYjdVwx9viv1oNONJdufeOaLnkJLbDktvjUxQ5sCyqPdkXF%7EEvX%7EXXg2fgbROOi2Own0myPqEVMpw8B4kSwsLpvfArG9JnMd-FQVsUSl0jsGGo9Id%7ELzlJZ2xsx2aURoLZrWdHutiSzKKi7yEfY5xG23%7EbSpp0QNJja2pJDSwYZjHCq%7E7QRrnUEC0%7EN9v7t%7EVDdVKWGd9VHwG5Hk7XSGA8hknCCHA__&Key-Pair-Id=K6UGZS9ZTDSZM
cbcb9e078d83aecba60e412e62023546
PDF Text
Text
Preventing Norovirus Transmission on Inpatient Psychiatry
The Problem
Norovirus is a highly contagious gastrointestinal virus that causes severe nausea,
vomiting, and diarrhea, predominantly transmitted during the winter season. It is
widespread in the community, and due to the small number of norovirus particles
needed to infect a person, the disease has tremendous potential to cause an
outbreak in closed communities with close and frequent person-to-person contact
(e.g., cruise ships and nursing homes). Deaconess 4 is an adult inpatient locked
psychiatry unit designed with multi-bed rooms as well as communal areas hosting
group activities and dining. These characteristics make the Deaconess 4 unit
vulnerable to rapid and extensive transmission of norovirus from an index case to
staff and patients.
The impact of norovirus has been significant in recent years:
FY 2012: illness among 14 staff and 10 patients; unit closure for 8 days
FY 2013: illness among 11 staff and 11 patients; unit closure for 23 days,
resulting in a loss of approximately 400 patient days
Increased Emergency Department length of stay for psychiatric patients
awaiting inpatient hospitalization
Increased length of stay for psychiatric patients who become ill with norovirus
Thus there is significant impact on the cost of care (efficiency) and timeliness
of care
Plan for rapid isolation of suspected cases, including a protocol for transfer to
the medical service when no single room is available on Deaconess 4
Implement rapid polymerase chain reaction (PCR) testing for norovirus
Establish a common database in Personalized Team Census to track
suspected cases, symptom evolution, and resolution
The Results/Progress to Date
One confirmed patient case with presumed transmission to one staff member
Reduction (to date) in number of bed-days lost due to norovirus infection:
Aim/Goal
The goal of this project was to screen for norovirus symptoms and develop
procedures to reduce the risk of spread in this high-risk environment.
1 Estimated as patient days lower than expected each month during norovirus season
The Team
Graham Snyder, MD, Infection Control
Cristinel Coconcea, MD, Psychiatry
Robin Kalaidjian, RN, Infection Control
Christine Petrich, MD, Psychiatry
Chris Fischer, MD, Emergency Medicine Gerald Howell, RN, Psychiatry
Melissa Mattison, MD, Hospital Medicine Liz Dunn, MD, Psychiatry
John Mafi, MD, Chief Resident
Rohn Friedman, MD, Psychiatry
Frank Barberian, Environmental Services William Greenberg, MD, Psychiatry
Nan Zullo, Information Systems
Mary Jo Brogna, Assoc Chief Nurse
The Interventions
Develop a protocol for screening prospective admissions in the ED and
patients and staff on Deaconess 4 and definitions of suspected, presumptive,
and confirmed norovirus
Develop an EVS protocol for routine cleaning and for special cleaning with
suspected cases
Enhanced food and hand hygiene practices for patients and staff
Lessons Learned
PCR has improved the certainty of diagnosing or excluding norovirus-related
illness, but the turn-around time for test results has been longer than
expected. The algorithm to identify and isolate ill patients was adjusted to
assume norovirus until the PCR result returns
A systems perspective is essential to make good decisions about moving
patient rooms and units or closing the unit to new admissions
Next Steps/What Should Happen Next
Analyze data at the end of norovirus season
Identify the most effective elements of the bundle intervention
Evaluate adjunctive interventions related to environment [e.g., UV disinfection]
For more information, contact:
Rohn S. Friedman, M.D., Vice-Chair, Psychiatry
rfriedma@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.
Rohn Friedman (<a href="mailto:rfriedma@bidmc.harvard.edu">rfriedma@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
Infection Control
Emergency Medicine
Hospital Medicine
Environmental Services
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Graham Snyder<br />Cristinel Coconcea<br />Robin Kalaidjian<br />Christine Petrich<br />Chris Fischer<br />Gerald Howell<br />Melissa Mattison<br />Liz Dunn<br /> John Mafi<br /> Rohn Friedman<br />Frank Barberian<br />William Greenberg<br />Nan Zullo<br />Mary Jo Brogna
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
Preventing Norovirus Transmission on Inpatient Psychiatry
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
-
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Providing Safe, Efficient Desensitization Protocols
The Problem
Patients with certain types of allergy to a medication that is needed for
treatment may have the option of undergoing desensitization in order to
safely receive the medication
o Desensitization involves giving very small doses of medication and
then gradually increasing the dose until the therapeutic (target)
dose is reached.
o Desensitization occurs in an Intensive Care Unit
o After successful desensitization, the patient may receive the
medication safely as long as doses are not missed
BIDMC has traditionally used a 7 dose protocol, which, upon review of the
literature and other institutional protocols, needed to be updated to a 12
dose protocol.
Aim/Goal
The goal was to update the desensitization process to create a safe, consistent
desensitization protocol for Intravenous antibiotics that is patient-centered, evidencebased, and efficient.
The Team
Erica Dente- patient
John Marshall, Pharm D - Pharmacy
Wendy McHugh, RN, MS- Critical Care Quality
Peter Clardy, MD- Director of Medical Intensive Care
Susan Holland, RN-FICU Nurse Manager
Kristen Russell, RN – MICU 6/7 Nurse Manager
Anna Kovalszki, MD – Department of Allergy
Autumn Guyer MD – Department of Allergy
Carol Bates, MD- HCA Primary Care
The Results/Progress to Date
Old Desensitization
Guidelines
Number of Steps
# of IV Bags
Produced by
pharmacy
# of protocols for
antibiotic
desensitization
Estimated Pharmacy
Production time
(minutes)
Time from ICU
admission to therapy
initiation
The patient contacted a nurse she knows from their work together on patient
engagement at BIDMC.
The problem was relayed to the ICU pharmacist who met with the patient to
review their experience in the ICU
The pharmacist conducted a literature search and convened a working
group to update institutional guidelines, creating an evidence-based 12 step
protocol.
The ICU Pharmacist, Physician, and Nurse Manager provided staff training
on the administration of the new protocol.
The Primary Care physician was notified of the streamlined admission plan.
7
7
12
3
25
1
30
10
9 hours
2 hours
Lessons Learned
The admission process is now streamlined and all IV antibiotics are included
under one standardized protocol
Rather than preparing 7 separate bags, the pharmacy now prepares only 3
bags for the entire process, reducing the time needed to prepare the
medications, as well as reducing the chance for error
Actively listening to patients and families. A shared sense of value provides
a connection vital for partnership, which ultimately leads to improved care,
increased efficiency, decreased cost and greater patient/family and health
care provider satisfaction.
The Interventions
New Desensitization
Guidelines
Next Steps/What Should Happen Next
Continue educating all ICU nurses and pharmacists on the implementation
of 12-step desensitization protocols and programing the smart pumps using
multistep option
Education in other patient care areas where patients may receive follow-up
care that once desensitized to a medication the patient is at no greater risk
of anaphylaxis then the general population.
For more information, contact:
John Marshall, PharmD Clinical Pharmacy CoordinatorCritical Care jmarshal@bidmc.harvard.edu
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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.
John Marshall (<a href="mailto:jmarshal@bidmc.harvard.edu">jmarshal@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Erica Dente<br />John Marshall<br />Wendy McHugh<br /> Peter Clardy<br />Susan Holland<br />Kristen Russell<br />Anna Kovalszk<br /> Autumn Guyer<br />Carol Bates
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 Safe, Efficient Desensitization Protocols
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
Safety
Timeliness
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cb57dfb3d63b81751475f742175592ed
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Radiology Resident Idea System
The Problem
The Results/Progress to Date
Residents have great ideas for systems-level quality improvement, but there is no
formal system for residents to communicate ideas to department administrators.
In 11 months, 48 ideas were submitted by 11 residents from all 4 class years.
40/48 (83%) of submissions have been completely resolved. 27/40 (68%) resulted in a
change.
Aim/Goal
Category
Daily workflow
Submissions (n = 48)
16 (33%)
On‐call/weekend workflow
5 (10%)
Patient safety
9 (19%)
Information technology
8 (17%)
Resident safety
3 (6%)
Other: Resource utilization
Education
To provide a platform for residents to report workflow inefficiencies, submit potential
solutions, receive feedback from department administrators about proposed ideas,
and actively participate in implementing changes.
4(8%)
3(6%)
The Team
Donna Hallett, Radiology Director of Operations
Elizabeth Asch, MD, PGY-5 Radiology Resident
Samir Shah, MD, PGY-5 Radiology Resident
Seth Berkowitz, MD, PGY-5 Radiology Resident
Sahil Mehta, MD, PGY-4 Radiology Resident
Mark Masciocchi, MD, PGY-4 Radiology Resident
Caitlin Connolly, MD, PGY-3 Radiology Resident
Jonathan Kruskal MD PhD, Department Chair, Radiology
Ronald Eisenberg, MD, Residency Program Director, Radiology
The Interventions
A senior radiology department administrator guided the Radiology Resident Quality
Improvement Director with support of the department chair to establish a committee
of 5 residents from all class years to implement the Idea System. An electronic
submission system was created per specifications of the committee based on Idea
Systems described in business management [1] and previously implemented by
technologists in our department. This project also adhered to the principles of Lean
methodology [2]. The committee meets every 5 weeks to review submissions, enter a
response on the electronic dashboard, and delegate tasks to implement proposed
changes.
Sample Change
Schedule lung biopsies in the morning so
complications can be managed as outpatient
Prompt ordering ED physician to note if
patient may/may not receive oral contrast
when ordering abdominal/pelvic CT so we
do not interrupt them to ask
Remove tamper resistant tape from Epi‐Pens
in sealed contrast reaction kits, since this
prohibits opening them in an emergency
When an ED patient is admitted in the
computer but still in the ED, keep imaging
studies on ED list in PACS instead of
switching to inpatient list to avoid delay in
interpretation
Chairs with torn arm‐rests and broken back
support repaired or replaced (many still
under warranty)
Provide notebooks to reduce use of high‐
quality printer paper for informal daily notes
Ideas that could not be implemented predominantly involved potential violation of
regulations or guidelines or a compromise of patient safety.
Lessons Learned
Residents learn through the committee’s response to submissions and by serving on the
committee about the intricacies of department operations and the process of making
changes at the systems level. The department learns directly from trainees “on the
ground” about potential areas for improvement and potential solutions. Implementing
information technology changes is complex and costly, but involving end-users at the
development stage helps avoid implementation problems. PQI projects have resulted
from submitted ideas.
All radiology residents may submit ideas, which must include a proposed solution,
under the following categories: Daily workflow, On-call/weekend workflow, Patient
safety, Resident safety, Information technology, and Other. Submissions are not
anonymous. There are no repercussions for suggesting solutions in a professional
manner.
Next Steps
Create similar systems for fellows and faculty.
References
1.
2.
2
Hamilton B, Wardwell P. Continuous Improvement System “Lesson 7: Idea Systems.”. e
Management, Greater Boston Manufacturing Partnership Inc. September 2009.
Kruskal JB, Reedy A, Pascal L, et al. Quality Initiatives: Lean Approach to Improving Performance
and Efficiency in a Radiology Department. Radiographics 2012 32:2, 573‐587.
For More Information Contact
Elizabeth Asch, MD,
easch@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.
Elizabeth Asch (<a href="mailto:easch@bidmc.harvard.edu">easch@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Donna Hallett<br /> Elizabeth Asch<br />Samir Shah<br />Seth Berkowitz<br />Sahil Mehta<br />Mark Masciocchi<br />Caitlin Connolly<br />Jonathan Kruskal<br />Ronald Eisenberg
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
Radiology Resident Idea System
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety