2
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7b8d68ef90fb640bbb03c121ec5c5366
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Text
Conducting clinical trials from home: The implementation of a remote work model in CARE
Krystal Capers, MPH , Valerie Banner-Goodspeed, MPH, Maximilian Schaefer, MD
1Department
of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
Methods
Background
Challenges
The Center for Anesthesia Research Excellence (CARE) was established in October
2014 to facilitate all aspects of clinical research within the Department of Anesthesia,
Critical Care and Pain Medicine, with an emphasis on in-hospital, 'boots on the
ground' assistance for researchers.
CARE participates in various research domains including:
Interventional trials
Simulation research
Physiologic studies
Quality Improvement research
Epidemiologic studies Outcomes research
Education research
Communication was vital while we worked remotely. Our team utilized various group
chats (mobile devices), worked simultaneously on shared documents (google drive),
and attended various team meetings (zoom).
We utilized a number of new web applications to communicate within our teams and
to keep our tasks on track, relying particularly on Smartsheet and Asana.
CARE research is also represented in various divisions including Critical Care,
Cardiothoracic Anesthesia, Pain Medicine, Obstetric Anesthesia, General Anesthesia,
and Education / Quality Improvement.
On March 11,2020 CARE implemented an effective remote work model due to the
COVID-19 pandemic, and was able to carry out 11 COVID research studies.
•
•
•
•
Meet the Team
Asana
Asana is a desktop and mobile app that
was designed to help teams organize,
track, and manage their work.
Each research study had an associated
list of tasks that were assigned to
members of the team.
Team members were able to mark
action items as complete and team
managers were notified in real time.
Asana also has a chat function that can
be utilized to communicate within the
team for each individual task that has
been assigned.
Results
•
•
•
Front Row (left to right): Trishna Sadhwani, Melisa Joseph, Valerie Banner-Goodspeed (Program
Manager), Maximilian Schaefer (Program Director), Krystal Capers, Aiman Suleiman Back Row (Left to
Right): Andrew Toksoz-Exley, André De Souza Licht, Evynne Gartner, Danny Le, Ariana Saroufim,
Lauren Kelly, Najla Beydoun, Peter Santer, Felix Linhardt, Tim Tartler, Omid Azimaraghi
Acknowledgements
•
We are particularly indebted to former CARE Project Manager Julia Dwyer for shepherding the group through
the transition to remote teamwork by setting up our electronic platforms, and providing boundless support.
•
We would like to thank the many physicians, nurses, and respiratory therapists who conducted the necessary
on-site work for our research trials in extremely challenging conditions. Of particular note, Elias Baedorf Kassis
MD, Chris Barrett MD, Somnath Bose MD, Joe Previtera RRT, Lenny Rabkin RRT, and Sharon O'Donoghue, RN
A heartfelt thank you to the CARE team, who pulled together, worked long hours, and tackled new projects
during a time of tremendous stress and anxiety. Thank you to former CARE Medical Director Bala Subramaniam
MD MPH for your support during CARE's transformation.
•
Smartsheet
Smartsheet is a web-based
project management program.
It can be used to assign tasks,
track project progress, manage
calendars, and share documents
We utilized Smartsheet primarily
for onboarding new team
members and for project start up
tasks.
Zoom
Zoom was the primary video
teleconferencing program used for our
remote work model implementation.
Our research team members were
accustomed to working alongside each
other, but the video feature allowed us to
see each other from our respective
locations.
The screen share function was utilized to
show our meeting agendas, and also to
navigate study documents and
applications together.
We were successfully able to enroll patients into 11 clinical trials and
observational studies while operating in this remote work model, including:
7 Interventional Trials
3 COVID drug trials
1 non-COVID drug trial
3 device trials
4 Observational Trials
3 Epidemiological Studies
1 Survey Based Study
The rapid conversion to fully remote with solid communication strategies allowed
us to have 3 of the first 5 IRB applications for COVID-specific human subject
research protocols at BIDMC.
Conclusion
Strong communication and technology solutions allowed us to remotely support
departmental research throughout the pandemic.
Demonstrable productivity and continued high work quality enabled us to remain
fully staffed, with no team members placed on furlough or redeployed.
While our team has returned on site, we have adapted this remote work model with
flex remote days and continued electronic project management support.
.
�
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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.
Krystal Capers (<a href="mailto:kcapers@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">kcapers@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Krystal Capers
Valerie Banner-Goodspeed
Maximilian Schaefer
Trishna Sadhwani
Melisa Joseph
Aiman Suleiman
Andrew Toksoz -Exley
André De Souza Licht
Evynne Gartner
Danny Le
Ariana Saroufim
Lauren Kelly
Najla Beydoun
Peter Santer
Felix Linhardt
Tim Tartler
Omid Azimaraghi
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia, Critical Care, and Pain Medicine
The Center for Anesthesia Research Excellence (CARE)
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Title
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Conducting Clinical Trials From Home: The Implementation of a Remote Work Model in CARE
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Patient and Family-Centeredness
Safety
Timeliness
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0442b823a4524313c283ff9067082520
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Text
Embracing our Humanity while Fostering Resilience:
The Perinatal Virtual Bereavement Debrief
Mandi Sandford MD, Rosanne Buck NNP,
Sheleagh Somers-Alsop LICSW, Dara Brodsky MD
Introduction
Progress to Date (since Feb 2021)
Healthcare workers routinely experience traumatic events and emotional stress, commonly
understood as occupational hazards. When a patient dies, grief, moral distress, rumination
over mistakes, and even impostor syndrome are some possible emotional responses felt by
the team.
At the beginning of the COVID-19 pandemic, a Neonatology Wellness Committee survey
found that staff sought improved debriefing experiences after patient deaths. While the
medical aspects of the cases were reviewed immediately after the demise at well attended
M&Ms, there were limited opportunities to process the holistic aspects of care and the
secondary effects on team members.
Goal
To acknowledge and embrace the emotional impact of caring for a dying patient and to foster
resilience amongst staff, we introduced a multidisciplinary, structured, facilitator-led virtual
debrief session focused on what it meant to care for this patient.
Intervention: The Perinatal Virtual Bereavement Debrief
Infant Death
(NICU, DR,
PPNU)
Pre-Huddle
(SW, hospitalist, NNP,
neonatologist)
Identify perceived
challenges for staff
Delineate themes
Invite all perinatal
clinicians directly
involved in clinical
care of deceased
infant and family
Virtual Debrief
7-14 days after infant death
1-hour meeting
o Intro (purpose, emaphsis on
confidentiality, case summary, review
of family structure and dynamics)
o Moderated open discussion
o Conclusion (“The Pause” to
acknowledge infant’s loss of life and
recognize team’s hard work)
Ethicist invited to relevant sessions
Post-Huddle
(SW, hospitalist, NNP,
neonatologist)
Discuss themes
Review what went well
Identify areas of
improvement
Determine whether
attendee check-in needed
and approach
-14 sessions, multi-disciplinary: neonatologists, NNPs, obstetricians, nurses (L & D, NICU,
Postpartum), SWs, RTs, spiritual care providers, specialists (BCH PACT team, cardiologist)
-n=12 attendees/session (largest - 34 staff from BIDMC, BCH, and a community hospital)
For more information, please contact Dara Brodsky, dbrodsky@bidmc.harvard.edu
Themes
Descriptions
Team members worry: Did I miss
something? Was I present with
parents in the way they needed?
Did I say too much or too little?
Did I do enough?
Team wishes to see patient through
their entire journey and when
absent at the time of death,
perceive a lack of closure.
Unanticipated Team rapidly pivots to meet the
events or rapid clinical and emotional needs of
patients and families in dire
redirection of
situations; yet, the very nature of
goals added
these events results in limited
angst
real-time processing for staff.
Team struggles with need to
Challenge of
balancing hope disclose infant’s expected poor
and reality with outcome and removing all hope.
High standards
of team
members
Impact of Virtual Debrief
Discussions recognize limits of interventions & sense of helplessness one
may feel when those limits are met.
Discussions lifted a perceived burden of responsibility that some providers
were carrying by acknowledging the larger team involved in supporting the
patient.
Sharing the patient’s story and post-discharge family update can provide
closure in a vicarious manner.
Providing this dedicated time signals to healthcare workers that their
emotional responses are normal, respected and valued. While clinician
emotional responses must be deferred in the moments of intense
operational demands, there is time and space for these responses once the
situation is defused.
Discussions allow senior attendees to offer approach, including importance
of titrating information and meeting families where they are at.
Discussions acknowledge that being with a family, supporting and not
abandoning them, provide family with the feeling that they were cared for.
family
Team cares deeply about providing Discussions allow attendees to witness the exceptional meaning in wellPriority of
coordinated family-centered care, show how healing occurs even if
family-centered time for parents to be with their
critically ill baby.
outcome is poor, and inspire providers to look for healing opportunities
care
Team honors cultural differences.
that transcend typical approaches.
Appreciation of Team values supporting each other By offering reflection on the compassionate care provided, team members
can recognize the amazing good that was done even in a bad situation.
neonatal team & during emotionally difficult
Interdisciplinary discussion allows providers to see the case from one
interdisciplinary periods and unexpected
outcomes.
another’s perspective and allows cross-discipline support of each other.
collaboration
Next Steps
1. We plan to evaluate the impact of these debriefs by surveying attendees after a 15-month period.
2. If NICU staff are interested, we plan to broaden these virtual debriefs and hold them during times of
increased stress in our unit such as periods of extremely high acuity, high morbidity, care of a complex
challenging patient, and limited resources.
Acknowledgements: We wish to thank our colleagues in the NICU, L& D, and Postpartum Units for their exceptional
commitment to our patients and families and for their willingness to share the impact these cases have had on them personally.
We thank NICU Leadership, specifically DeWayne Pursley, MD and Kathy Tolland, RN for their commitment to staff well-being.
For more information, contact:
�
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.
Dara Brodsky <a href="mail%20to%3A">dbrodsky@bidmc.harvard.edu</a>
Project Team
Mandi Sanford
Rosanne Buck
Sheleagh Somers-Alsop
Dara Brodsky
DeWayne Pursley
Kathy Tolland
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
Dublin Core
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Title
A name given to the resource
Embracing Our Humanity While Fostering Resilience: The Perinatal Virtual Bereavement Debrief
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Patient and Family-Centeredness
Timeliness
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4ae6a5c55a11871fe390c6c48b0458cb
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Text
3D Printed Nasopharyngeal Swabs for
†
COVID-19: Innovations and Lessons Learned
Development of Four New 3D-Printed Swabs
Cody J. Callahan,a Rose Lee,b,c Katelyn E. Zulauf,b,d Lauren Tamburello,e Kenneth P. Smith,b,d Joe Previtera,f Annie Cheng,b Alex Green,b,d
Ahmed Abdul Azim,c,i Amanda Yano,g Nancy Doraiswami,h James E. Kirby,b,d Ramy A. Arnaoutb,d,j
aDepartment
hDivision
of Radiology, bClinical Microbiology Laboratories, Division of Clinical Pathology, Department of Pathology, cDivision of Infectious Disease, Department of Medicine, eDivision of Urologic Surgery, Department of Surgery, fDivision of Respiratory Therapy, gDepartment of Medicine,
of Perioperative Services, Department of Central Processing, iDivision of Infection Control/Hospital Epidemiology, Silverman Institute for Healthcare Quality and Safety, and jDivision of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston,
Massachusetts, USA; dHarvard Medical School, Boston, Massachusetts, USA. Rose Lee and Katelyn E. Zulauf contributed equally to this work. Their names are listed alphabetically
Addressing the swab crisis
Creating & testing new swabs Clinical performance
Development of Four New 3D-Printed Swabs
Journal of Clinical Microbiology
Through an innovative, multidisciplinary, cooperative,
rapid-response
translational-re‐
search program,
we emergently
1: Define the mission
developed and
2: Establish norms
clinically validat‐
ed new swabs
3: Leverage expertise
for immediate
4: Communicate clearly
mass production
via the method
5: Stay positive!
of 3D printing.
Lessons learned
FIG 1 Control and prototype swabs. (a) From left to right, the control swab (C; Copan 501CS01), a repurposed urogenital cleaning swab approved for NP testing
through our process (R), prototype 1 (Resolution Medical), prototype 2 (EnvisionTec), prototype 3 (Origin.io), and prototype 4 (HP, Inc.). (b) From top to bottom,
close-ups of the heads of the swabs in panel a. Bars, 1 cm. (c) Examples of Gram stains of cheek swabs using control (top) and prototype (bottom) swabs. Bar,
10 !m. (d) Examples of materials testing. Clockwise from top left, head flexibility and robustness to fracture, neck flexibility and robustness to fracture,
robustness to repeat insertion into and removal from a tortuous canal (diameter, 3 cm), and break point evaluation.
Phase I: preclinical evaluation. (i) Design. An infectious disease physician, a clinical pathologist
(clinical microbiologist), and a respiratory therapist tested each prototype swab for design and mechanical properties (Fig. 1c and d). These included size measurements of the head, neck, shaft, and break point
(requirement of !15 cm to reach the posterior nasopharynx; head diameter of 1 to 3.2 mm to pass into
the midinferior portion of the inferior turbinate and be able to maneuver appropriately without catching
on anatomical variants such as septal spurs or a deviated nasal septum); surface properties, such as
smoothness (with roughness leading to an unpleasant feel and risk of bleeding); flexibility versus
brittleness of the head, neck, shaft, and break point (to avoid fracture during use); durability (e.g., ability
to tolerate 20 rough repeated insertions into a 4-mm-inner-diameter clear plastic tube curved back on
itself with a curve radius of !3 cm; ability of tip and neck to be bent 90° without breaking; ability to
revert to initial form following bend of 45°) (Fig. 1d); strength (to resist breakage under rough but
reasonable manipulation); and other factors as applicable (e.g., stickiness and smell) (Table 1).
(ii) Collection sufficiency. We assessed the ability to collect sufficient material for testing using Gram
staining of a swab of the interior cheek smeared onto a standard microscopy slide as a surrogate for NP
swabbing and comparison to Gram stain of a swab of the interior cheek using Copan Diagnostics, Inc.
(Mantua, Italy), model 501CS01 (FLOQSwab) as the control (Fig. 1c). Cheek swabbing was performed
instead of NP swabbing as the least invasive and most readily available source of secretions, making it
possible to test head designs even for prototypes that were deemed inappropriate as NP swabs. Slides
were heat fixed and Gram stained according to the BD BBL Gram stain test kit protocol (14). Slides were
examined at "40 magnification for the presence of both epithelial cells and bacteria. Prototypes were
passed if the amounts of bacteria and epithelial cells were qualitatively similar to those of the control
(which contained multiple bacteria and epithelial cells per high-power field).
(iii) PCR compatibility. We tested PCR compatibility by placing the swab head-downward after
breaking it off at the break point, when present (as in a typical NP swab collection), in 3 ml of modified
CDC VTM (Hanks’ balanced salt solution containing 2% heat-inactivated fetal bovine serum [FBS],
100 !g/ml gentamicin, 0.5 !g/ml amphotericin B [Fungizone], and 10 mg/liter phenol red [15]) overnight
to allow any PCR-inhibitory material to leach into the medium, spiking 1.5 ml with 200 copies/ml of
control SARS-CoV-2 amplicon target (representing 2 times the limit of detection on our system),
vortexing, and testing using the Abbott RealTime SARS-CoV-2 assay on an Abbott m2000 RealTime
system platform (16), following the same protocol as for clinical testing (37 cycles, with a cycle threshold
[CT] of "31.50 being reported as positive). PCR-positive prototypes passed.
Phase II: production considerations. We considered stability to autoclaving by repeating phase I
All prototypes displayed excellent concordance with
the reference (κ = 0.85 to 0.89). Cycle threshold (CT)
values were not
significantly differ‐
ent between each
prototype and the
control, supporting
the new swabs’
noninferiority (p
≤0.05). Study staff
FIG 2 Categorical concordance versus control swab. (a) Two-by-two tables giving coun
preferred one
of the prototypes over the others and
prototype versus the control swab and for control versus replicate control obtained within 24
samecontrol
individual. Discordant
are in gray,
totals total
for each swab
are below and to the rig
preferred the
swabresults
overall.
The
time
box, and the total number of pairs is in bold. K, Cohen’s kappa. (b) Scatterplot of C values
swabs for which
at least one swab was SARS-CoV-2
For discordant
pairs, the negativ
elapsed between
identification
of thepositive.
problem
and
assigned a C value of 37 (the maximum number of cycles run).
validation of the first prototype was 22 days.
T
Callahan et al.
T
Journal of Clinical Microbiology
of 0.18). Finally, the differences between CT values for the first and secon
swabs were comparable to the differences between control and prototyp
(MWU P values of 0.31, 0.26, 0.47, and 0.44 for prototypes 1 to 4) (Fig. 2b).
Staff and participant preferences. A written staff survey (see Materials a
ods) showed a preference for prototype 4, then prototypes 2 and 3, and then p
1. There was a slight preference for the control swab over prototype 4 (Fi
narrative feedback, prototype 4, which underwent the largest number of
†FIG 3 Subjective feedback. (a) Round-robin A/B testing of net preferences among prototypes 1 to 3 (large bold numbers) and the control (C). Each arrow points
Callahan
ettheal.
JCM
58:e00876
Arnaout
JCMwere59:e01239
through
our
(i.e.,
was
described
asunanimous
comparable
to the cont
from
the less preferred to
more
preferred swab.
Arrow process
weight indicates2020;
strength 28),
of relative
preference.
Preferences
except where2021
noted
with numbers separated by a slash: the first number is the number of responses for the direction indicated by the arrowhead, while the second number is the
(Fig.
number of responses that had the
opposite3b).
preference. The weight of the arrow is proportional to the difference (e.g., 7 ! 3 " a net preference of 4). Unless
otherwise noted, each arrow represents 12 to 15 separate responses. (b) Numbers of positive and negative comments received from study staff who
administered the swabs, tabulated by category.
In each plot, negative
feedback
the left of the zero,
positive
feedback is million
to the right. The
presence
Availability.
Swabs
areis toavailable
to while
order.
Several
have
been used a
of bars on both the positive and negative sides of zero reflects different opinions among study staff. n, total number of comments received about each
Downloaded
We performed a detailed multistep preclinical
evaluation of 160 swab designs and 48 materials
from 24 companies, laboratories, and individuals. We
created a public data repository on GitHub to share
results and feedback. We validated four prototypes
through an institutional review board (IRB)-approved
clinical trial that involved 276 outpatient volunteers
who presented to our hospital’s drive-through testing
center with symptoms suspicious for COVID-19. Each
participant was swabbed with a reference swab (the
control) and a prototype, and SARS-CoV-2 reverse
transcriptase PCR (RT-PCR) results were compared.
Downloaded from http://jcm.asm.org/ on December 17, 2020 by guest
In early 2020 the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) pandemic caused a se‐
vere shortage of nasopharyngeal swabs, which are
required for collection of optimal specimens, creating
a critical bottleneck blocking clinical laboratories’ abili‐
ty to perform high-sensitivity virological testing for
SARS-CoV-2.
�
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.
Ramy A. Arnaout (<a href="mailto:rarnaout@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">rarnaout@bidmc.harvard.edu</a>)
Project Team
Cody J. Callahan
Rose Lee
Katelyn E. Zulauf
Lauren Tamburello
Kenneth P. Smith
Joe Previtera
Annie Cheng
Alex Green
Ahmed Abdul Azim
Amanda Yano
Nancy Doraiswami
James E. Kirby
Ramy A. Arnaout
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
Clinical Microbiology Labs
Division of Clinical Pathology, Department of Pathology
Division of Infectious Disease, Department of Medicine
Division of Urologic Surgery, Department of Surgery
Division of Respiratory Therapy, Department of Medicine
Division of Perioperative Services
Department of Central Processing, Division of Infection Control/Hospital Epidemiology
Silverman Institute for Healthcare Quality and Safety
Division of Clinical Informatics, Department of Medicine
Harvard Medical School
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
3D Printed Nasopharyngeal Swabs for COVID-19: Innovations and Lessons Learned
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
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Text
Rethinking Policies, Guidelines, Procedures And Competency Validation
Charlotte L. Guglielmi MA, BSN, RN, CNOR, Elena G. Canacari BSN, RN, CNOR; Senem Hicks PhD, RN; Jeffrey R. Keane BSN, RN, CNOR;
Marianne Kelly BSN, RN, CNOR; Debra Savage MSN, RN, CNOR; Deborah H. Tassone MSN, RN, CNOR
Background and Planning
Team
The management of policies, guidelines,
procedures and competency validation tools
in the perioperative setting has continually
become more complex along with the
diversity of our workforce. Our team
recognized that there was redundancy and
overlap in many of our documents that limited
staff to easily access and understand the
information that they need to practice safely.
• Associate Chief Nurse Perioperative
Services
• Clinical Manager Perioperative Education
• Unit-based Educators: CVI OR, East OR,
Perioperative Nurse Entry Program, West
OR
• Perioperative Information Management
System (PIMS) Resource Nurse
Assessment
2
Literature Review
• Workforce
diversity
• Adult learning
styles
• Differences
between digital
natives and
digital
immigrants
learning
attributes
Exploration of the
attributes of our
learning management
system which offers
• Ability to provide
learning
• Performance
reviews
• A single source of
truth for
documentation of
employee
compliance
Findings
3
Review of the
content of policies,
skills checks and
other competency
validation tools
Found
• Overlap in content
• In some instances,
not congruent
4
Brain-stormed how
can we deliver
content using TeachBacks
• Digital learners
(Easily retrieved,
using graphics
before text)
• Digital immigrants
(printable as a
document with
linear naming of
the must dos)
Policy #:
Purpose:
Beth Israel Deaconess Medical Center
Perioperative Services Manual
Immediate-Use Steam Sterilization (IUSS) in the Operating
Room
PSM 200-104
O.R. sterilizers are used to ensure that sterile instruments are
available at all times to meet the surgical team’s and patient’s
changing needs during a procedure.
Perioperative Services Manual
Competency Checklist
Title: IUSS Sterilization Protocol East / West Campus
PSM 500-641
Name:
Person Validating Practice:
Immediate-Use Steam Sterilization
1. Immediate-use steam sterilization (IUSS) should be kept to a minimum and
should only be used in urgent clinical situations.
2. Prior to immediate-use sterilization, the recommended critical cleaning and
decontamination steps are completed by CPD staff according to
manufacturers’ instructions for use.
3. Only closed sterilization containers will be used for IUSS to prevent
contamination during transfer to the sterile field. To accommodate the
closed containers, O.R. Sterilizers
a. are set on pre-vacuum
b. no IUSS loads will be processed using gravity displacement
4. A chemical indicator(s) will be used within the container being sterilized and
validated that sterilization parameters have been met.
5. Sterilized items are used immediately during the procedure for which the
items were sterilized.
6. IUSS should NOT be done on implants except in a documented emergency
situation when no other option is available. The Circulating RN should notify
the Nursing Director/ designee of the need to IUSS
7. An IUSS log is maintained at each sterilizer to record information on each
IUSS load.
Associated Documents
1. PSM 200-104 Appendix 5 Teachback IUSS pages 1 and 2
2.
PSM 500-153 Skill Checklist Immediate Use Steam Sterilization – Loading/
Unloading an IUSS Sterilizer
3.
PSM 600-401 Biological Monitoring of Sterilizers
4.
PSM 600-401 Appendix 5 Biological Monitoring Immediate Use Steam
Sterilizers
Outcomes
• Favorable feedback was
received after the release
of the trialed policies.
• All documents are easily
retrievable in the on-line
Perioperative Services
Manual.
Date:
•
Definition:
“Immediate use” is broadly defined as the shortest possible time between a
sterilized item’s removal from the sterilizer and its aseptic transfer to the sterile
field. Immediacy implies that a sterilized item is used during the procedure for
which it was sterilized and in a manner that minimizes its exposure to air and
other environmental contaminants. A sterilized item intended for immediate use
is not stored for future use, nor held from one case to another.
Crafting a New Direction
1. Policy stating the must dos and the references
companion documents as appendices.
2. A competency validation tool which outlines the
steps to delivering the care.
• Skills checks and other competency
validation tools were redundant with the 3. Teach-back(s) that are point of care digital
learning tools.
steps of the related policy and, in some
4. Implementation during the FY 2018 review
instances, not congruent.
cycle.
• Using a paper system of competency
5. Plan: Convert all policies over the three year
validation was cumbersome.
review cycle.
• Content of our many of our policies
were too broad and included a lot of
procedures.
Title:
Assoc. Doc 2: Skills Checklist /
Competency Validation Tool
Assoc. Doc. 1: Teach-Backs
Policy Statement:
A four part assessment was completed:
1
Policy
TAP TO GO BACK
TO KIOSK MENU
• System is designed to:
• highlight continuous improvement in high
reliability teams,
• Capture competency validation with a single
source of truth measuring the steps of care
delivery in the competency validation process,
and
• Place relevant tools into the hands of the
people who do the work where they work.
The CPD Technician demonstrates the ability to accurately operate the Immediate Use
Steam Sterilizers and perform appropriate quality control measures
Method of Validation:
Return demonstration/ Peer Review In-service or Course Question/ Answer
Simulation Other, List:
Key:
Met All & Initials (check box and initial if orientee demonstrates all elements at one session)
Elements were met in multiple sessions
(Note date met & initial individual element- validator add name above)
Critical Elements
Observed
Step #1 Perform a Bowie-Dick Test (Dart Test) - Blue Pack:
1. At midnight, tests each Immediate Use Steam Sterilizer by selecting the correct
cycle; (Vac. B+D Test) presses “Enter and Ok”; places the Bowie-Dick pack on
the rack over the drain, closes the door and starts the cycle. Goes into
Censitrac and scans each IUSS. Selects Dart Test, sends the data, selects the
cycle and saves.
2. At the end of the cycle, opens the IUSS, remove the pack, opens and verifies
the color on the sheet (makes sure it turned Black and is a uniform pattern).
3. Goes into Censitrac, selects proper IUSS load, goes in “Indicator”; types in
Bowie Dick Test lot #, selects “Pass”, and saves.
4. If the Bowie-Dick test fails once, repeats the process. If it fails a second time,
puts a sign on the IUSS autoclave, indicating it is (Down) and notifies the
Supervisor to call for service.
Step #2
Performs a Biological Test:
a. Labels the Biological Test is (Attest 1492V) Rapid Readout (Brown Cap)
b. Places the BI inside the (new) IUSS container and close the lid
c. Selects the correct cycle: ( Prevac 270°/ 4m /1 dry ) Enter and Ok
d. Closes the door starts the cycle.
e. At the end of cycle, opens the container, takes out the BI and immediately
brings to CPD to incubate.
f. Changes the BI Control every 24 hrs.
g. Always matches the BI and the control in the incubator.
Sterilization Assurance:
In Censitrac opens to the proper sterilizer load when implanting a Biological
a. Selects Indicator; types in Biological, lot #, controls lot #, in that screen and
then selects “save changes”, selects “done”.
b. Records the BI results 24 minutes later, opens Censitrac, selects proper sterilizer
load and records indicator as pass or fail on the load result; prints sterilizer
load report.
c. Properly places Censitrac printout into Steam log.
d. Attaches Sterilizer printout, verifies date and time of load
e. Records BI results in 3M BI Monitor Log
f. Notifies supervisor or charge person required for a failed BI.
References
1. Jones A. Organisational commitment
in nurses: is it dependent on age or
education? Nursing Management.
2015; 21(9):29-36.)
2. Porter-O’Grady T, Malloch K.
Quantum Leadership, Building Better
Partnerships for Sustainable Health,
4th Edition. 2015, Jones & Barlett
Learning, USA. P.3
�
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.
Charlotte L. Guglielmi (<a href="mailto:cgugliel@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cgugliel@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Perioperative Services
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Charlotte L. Guglielmi
Elena G. Canacari
Senem Hicks
Jeffrey R. Keane
Marianne Kelly
Debra Savage
Deborah H. Tassone
Dublin Core
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Title
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Rethinking Policies, Guidelines, Procedures And Competency Validation
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
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4a0dbecc2416f183e03b34090e712e5d
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Text
The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Introduction
Problem Identification
Variation occurs in any large health care organization when local teams adapt workflows. Some variation is good
and results in improved processes that should be spread. Conversely, too much variability can lead to poor
outcomes and an inconsistent experience for patients, providers, and staff. Hence, large organizations must strike
a balance between standardization and local autonomy. Healthcare Associates (HCA) is an academic primary care
practice where over 300 dedicated professionals care for greater than 40,000 patients. HCA is divided into four
suites - Atrium, North, Central, and South – each serving as a local care team with unique culture and physical
space. As is true in many large practices, standardization and reliability is a challenge for HCA.
In Fall 2017, HCA leadership identified variation in the check in and rooming process. The check in and rooming
process is defined as all tasks occurring during a period beginning when a patient arrives at the practice and
ending when they are seen by a provider in an exam room.Tthis process occurs for every patient at every visit.
Multiple interactions take place that have the potential to positively impact outcomes at the patient, practice, and
system level. The Arrive-Register-Room-Care (AR2C) Initiative was formed to identify opportunities for
improvement and spread best practices.
Aim
To usea rigorous improvement methodology to design a highly reliable process for check-in and rooming
which will improve the health of our patients, lead to better days for everyone, and improve flow while
maintaining high levels of patient centeredness.
The Team
➢ Tobie Atlas, Patient and Family Advisory Council
Co-Chair
➢ Nisha Basu, MD, MPH, former Director of
Population Health
➢ Angela Coppola, Practice Representative and
Medical Assistant
➢ Leonor Fernandez, MD, Physican Lead for
Patient Engagement and PFAC Co-Chair
➢ Stephanie Fryman, former Medical Assistant
➢ Mathilda Ganjoli, Medical Assistant
➢ Whitney Griesbach, former Practice Manager
TAP TO GO
BACK TO
KIOSK MENU
➢ James Heckman, MD, Assistant Medical Director
➢ Brendan Murray, MBA, Practice Operations
Manager
➢ Kayla Tremblay, MBA, Senior Project Manager
➢ Heather Wathey, Practice Administrator
➢ Lauren Wemple, MPH, Population Health
Manager
To better understand the challenges and opportunities in the check in and rooming process, the AR 2C
team created process maps, hosted simulation sessions, and collected baseline data.
Process mapping
Each team participated in process map
development at their suite team meetings.
The process maps were refined with
observation in each suite. The final process
maps visualized variation in processes
between the suites (see Figure 1).
Simulations
To further engage staff in identifying
opportunities for improvement, the AR2C
team organized five simulation sessions. The
sessions took place after hours and
simulated the check in and rooming process.
Staff from all of the suites and a variety of
roles participated. Patients were recruited
from the HCA Patient and Family Advisory
Council. Each simulation ended with a
debrief to share lessons learned and
opportunities for improvement (see Figure 2).
Practice leadership paid staff overtime and
supplied pizza for dinner to encourage
participation. The simulations allowed the
team to truly understand the challenges
facing frontline staff and dive deep into
issues without interrupting day-to-day
operations. This facilitated trust and mutual
respect across the disciplines.
Figure 1: Process maps visually represented significant
variation between the suites (Click to enlarge)
Figure 2: Team debrief after a simulation session.
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Problem Identification (Continued)
Baseline Data
Over four weeks in summer 2018, the AR2C team collected baseline data to understand the performance of the
current check in and rooming process (see Figure 3). The data identified opportunities to improve communication,
prioritization, and flow.
Figure 3: Measures for the ARC Initiative
Measure (click for
definition)
Throughput time
Care Gap Closure
Staff Experience
Provider Experience
Patient Experience
Figure 4 (right):
Format
Type
Paper sheet that follows patient
Chart reviews
Paper or e-survey
E-survey every 2 weeks
Paper e-survey at check out
Process
Outcome
Balancing
Balancing
Balancing
PDSAs
The original concept for the flow management system evolved with each PDSA by incorporating feedback
from providers and staff (see below). A flag system was added to address provider feedback from the
PDSAs. The final system incorporated a whiteboard, algorithm, and flags.
PDSA
Stoneman
Residents
developed a tool to
capture throughput
time.(click to
enlarge)
Learnings & Improvements
1-5, 8
Test whiteboard and
algorithm in each
suite for 1 session
• Removed scheduled patients column
• Maintain HIPPA compliance by writing patients initials and time of visit
on board
• Need a signal that room is empty and ready for next patient
• Use magnets to indicate tasks needed during visit
• Use markers with clicky tops
• Some providers have a long walk to the board from their rooms
• Location of whiteboard needs to be convenient for team
6-7, 9
Test whiteboard and
algorithm with
residents for 1
session
• Consider a signal to indicate when residents are precepting and
almost done with their visit
10-12
Test a flag system to
indicate when rooms
are open and when
residents are
precepting
• Flag system reduced burden on providers
• Residents happy with precepting flag and impact on flow
Intervention
The AR2C team met with HCA Lead Medical Assistants to
understand how they currently manage flow and priorities
within the suites. Several local bright spots were identified.
Furthermore, the Lead MAs suggested re-instating a
whiteboard system that was piloted in the past but not
sustained or spread due to staffing challenges. Using this
information, the AR2C team developed a prototype of a flow
management system.
The initial prototype answered the questions, “What needs
to get done?” and “In what order should I do it?” To
determine if the prototype worked, the team ran over 12,
PDSAs touching each of the HCA suites. See the PDSAs
section for details on the types of tests and improvements
made to the system.
Description
Figure 5 (above): the first PDSA of the
flow management system. (click to
enlarge)
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
The Flow Management System answers two questions:
What needs to be done?
In what order should it be done?
Figure 7: Color coded magnets
correspond with frequently requested
tasks.
Figure 6: A whiteboard, displayed near the MA station, visually shows which
rooms are open and where patients are in the practice. Medical Assistants
update the board as patients check in and arrive for their visit. Providers can
communicate with Medical Assistants for needed tasks using magnets in the
far right column
Figure 8: Flags for each exam
room are visible from the
whiteboard, and indicate when a
room is open (green) or when a
resident is precepting (red).
Figure 9: The flow management system is built on an algorithm that Medical
Assistants use to prioritize tasks. The algorithm prioritizes rooming patients
over other tasks to optimize flow. After completing a task, Medical Assistants
return to the board to determine what task to do next.
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Roll Out and Continuous Improvement
Results (cont)
The flow management system was rolled out first in the South and Central Suites. To
prepare for the roll out, the AR2C team led a primary care practice flow game at suite
team meetings to help illustrate the flow management theory behind the system.
Each team member was invited to take a survey monkey training that quizzed team
members on how the board works and how to use it in different scenarios.
To encourage continuous improvement, a poster was hung next to the whiteboard
where team members could identify issues or opportunities for improvement. The
AR2C team reviewed the list each day and made adjustments or changes to the
whiteboard to improve operations. Changes were shared with the whole team in an
end of the week email.
In parallel to the AR2C rollout, the operations management team held basic
competency training with the other two suites. The emphasis was on what work
needed to be completed prior to each visit but there was not explicit instruction given
on how they should complete the work.
Figure 8: Average care gap closure
rates (click to enlarge)
Figure 10: Average 1st recorded blood pressure
(click to enlarge)
CLICK HERE TO TAKE OUR ONLINE
TRAINING MODULE
Results
Post intervention data was available for the two intervention suites and one control.
Preliminary results indicate that there was a practice wide trend towards increased
care gap closure (figure 8). This trend persisted when data was stratified by suite and
provider type, with the exception of resident providers in south suite. We observed an
increase in wait times in control suites and a reduction in wait times in intervention
suites( figures 9a & 9b). These trends persisted when data was stratified by suite and
provider type. Intervention suites also demonstrated a reduction in first recorded
systolic and diastolic blood pressures (fig 10). Post intervention surveys of providers,
staff and patients were ongoing at the time of abstract submission.
Figure 9a: Wait times in control suites stratified by
arrival times (click to enlarge)
Figure 9b: Wait times in intervention suites
stratified by arrival times (click to enlarge)
For more information, contact:
Kayla Tremblay, MBA, ktrembl1@bidmc.harvard.edu | James Heckman, MD, jheckma@bidmc.harvard.edu
�The Arrive-Register-Room-Care
2C)
(AR
Initiative: Designing Reliable Processes at HCA
Kayla Tremblay, MBA and James Heckman, MD
Lessons Learned
➢ Track your learning from PDSAs. We used an ➢
excel spreadsheet to ensure we captured
everything.
➢ Start with a prototype to test feasibility. Our
prototypes were inexpensive and easy to start
with, and we refined our design over time.
➢ An inexpensive low-tech tool, implemented
effectively, can generate results. Whiteboards,
flags, and some arts and craft supplies were all
we used in this project. Using PDSA to test
ensured that our design was effective.
Engage the team in testing and
implementation. The system would not have
been successful without a lot of feedback from
the team directly using the tool.
Next Steps
➢
➢
➢
➢
➢
Roll out in North and Atrium Suites
Conduct statistical analysis on results
Complete provider, staff and patient experience
surveys
Collect more data on South Suite residents
Investigate ways to automate the system
➢
➢
➢
Repeat experience surveys for Medical Assistants
Identify additional opportunities for improvement in
the check-in and rooming process
Use lessons learned to improve other processes in
the practice
Acknowledgments
➢
➢
➢
Thank you to everyone who made this project a success including: Blair Bisher, Marc Cohen, Eileen Reynolds, all
HCA Medical Assistants, all HCA faculty, residents, and Nurse Practitioners,The Office of Healthcare Quality.
Study data were collected and managed using REDCap electronic data capture tools hosted at BIDMC1 REDCap
(Research Electronic Data Capture) is a secure, web-based application designed to support data capture for
research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data
manipulation and export procedures; 3) automated export procedures for seamless data downloads to common
statistical packages; and 4) procedures for importing data from external sources.
1Paul A. Harris, Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, Jose G. Conde, Research
electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing
translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81.
Figure 11: White Board in use
in South Suite(click to enlarge)
For more information, contact:
��Figure 4 (right):
Stoneman Residents
developed a tool (right)
that captured throughput
time for over 90% of HCA
visits.
Click to
return
to slide
�Figure 5: The first PDSA of the flow management system.
�Care gap closure rates
Care gap closure rates increased practice wide. This trend was evident at the provider and suite level
with the exception of south suite resident patient vists.
�Wait times stratified by patient arrival time
In the control suite we observed an increase in median wait times. In the intervention suite we observed
reductions in median wait times.
�First Recorded Blood Pressure
We observed a trend towards reduced first systolic blood pressure among patient seen in an intervention suite. This trend
persisted when stratified by suite and provider type.
�2C
AR
Flow Management System
Whiteboard in use in South Suite 4/12/2019
�Measures defined
Measure
Definition
The time a patient is waiting for their provider. This period begins at the time of check in or the time of
appointment, which ever is later, and ends when the provider enters the room to see the patient.
Wait time
Care Gap Closure
Staff Experience
Provider Experience
Patient Experience
Example:
If Patient A arrives at 8:30 am for an 8:50 appointment and is seen by the provider at 9:10 then the wait time is
calculated to be 20 minutes.
Patient specific tasks that must be completed by an MA prior to seeing a provider:
Examples:
• PHQ2-Depression questionnaire
• Tobacco Screening
• Fall Screening
• Point-of-care Hemoglobin A1c testing
Staff were given a 10 question survey that measured their experience of job stress, team work, provider
interaction, and patient interaction.
Faculty and Residents were given a 9 question survey that measured their experience of job stress, team
work, provider interaction, and patient interaction.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
<p>Kayla Tremblay (<a href="mailto:ktrembl1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ktrembl1@bidmc.harvard.edu</a>)<br />James Heckman (<a href="mailto:jaheckma@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jaheckma@bidmc.harvard.edu</a>)</p>
Department
Any departments listed on the poster or identified in the spreadsheet.
Health Care Associates
General Medicine
Ophthalmology
Volunteer Services
Patient and Family Advisory Council (PFAC)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
James Heckman
Kayla Tremblay
Tobie Atlas
Nisha Basu
Angela Coppola
Leonor Fernandez
Stephanie Fryman
Mathilda Ganjoli
Whitney Griesbach
Brendan Murray
Heather Wathey
Lauren Wemple
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
The Arrive-Register-Room-Care (AR2C) Initiative: Designing Reliable Processes at HCA
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness
Timeliness
-
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be3eeb4231e36fcad62fa3f95e052a0f
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Smoothie, Frappe and Blended Supplement Station Process Improvement
TAP TO GO
BACK TO
KIOSK MENU
Completed By: Jessica Gloss, MS, RD, LDN
Introduction/Problem
The Interventions
Blended specialty supplements, smoothies and frappes are prepared daily for patients with increased nutritional
requirements. Orders are placed by a Registered Dietitian in POE (Provider Order Entry).
Blended supplement, smoothie and/or frappe orders appear in the patient meal ordering application HealthTouch
under the patient profile and the CSR (Customer Service Representative) orders at specified meal periods.
Supplements print on meal tickets and are made to order then delivered as part of the patients meal tray. Patient
orders have increased since October 2018, likely attributed to an introduced smoothie menu.
Multiple problem areas were identified:
•
•
•
•
•
•
Steady increase in blended drink production demands increased labor
Location of blending station, ingredients, cups/covers and utensils: cause staff to make unnecessary motion
resulting in increased time spent making product
Not enough blender containers: cause staff to make additional steps to the dish room and back, while waiting 2.5
minutes or more for blender container to be clean and sanitized
One blender base: increased time to make multiple products
Physical size of workspace : two shelves 20in x 16 in. each
Inconsistency in order vs. standard recipes: cause overproduction
➢
First, staff were observed making specialty supplements, smoothies and frappes to determine time taken to
produce at baseline. Mean: 3.05 minutes, with longest time taken: 9.25 minutes
➢
Then a new blending station was installed
➢
Relocated closer to trayline
➢
Increased workspace and added undershelf bin for dirty blenders and utensils
➢
Easily accessible storage containers for regularly used ingredients, cups, covers and utensils
➢
Added additional blender container
Results/Progress to Date
With roll-out of new blending station, time taken to produce specialty supplements, smoothies and frappes
was reduced. Mean: 2 minutes, with longest time taken 3.25 minutes.
East Campus Smoothie, Frappe and Blended Supplement Usage Per Month
900
800
763
700
600
500
563
400
621
838
727
598
701
572
475
802
773
640.5
739
702
300
200
100
0
1/1/2018
2/1/2018
3/1/2018
4/1/2018
5/1/2018
6/1/2018
7/1/2018
8/1/2018
9/1/2018
10/1/2018
11/1/2018
12/1/2018
1/1/2019
2/1/2019
Aim/Goal
Reduce overall time and steps taken to make smoothies, frappes, and blended supplements on the
East Campus trayline. Reduce physical waste of product by reviewing recipes and retraining staff.
The Team
➢ Jessica Gloss, MS, RD, LDN
➢ Kelsey Whalen, RD
➢ Jill Matson
Food Service Manager
Operations Manager, Patient Food Services
Project Manager, Food Services
Next Steps:
➢ Update #13 job flow and provide training regarding daily stocking of blending station, including quantity
of Greek yogurt , Staff training regarding flow of dirty blenders to dishroom
➢ Review recipes and provide staff retraining of how to place orders in Healthtouch and production
For more information, contact:
Kelsey Whalen, RD Please email kmwhalen@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.
Kelsey Whalen (<a href="mailto:kmwhalen@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">kmwhalen@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
Kelsey Whalen
Jessica Gloss
Jill Matson
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Title
A name given to the resource
Smoothie, Frappe and Blended Supplement Station Process Improvement
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f02ae15b743f6da38fc5c461e3d0b617.pdf?Expires=1712793600&Signature=EzmCkmWc-cKpj6XlFxYdw%7E5H9sOKjhhXjhSkGrDjzymMpUwhaFTfiCLsRApys4wtUYf1vy-v-YxUsRT%7EIswAy1dvv2qFzc117wuZMU%7EmUXVjrU9JpXY%7Ec7VvK6hb9VXq36Te9AtEzCF-Rqb6OghU8-ggFwtXDxrN47ucwq9CEHc8xOY3vBIf9r7%7EA8N1qAE2s2jECCA5BYrvfb-LyvaxiqjOVzfeZO8QxkjTzIbLUbwyxQsD-sRa08B%7EyHGjwfKGSYg1GQ2cDkbsHzBRmCi46wQrZF0c2Yvmz67K-2hLuFbWNUbSTOjGrFccLKFIYgxHUemrkrpjC7Q-eCbEg2LIqw__&Key-Pair-Id=K6UGZS9ZTDSZM
eee7694208e08b9a9bdb6ff750a5c486
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Smart Waiters System Collaboration
Ashlee Hall, Donna Spina, Shana Sporman
Introduction/Problem
Each day, the Ullian Cafeteria on East Campus serves an average of 1950 customers.
The main production for this occurs one floor below the cafeteria. This leads to
challenges in maintaining an appropriate supply of items at any given moment. In
addition, storage for food inventory in the cafeteria is limited, leading to a constant
need for communication between the Retail Team and Culinary Production Team. The
primary space for transfer of food is a narrow dumbwaiter between both floors. This
also served as the method to send dirty and used items back to the main kitchen.
• During time between breakfast and lunch, the dumbwaiter had a bottleneck of food
going both directions, up and down.
• There was limited communication between kitchen and retail staff, causing delays on
both sides.
• Wasted time and motion from deli prep, entrée and cook positions.
• Inaccurate standard operating procedures causing delays to the customer.
Aim/Goal
TAP TO GO BACK
TO KIOSK MENU
The Interventions
➢ GEMBA - Interviewed staff to find out the most frustrating points
➢ Identified forms of waste across entrée, production, and deli station job flows
through spaghetti graphing motion, measuring number of steps, and timing
dumbwaiter motion
➢ Value steam map process
➢ Value graphed solutions
➢ Observed wasted time for
guests during breakfast service
Results/Progress to Date
Improve flow of food and dirty dishes between first floor kitchen and second
floor retail area utilizing the dumbwaiter, as well as improve communication
between kitchen and retail staff to decrease wasted movement of staff.
The Team
➢
➢
➢
➢
➢
➢
➢
➢
Ming Cheung, MS, RD, LDN, General Manager, BI Needham Food Services
Ashlee Hall, Retail Manager, BIDMC Food Services
Stephen O’Brien, Operations Manager, Northeast Health System s EVS
Courtney Shea, CNM, Cape Cod Hospital
Caitlin Sheehan, RD, Operations Manager, Brigham and Women’s Hospital
Tim Sheehan, RD, General Manager, Lahey Medical Center
Donna Spina, Operations Manager BIDMC Food Services
Shana Sporman, MS, RD, Director BIDMC Food Services
Top photo of prior state of dumbwaiter and spaghetti diagram of wasted motion between deli,
dumbwaiter, oven, and entrée service table
Resulting dumbwaiter signage, spaghetti diagram, and new systems
For more information, contact:
Ashlee Hall, ajhall@bidmc.harvard.edu; Donna Spina, dspina@bidmc.harvard.edu
�Smart Waiter System Collaboration
Ashlee Hall, Donna Spina, Shana Sporman
Results / Progress to Date
Conditions upon completion:
• Installed visual controls to decrease need to use phone for
communication
• Reduced wasted motion in set up and breakdown of stations through
single space for used pans
• Implemented new standard operating procedures to decrease
unnecessary or inappropriate processing of inventory to place into
service
• Eliminated cross-contamination in dumbwaiter between in service and
out of service food
• Increased breakfast sandwich sales by approximately 10% due to
decrease in wait time.
Time Saving Conclusions:
• Breakfast Sandwich production time pre-project: 105 seconds per
transaction; 13.7 seconds per transaction with new system. This
equates to 182.6 minutes per day time reduction for customers.
• 300 steps saved (87%) while cleaning breakfast bar to reset for salad
bar
• 18 minutes saved for retail production cook no longer awaiting
dumbwaiter
Lessons Learned
➢ Kanban Card System challenging to maintain for front line staff and is
remaining a work in progress
➢ The light used as the visual cue for the dumbwaiter location cannot be battery
operated. A reflector or bike light is a more sustainable visual control.
➢ A change of job flow was necessary for the retail porter to accommodate the
new dirty dish rack’s transit between Ullian Cafeteria and the 1st Floor Kitchen.
Next Steps
➢ Revise Kanban Cards to be more sustainable
➢ Reevaluate placement of dirty dish rack and schedule of removal from cafeteria
➢ Request return of System Green Belt Team to evaluate other areas for
improvement
For more information, contact:
Ashlee Hall, ajhall@bidmc.harvard.edu; Donna Spina, dspina@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.
Ashlee Hall (<a href="mailto:ajhall@bidmc.harvard.edu">ajhall@bidmc.harvard.edu</a>)<br />Donna Spina (<a href="mailto:dspina@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dspina@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
Donna Spina
Ming Cheung
Ashlee Hall
Stephen O’Brien
Courtney Shea
Caitlin Sheehan
Tim Sheehan
Donna Spina
Shana Sporman
Dublin Core
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Title
A name given to the resource
Smart Waiters System Collaboration
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/5c98fd4db5eba9b784ba1b041fd1ea82.pdf?Expires=1712793600&Signature=GwLmWo4NmredUgwH1W7ftTe6F1xh4LG70njNzQFX2dviF%7EoZ48C0oKlNgMRDgBRnxYXLCuAv4nJFX3CfTIi7YX1fzmcbkmu0dtLSCZIitNNne7TDKlakcVTgSNZ5y8I6mCl6q7tcKNuyzAkkTod9P1MSbyUQyYvUcbLze%7E1UyKsOyNPGSHvOZyliCaJCqe8mrkh9luqxw8z881snEF-2kaBnT5QuaNiLz8ymt4AkFZdXpquiwH7hCQUr6gNi7krhKVEclHxfqU0%7EimkO8U9yNix41mkUWwz5ODHmmdZ56%7ECLL1H8XVpyh8cF1J0k37ppp-gTXHKeYw0XRlLxXcGxGg__&Key-Pair-Id=K6UGZS9ZTDSZM
0f974d07d1c6ae4ef6aa60c483689d20
PDF Text
Text
•Therapeutic Optimization
•Drug information
•Coordination of Care
•Appeal
•Conversion – New rx (to BI or contract pharmacy)
•Conversion – Existing rx (to BI or contract pharmacy)
Sequencing Pharmacy Clinical Workflow
TAP TO GO BACK
TO KIOSK MENU
Qua Tran, Chirag Desai, Jinkyu Lee, Chirag Patel, Parth Patel
Introduction/Problem
Previously in the ambulatory care setting, ambulatory pharmacists generally work off referral
base notices. This limits the efficiency of pharmacists and reduces the amount of patients
that they can care for. Ambulatory pharmacists require a tool in order to identify patients prior
to a referral to maximize overall efficiency. Beth Israel Deaconess Medical Center (BIDMC)
has created an analytic tool to identify high-risk patients and streamline workflow for
ambulatory clinics in a user-friendly dashboard.
Learning Objectives:
1. Discuss the impact of dashboard on ambulatory pharmacy workflow.
2. Identify methods to maximize ambulatory pharmacist presence in the clinics.
The Interventions
Patient Education – Initial
Patient Education – Follow Up
Therapeutic Optimization
Drug Information
Coordination of Care
•Patient Education - Initial
•Patient Education – Follow Up
•Therapeutic Optimization
•Drug information
•Coordination of Care
•Appeal
•Conversion – New rx (to BI or contract pharmacy)
•Conversion – Existing rx (to BI or contract pharmacy)
Appeal
Conversion – New Rx (to BI or contract
pharmacy)
Conversion – Existing Rx (to BI or
contract pharmacy)
Results/Progress to Date
Aim/Goal
Creating clinical and pharmacy visibility through analytical techniques to improve
patient safety while optimizing clinical workflow.
The Team
Qua Tran CPht – Pharmacy Data Analyst
Chirag Desai RPh – Director of Ambulatory and Pharmacy Business Development
Parth Patel BSN, RN – Manager of Pharmacy Data Analytics
Jinkyu Lee, Pharm D, CSP – Specialty Clinical Pharmacist Supervisor
Chirag Patel CPht – 340b Compliance Coordinator \ Pharmacy Data Analyst
For more information, contact:
Qua Tran Email: Qtran@bidmc.Harvard.edu
�Sequencing Pharmacy Clinical Workflow
Qua Tran, Chirag Desai, Jinkyu Lee, Chirag Patel, Parth Patel
More Results/Progress to Date
Beth Israel Deaconess Medical Center has created an application that pulls all the necessary
information from the EMR system and relays it to a user-friendly dashboard. This includes,
but is not limited to, prescribed medications, laboratory values, future and prior clinic history,
and re-admissions. The dashboard portrays up to three weeks of data, one week prior to the
given date and two weeks future of the given date. This allows pharmacists to prepare in
advance for certain patients and retroactively follow-up on patients.
Target Audience:
Health Care Executives
Nurses
Nurse Practitioners
Operations Professionals
Pharmacy Technicians
Pharmacists
Physicians
Quality Improvement Professionals
General / Other Professionals in Health
Care Industry
Pharmacists are spending more time with their patients rather than identifying high-risks
patients or waiting for a referral. Prior to the rollout of the dashboards, pharmacists were
seeing an average of 5-10 patients per week based off physician referrals. With the rollout of
the dashboard, the amount of patients seen has at least doubled per pharmacist. The
dashboard has allowed pharmacists to proactively identify patients who have not had a clinic
visits in over a year or who have not had appropriate lab draws for high-risk medications. The
real-time identification of these patients has been monumental for the clinic providers and
allowed for full integration of a pharmacist into an interdisciplinary team for each clinic. The
increased pharmacist utilization has allowed for implementing clinical pathways with high
compliance as well as ensure best outcomes and provide optimal performance. The
dashboard has allowed for innovative ways to utilize data-driven decision making to reduce
variations in care and improve patient outcomes.
Lessons Learned
Medication Database: Database only updates once every week
Version 1.0 to Version 2.0: Additions of Med List, Labs, Clinics
Same Day Schedule Changes: Inability to reflect on database
Labs Synchronization: Inability to capture scanned in labs
Next Steps
Dashboard Filters: Ability to differentiate
Specialty Patients, New Prescriptions,
Clinic and etc.
Addition of Ambulatory Clinical Care Pharmacists: More feedback on how to improve
dashboard
SureScripts: Access to medication reconciliation and pharmacy dispensing history
Medication Compliance: Addition of medication compliance through pharmacy renewals
and pharmacy adjudication times
For more information, contact:
Qua Tran Email: Qtran@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.
Qua Tran (<a href="mailto:qtran@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">qtran@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
Qua Tran
Chirag Desai
Parth Patel
Jinkyu Lee
Chirag Patel
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
Sequencing Pharmacy Clinical Workflow
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/47903462f887d1217854e422d446c579.pdf?Expires=1712793600&Signature=AzUV-e49nK-kGlAUAUItRhWsjd93jjtrPz6VbeCAsT%7Ef3Y3%7EkgKE8rfDJcQVl6h7E6UKEGNNRKiZdLp18VM5JUfy78s7do0FttCYSol-Wu6WTNtXvXD79nqHvTgPgydRL%7EqKvrrhg2q4N6izC48Jk5QX-v2qA27aKX64HA0RUu0aqFJTuAe3IgMgoMF60l2MmqG9igexC8BvRnsu6W8%7E0arDs4FEGlICLsMu0%7EQfmm129iodRC8UrYKU8DSkYVyQadN4fdWtacNNqg4KqExmutU8374aSoFZYltkPSssE0UNHmxaDO1zF4-KDc0nMUJXA7YAH0oH9x7TKm4t5NDb1A__&Key-Pair-Id=K6UGZS9ZTDSZM
027c4ffcf05f669118d832436a2aef7b
PDF Text
Text
Reducing the No Show Rate at Healthcare Associates
TAP TO GO BACK TO
KIOSK MENU
Kayla Tremblay, Blair Bisher, Whitney Griesbach, Jeff Vale, Randy Gonchar
Introduction
Reducing no shows is a common theme among primary care
and outpatient practices. A missed appointment can represent
lost revenue, reduced efficiency, wasted resources, and
increased health risk.
In 2015, HCA developed a practice No Show Guideline outlining
a progression of letters to send to patients if they miss
appointments. However, the guideline was not reliably followed
by the practice. Providers sent letters ad hoc without
designated administrative support. The practice also lacked a
formal tracking process to escalate patients for consideration
for discharge. Additionally, patients were not informed of HCA’s
expectation that appointments be kept or cancelled in advance.
In October 2017, Healthcare Associates commissioned a task
force to address the practice’s high no show rate of 20.4%
including did not keep and same day cancellations. The task
force met weekly from October 2017 through October 2018. A
sustained improvement of 3% over a period of 10 months was
expected to generate $490,000 in additional revenue for the
practice.
Interventions
100%
95%
90%
85%
80%
75%
70%
65%
60%
55%
50%
Patients who Total number of
missed
DNK
appointments appointments
Figure 1. HCA found that 3% of
patients represented 12% of DNKs.
Key Interventions
visits and represent roughly 25% of all visits
scheduled at HCA with a 5%-10% no show rate
Developed patient education materials
(see Figure 3). Using the Clienttell Broadcast
Including a letter to give all patients and send
feature, a text message or recorded voice
with appointment reminders, a sign to hang in
message was sent to all patients the night
practice, and scripts for phone staff.
before their visit.
Created a cancellation voicemail
Additional Interventions
To allow patients to cancel appointments without
waiting on hold. Checked at least once per hour. Developed operational definitions and
measurement plan
Operationalized patient letters after missed
Analyzed data for patterns
appointments
Created workflow for staff to send patient letters Asked patients about barriers to keeping
appointments
and involve practice manager as needed (see
Sent daily email to management
Figure 2)
Set expectations for accurate and timely visit
Sent reminders to patients who scheduled
dispositioning
within 72 hours of visit
Removed staff ability to override blocks
Patients who schedule their visit less than 72
hours in advance do not receive reminder calls.
Adjusted call confirmation timeline
These visits are primarily episodic/urgent care
Encouraged text message enrollment
25%
Aim
20%
Reduce HCA’s did not keep rate by 3% from 10.2% to 7.2% by September 30, 2018.
15%
10%
The Team
Blair Bisher, MHA, Director of Ambulatory Operations, Division of General Medicine
Kayla Tremblay, MBA, Senior Project Manager, Healthcare Associates
Whitney Griesbach, Practice Manager, Healthcare Associates
Jeffrey Vale, Patient Access and Call Center Manager, Healthcare Associates
Randy Gonchar, Patient-Family Advisory Council Representative, Healthcare Associates
HCA No Show Rates by Visit Type
HCA No Show Documentation Process
5%
0%
2-Oct
Figure 2. HCA’s workflow for documenting patient
missed appointments. (Enlarged on slide 2)
2-Nov 2-Dec
Epi
Long
2-Jan
Med
2-Feb 2-Mar
New
Figure 3. Episodic visits represent 25% of HCA visits
and have a 5% to 10% no show rate.
For more information, contact:
Kayla Tremblay, MBA, Healthcare Associates | ktrembl1@bidmc.harvard.edu
�HCA No Show Documentation Process
PR dispositions
patients who Did Not
Keep as “DNK”
How
many no
shows in
last 12
months?
Look up patient in OMR; review
profile and notes (exclude
patients admitted or expired)
0
Email practice
manager to place
block
Send OMR Letter,
use “No Show I”
macro
3
Third Missed
Appointment
Second Missed
Appointment
Patient
on
Patient
Site?
N
2
1
First Missed
Appointment
TAP TO GO BACK TO
KIOSK MENU
N
Fourth Missed
Appointment
New
patient?
Send to Practice
Manager to initiate
consideration for
discharge
Y
Call patient
Y
Send patient site
email, use “No
Show I” macro
Reach
patient
?
Y
Document in OMR,
use “No Show
Outreach” Macro
Meeting with
provider, Assistant
Med Director,
Practice Manager
Use “No Show
Call Script”
Update Block
Send letter to
patient via
certified mail,
use “Patient
Discharge
Letter”
N
Send OMR
Letter, use “No
Show II”
Develop patient
support plan
N
Discha
rge?
Y
Document in
OMR
�Reducing the No Show Rate at Healthcare Associates
TAP TO GO BACK TO
KIOSK MENU
Kayla Tremblay, Blair Bisher, Whitney Griesbach, Jeff Vale, Randy Gonchar
Results
Lessons Learned
HCA Daily Did Not Keep Rate
Figure 4.
16%
In May 2018 HCA
achieved the goal
of a 3% reduction in
the no show rate
from 10.2% to 7.2%
In the last few
months of the
project the median
shifted up and
ended at 7.7%. The
team suspects this
is likely due to
seasonal variation
and summer
vacations.
Starting Median: 10.2%
14%
12%
10%
8%
6%
Lowest Median: 7.2%
4%
Ending Median: 7.7%
30-Oct
13-Nov
27-Nov
11-Dec
25-Dec
8-Jan
22-Jan
5-Feb
19-Feb
5-Mar
19-Mar
2-Apr
16-Apr
30-Apr
14-May
28-May
11-Jun
25-Jun
9-Jul
23-Jul
6-Aug
20-Aug
3-Sep
17-Sep
2%
DNK rate
Median
Figure 5.
HCA Weekly Did Not Keep Rate (Year Over Year)
14%
HCA’s weekly no
show rate fell over
the project period.
In comparison to
the prior fiscal year,
HCA’s performance
improved. The
upwards trend of
the no show rate
was reversed
during the project
period.
12%
10%
8%
6%
4%
2%
FY17 DNK Rate
FY18 DNK Rate
17-Sep
3-Sep
20-Aug
6-Aug
23-Jul
9-Jul
25-Jun
11-Jun
28-May
14-May
30-Apr
16-Apr
2-Apr
19-Mar
5-Mar
19-Feb
5-Feb
22-Jan
8-Jan
25-Dec
11-Dec
27-Nov
13-Nov
30-Oct
0%
Clarify operational definitions. The complexity
of measuring the “no show rate” was a challenge
at the start of the project. Ultimately, we chose to
focus on the did not keep rate. Although this is
not a perfect measure, it allowed us to see the
impact of our interventions more directly.
Question assumptions. Many of our successful
interventions came from questioning our
assumptions and finding measureable support
for or against deeply held beliefs.
Partner with patients. Research suggests that
patients are often unaware to the impact of no
shows on the provider (Lacy , et al), which is
why effective partnership with patients is
essential.
Invest management attention. Each
intervention required continually following up
with staff to reinforce expectations and goals.
Because the DNK documentation process was
new to everyone audits were performed to
understand where there were gaps in training.
We also invested one hour per week to our task
force meeting.
Next Steps
Ensure sustainability by:
Communicating cancellation expectations to
patients up front, either through a letter with
their appointment confirmation, at check out,
verbally, or in a practice welcome packet.
Reliably reminding patients of their
appointments, including a broadcast message
the night before, supported by a functional
technical platform.
Training all new Practice Representatives on the
DNK documentation workflow and expectation
to disposition visits in a timely way.
Maintaining a workflow to manage the
cancellation voicemail box.
Continued management attention and
expectation setting with staff, including regular
auditing and follow up.
Continued and consistent measurement of the
DNK rate over time.
Acknowledgments
Thank you to the many people that made this project a success including: Tobie Atlas, Marc Cohen, Leon
Daneschvar, Leonor Fernandez, Rebecca Glassman, Amy Goldman, Jim Heckman, Tim Loo, Kevin Maguire,
Charmaine Massey, Brendan Melvin, Felipe Molina, Francine Patterson, Eileen Reynolds, Sam Skura
For more information, contact:
Kayla Tremblay, MBA, Healthcare Associates | ktrembl1@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.
Kayla Tremblay (<a href="mailto:ktrembl1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ktrembl1@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Associates
General Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kayla Tremblay
Blair Bisher
Whitney Griesbach
Jeff Vale
Randy Gonchar
Acknowledgements:
Tobie Atlas
Marc Cohen
Leon Daneschvar
Leonor Fernandez
Rebecca Glassman
Amy Goldman
Jim Heckman
Tim Loo
Kevin Maguire
Charmaine Massey
Brendan Melvin
Felipe Molina
Francine Patterson
Eileen Reynolds
Sam Skura
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
Reducing the No Show Rate at Healthcare Associates
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/41ca6ef7e827f258aa4334d9d5f41345.pdf?Expires=1712793600&Signature=Ri48c4qc77oEa28C2QiYUK33mq1%7EqiJhbpnIZcnl1EFzblTOaFZxdQotTGDlHCaF2wYDVyrOQixolnGVvKrWetJ5v8fKkS5c%7Ex12AV6rdu8P33ThswtDNFOiqXJSgNBmatRuCSdcAYzhDcL9sbD3gaVd%7E3IAWVYEsOw%7Ee-7Viodr%7EW%7E2CtwYBIaibKCoPYS8vcr%7ElYLXRCGLXar%7EeilwAa9nFwJ%7EAt2BDF73u6jaxG3lMEz8AKq1elh%7EKA25ZxqI42aDf2FkAua5WWWdlrxUUxjP3Vyyd3HsuwyTfdIme6Je6T3K5lnpKNxLMwd%7EosFQNnxHyke5re5usjEPfL0Jlg__&Key-Pair-Id=K6UGZS9ZTDSZM
e4736d5e5e0da8bc2538a7b98f00fc38
PDF Text
Text
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Reducing Length of Stay for Total Joint Replacement Patients
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Nicolette Burnham, RN, MSN, Charlotte Clements, RN, & Jenny Barsamian, RN, MSN
The Interventions
Introduction/Problem
Background:
- BIDMC’s primary Total Joint Replacement (TJR) surgical service line was identified as one of
the top three service lines to have a substantially higher observed length of stay (LOS) relative
to their expected LOS.
- Additionally, the LOS index for knee and hip replacement patients at BIDMC was significantly
higher than that of comparison hospitals and Academic Medical Centers (AMCs)
LOS FY 17
Hip
Knee
BIDMC
Compare Group
1.79
1.74
Care Standardization
•
•
•
•
•
•
•
AMCs
2.91
3.37
A large multidisciplinary team was assembled to address barriers to goals and identify
opportunities for improvement in the following areas:
2.12
2.24
Vizient Consultants conducted a week-long, detailed analysis of the Joint Replacement Program at
BIDMC to identify opportunities for improvement in decreasing the length of stay for knee and hip
replacement patients.
Baseline
% DC’d on Target
10/2017-4/2018
Hip
Knee
13% (POD1)
40% (by POD2)
Factors contributing to increased length of stay (LOS):
- Lack of standardized target length of stay
- Inconsistent patient education materials and messaging around LOS and discharge disposition
- Lack of standardized protocol for surgical pathways, post-op orders, and post-op care
- Identified clinical complications, such as hypotension and pain management, delaying discharge
Aim/Goal
1.
2.
3.
4.
Streamline care for TJR population
Standardize messaging around LOS and discharge disposition to improve patient expectations
Improve patient experience
Decrease LOS for TJR patients
Target Discharge Date:
- LOS for Hip Replacement – 1 day
- LOS for Knee Replacement – 1-2 days
Goal % Discharged on Target:
- 33% of hips discharged on POD1
- 66% of knees discharged by POD2
•
•
•
•
Revision of Total Knee Replacement & Total Hip Replacement Pathways
Standardization of Post-Operative Order Sets
Surgeon agreement on Patient Selection Criteria
Creation of Pre-Operative Hydration Protocol
Consistency of patient messaging throughout the care continuum
Shared decision making amongst full care team re: readiness for discharge
Standard language regarding patient pathway, milestones, and barriers to
discharge during Patient Progression Rounds
Educational Materials
Begin Revision of Contents of Pre-operative Education Folder
Creation of Updated Patient Education Videos for
Department Website
Revision of Course Outline for Total Joint Replacement
Pre-Operative Class
All patients to receive gift bag with supplies for Pre-Operative
Hydration and Infection Prevention
Inpatient Experience
•
Development of Nursing Care Bundle
•
Increased frequency of physical therapy visits to twice daily, plus a visit POD
#0 when clinically indicated
•
Altered whiteboard template to include transparent plan of care and discharge
date
•
Tracking of weekly data related to length of stay, identifying patient on/off
target and barriers to discharge
For more information, contact:
Nikki Burnham, MSN, RN, Nursing Director 7 Stoneman, nburnham@bidmc.Harvard.edu
�TAP TO GO BACK
TO KIOSK MENU
Reducing Length of Stay for Total Joint Replacement Patients
TAP TO GO BACK
TO KIOSK MENU
Nicolette Burnham, RN, MSN, Charlotte Clements, RN, & Jenny Barsamian, RN, MSN
Results/Progress to Date
Lessons Learned
Change is not possible without engagement of all stakeholders
Clear and consistent messaging to patients is important throughout the care continuum
There is no such thing as a “quick change”: In order to make a long-lasting, effective change,
you need to look at each step in the process and how it relates to other parts of the process
Sustainment requires continued focus by all members of the team
Next Steps
Monitoring % of patients DC’d on target began in April 2018. Over time, % patients DC’d on target has
improved in both Total Hip Replacement patients and Total Knee Replacement patients. Total Hip
Replacement goal changed to 60% in March 2019 due to being above goal for 5 months
Complete Pre-Operative Educational Materials Folder
Complete Physical Therapy Educational Videos for Department Website
Continue to track weekly data on LOS, identifying patients DC’d on and off target, with
barriers to DC
Continue to track patients’ experience through follow-up calls and post-discharge surveys
The Team
Aaron Block, Beatrice Noel-Destin, Bernard Lee, Caroline Kenney, Charlotte Clements,
Corinne Fairweather, Deborah Adduci, Douglas Ayres, Elena Canacari, Elise O’Reilly,
Elizabeth Coyte, Erica Marsh, Jacob Drew, Jane Wandel, Jeanette Gutierrez,
Jenny Barsamian, Joshua Medeiros, Krysta Cass, Lauren Doctoroff, Lauri Askari,
Leah Lammer, Marcelle Denis, Mariela Arnal, Mary Ellis, Michael Baratz, Nancy Zhou, Nicolette
Burnham, Phyllis West, Robert Davis, Ryan Cuerdon, Stacy Lewis, Susan Dorion,
Ted Vander Linden, & Tracy Lee
For more information, contact:
Nikki Burnham, MSN, RN, Nursing Director 7 Stoneman, nburnham@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.
Nicolette (Nikki) Burnham (<a href="mailto:nburnham@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">nburnham@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Perioperative Services
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Nicolette Burnham
Jenny Barsamian
Charlotte Clements
Aaron Block
Beatrice Noel-Destin
Bernard Lee
Caroline Kenney
Corinne Fairweather
Deborah Adduci
Douglas Ayres
Elena Canacari
Elise O’Reilly
Elizabeth Coyte
Erica Marsh
Jacob Drew
Jane Wandel
Jeanette Gutierrez
Joshua Medeiros
Krysta Cass
Lauren Doctoroff
Lauri Askari
Leah Lammer
Marcelle Denis
Mariela Arnal
Mary Ellis
Michael Baratz
Nancy Zhou
Phyllis West
Robert Davis
Ryan Cuerdon
Stacy Lewis
Susan Dorion
Ted Vander Linden
Tracy Lee
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
Reducing Length of Stay for Total Joint Replacement Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/0cb1e52972d1cf2327b79b051cf1a3c6.pdf?Expires=1712793600&Signature=PWz6TNcU%7EV-5pWrtYazM-awpCi%7Eunq2A3Dc4-5DWVNo8lk0eAV-Wd59EoJxZc5fNXZ2Is0LOlLfFOT9lTFmBdkMtuffR5vmD8R2%7EgVqgV0iyydFgVKHuJ3iixUQRn7OLOak3Y66IXk6BPI%7EYqC0FEEdl1r7Kde0pbnayHtMR1Orc-IiohkwdKjN-AQDHSmZAy0y%7EAwzhb81kOlm-RZltSHz1wV7222eueZcSTwGHKlJYC2WmEYGRB1LWH5EjZ6DZHZPN80asHqPGPVIApP-4qzCbFRh8ZQkCtrdQWIefLU96ooO-TqTtC62MO3LzBVD43xNbh-LGxKsp9ClRScl0Vw__&Key-Pair-Id=K6UGZS9ZTDSZM
8e3b5d5c9a1977113f643933e10c66bf
PDF Text
Text
Reducing Blood Waste Through Interactive Dashboard
Pamela Stravitz, Monique Mohammed, Nathan McLamb MD, Kerry O’Brien MD
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Beth Israel Lahey Health
Background
Results
Blood waste is a major issue throughout all hospital networks.
The cost of these errors affect multiple aspects of an
organization, including administration and inpatient care. The
loss of such clinically vital products can also harm medical
centers’ finances, reliability, and ability to be fully equipped to
provide great patient care. Current improvement efforts focus on
retraining efforts which often only decreases blood waste for a
short while. More permanent solutions are largely unpracticed,
including consistent feedback, data monitoring, and goal setting.
In early 2019, the QI team at Beth Israel created a dashboard,
focused on interactivity and data translation, to put the affects of
blood waste into a larger perspective and one entirely focused on
improving patient care.
With the design phase completed, focus is shifted to the
proper distribution efforts of the dashboard. Future
improvements include:
• Establish consistent data review periods and contact list
• Create warning systems for high blood waste practices
• Establish goals set by the unit leaders
• Add accountable parties to unit identifiers
• Conduct more interventions associated with Patient Blood
Management2, a system adopted by the AABB
Very few institutions are currently recording blood waste data
in an accessible way. Thus, we are currently only able to make
comparisons within the medical center network. We expect
higher participation data availability in coming years.
According to the American Association of Blood Banks 31st
edition standards under section 8.2, “The following shall be
monitored: usage and discard.1” However, the lack of mandates
allowed us to represent the data in a way that unit managers most
wanted to see and answer the questions how does my team compare to
other units and where is my team making mistakes?
Date
Product
Unit
Formatted
so dates in
year 2019
required.
Drop down list:
red cell, cryo,
plasma,
platelet, RhlG
Free text,
general
location
identified
3/1/2019
Plasma
OR
Comment
Free text to
describe events
and reason for
waste
Error
Drop down
list: fever,
IV issue,
cooler etc.
No IV access
IV Issue
3/4/2019
Cryo
L&D
Left in cooler
Cooler
Issue
3/8/2019
Red Cell
EW
Lost in tube
Tube
Mechanics
Table 1. A few of the categories required when
cataloguing a blood waste incident. Three fabricated
examples show the content of the data tab, filled in by
the Blood Bank manager at BI. Waste is categorized by
month and year, product, unit, and error type.
References
1. American Association of Blood Banks Standards 31st
Edition, 2018. Print.
2. Patient Blood Management (PBM), AABB
http://www.aabb.org/pbm/Pages/default.aspx
Image A. This dashboard analyzes the blood wasted within the hospital network, classifying waste by reason, date,
product type, and location. It is currently being used to present to the floors and blood bank, showing in which units
the errors are occurring and explaining the reparations of lost blood products.
Materials & Methods
The data is categorized by the product wasted, issue type, and
unit in which the waste occurred. Details of each incident are
recorded in the “data” tab by the Blood Bank manager. The
data columns that are used to provide information for the
dashboard’s pivot tables and charts are formatted and
standardized, shown in Table 1. Other columns include
“general unit,” to further organize the waste and whole blood
number, or “WBN” to link waste to blood identification.
Because the raw data entry is not user friendly, users can access
a cleaned version of these data in by selecting their unit from
the drop down list. A new sheet auto populates a table with the
appropriate waste events, shown in Image B.
The dashboard contains four tabs:
• Data – Table 1. Tab in which the raw data is collected. Upon
release, this tab is hidden from users.
• Dashboard– Image A. Unit errors shown by reason for waste,
product, and location by month and year.
• Dropdown List– Hidden from users. Contains formulas and
lists that feed information to the dashboard.
• Unit Data– Image B. This tab is only available once a user
accesses specific unit data through the drop down menu. A
new “unit data” tab will open if a second unit is chosen.
Image B. This new tab contains all cases originating in
the OR during 2018. It comes pre-formatted as a table,
only containing relevant columns from the raw data. The
tab is created automatically upon selection of a unit from
the drop down menu on the dashboard.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Pamela Stravitz (<a href="mailto:pstravit@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">pstravit@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
Blood Bank
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Pamela Stravitz
Monique Mohammed
Nathan McLamb
Kerry O’Brien
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
Reducing Blood Waste Through Interactive Dashboard
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/cc886d6906bccab0237fcd911c0b7eea.pdf?Expires=1712793600&Signature=AsFOBtq3P51bz9Zg7IeWDHZfpYq0nMS0Vmi8wbXP16uDG3ebzV987yxbbZTo3pr-0MydiYpGUp3fAG9Iv53t1xTo8ZfeZWAVjD5%7EQDF3ToKARoSwcXsBFM0%7EWvh72PrjUopmtKpWZYbbTBmtdZpk6-6zaPp%7E3A0BH0gxXU6WuzCnfoTDaSKyDMLERHJrJzmn0YHCTv2PAGd%7E7iaOYluOgf6DlHkDkVMHT%7ELPaxWcy5VphJ9NxYKdR9dp91eRomExCBAq9p0K0EQXDlKvhlceVcwqGdqioG9uDi-sezv98x6oMGO7T39F2PHbiy0zpf6JuicIuAg-jNFgZgMMXEg%7E%7Ew__&Key-Pair-Id=K6UGZS9ZTDSZM
17d65cc1a819e3f4501b9b0115569043
PDF Text
Text
Qualitative factors associated with “no shows” in outpatient dermatology
Nicole Gunasekera MD MBA, Pallavi Basu BA, Rachel Reynolds MD, Martina Porter, MD
Introduction/Problem
Wait times for outpatient dermatology appointments can be months long. When patients do not keep their
appointments, there is a missed opportunity to provide timely care to another patient. ”No shows” have
implications for access to care, financial costs, and provider burnout.
TAP TO GO BACK
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The Interventions
Analyzing patient and appointment data for the dermatology department from June 2017 to
September 2018 across clinics at the Main Campus, Chestnut Hill, Lexington, Needham, and
Chelsea offices
Soliciting input from other BIDMC leaders who have worked on appointment non-attendance in their
respective departments
Conceptualizing pilot interventions to reduce the appointment non-attendance rate in dermatology
Results/Progress to Date
Aim/Goal
The aim of our study is to quantify the appointment non-attendance rate at each of our clinic locations
and to identify qualitative patient and appointment characteristics that are associated with increased risk
to miss appointments. Based on these findings, we hope to identify and pilot interventions to reduce
wasted appointments by 15% over 2 years.
The Team
Nicole Gunasekera, MD MBA, Dermatology Resident
Pallavi Basu, BA, Dermatology Clinical Research Student
Rachel Reynolds, MD, Vice Chief of Dermatology
Martina Porter, MD, Dermatology Attending
Factors associated with significant differences in no show
rates include:
Age
Insurance type
Race
Primary Language
Marital Status
Distance from home to clinic
New v. established patient
Appointment type (e.g., urgent v. routine, high risk
clinics)
Lead time (time from appointment booking to the
appointment)
Clinic site
Appointment month, day of week, and time
SDC – Same day cancellation; DNK – Did not keep (“no show”)
For more information, contact:
Nicole Gunasekera MD, ngunasek@bidmc.Harvard.org; Martina Porter MD, mporter3@bidmc.Harvard.edu
�Qualitative factors associated with “no shows” in outpatient dermatology
Nicole Gunasekera MD MBA, Pallavi Basu BA, Rachel Reynolds MD, Martina Porter, MD
More Results/Progress to Date
Lead time is the number of days between when an appointment is booked and the appointment itself.
Appointments booked 30-180 days in advance have highest no show rates.
Self-pay and MassHealth patients have much higher no show rates than patients with other insurance
types.
Lessons Learned
Many qualitative factors are associated with high no show rates. Some are likely easier to modify
than others.
No show rate does not increase linearly with appointment lead time; appointments with lead times of
30-180 days have higher rates of no shows.
Underserved patients have high no show and same day cancellation rates.
Next Steps
Evaluate most common chief complaints associated with appointments scheduled for 30-180 day
follow up, with hypothesis that adjusting the cadence of follow up may reduce no shows
Collect survey data from non-English speaking and non-white patients to understand barriers to
attending appointments - based on this data, identify and pilot interventions to reduce these barriers
Pilot a waitlist functionality so that cancelled appointments can be filled efficiently
Non-white patients have higher no show rates than white patients.
For more information, contact:
Nicole Gunasekera, MD, ngunasek@bidmc.Harvard.org; Martina Porter, MD, mporter3@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.
Nicole Gunasekera (<a href="mailto:ngunasek@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ngunasek@bidmc.harvard.edu</a>)<br />Martina Porter (<a href="mailto:mporter3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mporter3@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Dermatology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Nicole Gunasekera
Pallavi Basu
Rachel Reynolds
Martina Porter
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
Qualitative Factors Associated with "No Shows" in Outpatient Dermatology
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/ba66371cdafe7642afba525472a41200.pdf?Expires=1712793600&Signature=sJZ1C%7ETeRL2uChYZJl9Bvr07vteK-KmDRCLCoZvl5WaxB3CLHkG84%7EocCkb4OI6duCaXHDzNBe0w4aaSdxhkIa05qkqq9JwPHz%7EJG3sTIKfsyX2yIlDZ15dp97bZ5bHSb%7EXUEtTfaqqfTi9m-nozyyF1TFXjSZHoxaBllqJThxBDpID1Ewvah0jAjJvvHtn3VsA6kGEz4EXfLnt%7EmTFw-RaNzgePfzzvxe-Swh0AlLUEqfL2B3P8YktOK49UL8S7rUBVvdyZFngyxa19CEPh9BTGgqjnDEx2-O0L6274SUTcwbtTfBHm95hBPkNM2Kka%7E7nlmbzBxPLvvg4NQc5kSw__&Key-Pair-Id=K6UGZS9ZTDSZM
a167d25c6f74c3b36bc030b221f52c46
PDF Text
Text
Perioperative Throughput East Campus Team
Elena Canacari, RN, BSN, CNOR; Michelle Ucci, RN, MSN, CNOR; Jacky Glenn, RN, MBA;
Ross Simon, BA; Eswar Sundar, MD; Pete Panzica, MD; Mary Ellis, RN, BSN
Analysis
Background
Results
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Audits Identified Delays Hindering Throughput
The objective of this project was to improve
throughput of patients in all phases of the
perioperative process.
(pre-op, intra-op, and post-op)
Prolonged throughput impacts:
•
•
•
•
the patient and family experience
team cohesion and satisfaction
overall efficiency
finances
Goals
Holding Area Delays
1. Create a culture of teamwork and interdisciplinary
collaboration: turnover time is not just
“cleaning the room.”
2. Assess barriers to throughput in each phase of care.
3. Enhance dashboard functionality for improved visual
cueing of patient progression.
4. Reduce average turnover time in the operating room
to the following targets (wheels out to wheels in)
•
•
Feldberg OR’s: 36-minutes
Shapiro OR’s: 29-minutes
Education/Awareness
Added Section to Morning Huddle Report to
Raise Awareness of Need to Reduce Turnover Time
Annual Operating Plan
Shapiro 7, Feldberg 9
Focus on Improving Patient
and Family Experience
OR Dashboard Optimization
Strengthening Team
Collaboration and
Communication
Clarifying of Roles
Trialing new methodology
for targeted turnover rooms
Interventions
Decreased Overtime usage
Ability to perform additional
OR add-on surgeries
Team
Title
Associate Chief Nurse, Operating
Rooms
Nursing Director
Assistant Nursing Director
Administrative Clinical Advisor
Sr. Management Engineer
Director of Clinical Operations- East
Anesthesiologists
Surgeons
Nurses
OR Attendant Supervisor
Analyst
Unit Based Educator, East Campus
1. “Room Ready” Language Intervention
• Changed to reflect an indicator helpful to efficiency:
• All equipment and implants are available for immediate
use AND all team members involved in the care of the
patient are ready to receive the patient in the OR.
2. Page to Roll-Back
• Implement alert [page] to reduce delays getting
surgical team into room when both the “Room Ready”
checkbox is checked AND when the Preop Checklist is
completed.
3. Turn Over Time Intervention
• Standardization of when to call for turn-over. Changed
“Close” to “Closed” to be more reflective of a
completed state of the surgery.
• At closed, the care of patient is now in the hands of
anesthesia and nursing. A call to the OR front desk for
turn-over assignment is made. OR Attendant staff to
come into the room and assist with patient care under
the direction of the nurse.
Room Ready (Page) Alert
Lessons Learned
Dashboard Enhancements – Visual Cueing
•
The Dashboard Enhancements provide nursing and
anesthesia leadership a bird’s eye view of what is
happening in each operating room. The color
borders on the cases indicate different stages of
getting ready in the room to receive the patient.
This allows for deployment of additional support if
running behind.
•
•
Taking a fresh approach to turnover reduction by focusing on throughput rather than just the
“cleaning of the room” turnover provided more opportunities for improving turnover times
Ensure that all operating suites affected by changes we make, are fully informed of planned
interventions prior to implementation
Buy-in from all role groups is critical for adoption of culture changes in relation to parallel
processing opportunities in perioperative throughput
Next Steps
•
•
•
•
Evaluate turnover time in daily targeted room in comparison to turnover time goals
• Compare to average turnover times in non-targeted rooms
Develop/Implement additional dashboard enhancements for optimal efficiencies
Calculate accurate surgical time averages for impacts to OR scheduling
Explore barriers to throughput from contributory departments
• Nuclear Medicine
• Radiology
• Labs
• Pharmacy
�
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.
Michelle Ucci (<a href="mailto:mucci@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mucci@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Perioperative Services
Nursing
Engineering
Anesthesiology
Surgery
PACU
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Michelle Ucci
Elena Canacari
Jacky Glenn
Ross Simon
Eswar Sundar
Pete Panzica
Mary Ellis
Dublin Core
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Title
A name given to the resource
Perioperative Throughput East Campus Team - Deep Dive into Perioperative Throughput: A Novel Interdisciplinary Approach
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Patient and Family-Centeredness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/82f6ef915e7e01e8cbde01628d26d1e6.pdf?Expires=1712793600&Signature=phg2x4EGVOEIiI5rwY7s%7Eiu4TchtMYKYp539SPc-SqTP4XWoUMHAxgURK8G40O5tCOF8k6RdayZG2dCC8xLBKNS3yxxBO-BivY3Jk8s8rzjw%7EVm5nRZQcYtD-hblZtdczWCafZrOXNbEzr8fRnXlvz9l0MY6wvqFa3omJZT7SJFK38bzUzRIrr5B4os3IFmMYb1JaLwF1nJTpv%7EKyJknvAowsxcr3Ar44nXplYqrxyQLj%7EOr2Qo-mMi3p-yWiA6cuP%7E83loNijq3peMSlLi5Q%7EU-mGqwdUfROxlfbGBTTs1krf-ubu71wYUiK7diJxYtt1CpVtdRf4iXCnR7i4Tt5Q__&Key-Pair-Id=K6UGZS9ZTDSZM
b90c7c5de62f70792d646fae30348d12
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Text
Patient Self Scheduling
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Authors: Amy Goldman (Ambulatory Services) and Chris Rodrigues (Office of Improvement & Innovation –i2)
Introduction/Problem
Patient demands for greater convenience and ease of access to their clinicians has encouraged health
systems to move towards patient self-scheduling. We aspire to improve efficiencies and enhance patient
engagement by developing an integrated scheduling option embedded in PatientSite. For practices to be
successful, there needs to be a capacity management systems in place to ensure there is sufficient
appointment availability.
Aim/Goal
While the technical system developed the self scheduling infrastructure, the project team explored the
operations of how provider access and capacity is managed. By developing the self-scheduling
functionality concurrently while exploring opportunities to improve operations, this ensured a successful
implementation of patient self-scheduling that is fully integrated into the practice. Patient self-scheduling
will be piloted by Healthcare Associates, Orthopedics, and OB-GYN (Needham)
The Interventions
➢
➢
➢
➢
Designed and developed self-scheduling functionality for patients requesting appointments
Identified use cases related to the process of appointment scheduling.
Identified foundational best practices of clinical areas who hope to utilize self scheduling
Created patient self scheduling readiness checklist to guide practices to evaluate access and
capacity management as well as track the self scheduling implementation requirements
➢ Developed provider sets to ensure patients are able to self schedule appointments with provider or
care team
➢ Developed patient self scheduling work list for practices to triage self scheduled appointments
➢ Created a marketing and communication strategy to promote self schedule to patients, providers, and
staff
Results/Progress to Date
Operations
FY18 Operational:
FY18 Systems
FY19
• Evaluate capacity of pilot areas to
support Patient Self Scheduling
• Department to identify and implement
opportunities to improve access and
template management to support Patient
Self Scheduling –
• Practice guidelines, workflows, and
performance expectations are defined
and measured
• Request is delivered and accepted by IS
(approved through Triage)
• New functionality to support phase 1 is
developed
• Testing of new functionality is completed
(unit, integrated and user acceptance)
• At least one of three pilots areas have
implemented patient self scheduling
➢
Evaluated
current state
templates
FY18 Q1
FY18 Q2
Project sponsor: Sam Skura and Manu Tandon
Project team: Amy Goldman, Stacey Poltack, Geoff O’Hara, Michael Monroe, Jing Ji, Larry Markson, Qiana
Wang, Ellen Volpe, and Chris Rodrigues
IS Collaboration and Pilot Practices: Healthcare Associates, Orthopedics, and OB-GYN (Needham)
FY18 Q3
PSS Preparation
Align visit types
Messaging to Patients
Visit Specific Questions
Care Team configuration
Workflow Changes
FY18 Q4
FY19 Q1
Development
continues
Unit Testing
Development
Phase 1
Business
Requirements,
Design and
approvals
The Team
➢
➢
Define Use
Cases
Schedule Template and
Visit type updates
Appointment holds
Measure 3rd Next Available
and PatientSite Enrollments
Development
Phase 2
Soft launch &
Assessment
FY19 Q2
Full launch –
Practices to
market PSS to
patients
FY19 Q3
Identify phase II
practices
FY19 Q4
Unit testing
Development
User Acceptance Testing
Configuration
Soft Go Live
Analysis &
Planning
Systems
Patient Self Scheduling Road Map
For more information, contact:
Amy Goldman, Director of Ambulatory Services, agoldma2@bidmc.harvard.edu
�Patient Self Scheduling
Authors: Amy Goldman (Ambulatory Services) and Chris Rodrigues (Office of Improvement & Innovation –i2)
Next Steps
➢ Pilot practices to begin marketing
self scheduling to patients
➢ Measure performance
➢ Refine patient self scheduling
practice readiness checklists
➢ Identify the next phase of
practices to adopt patient self
scheduling
For more information, contact:
Amy Goldman, Director of Ambulatory Services, agoldma2@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.
Amy Goldman (<a href="mailto:agoldma2@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">agoldma2@bidmc.harvard.edu)</a>
Department
Any departments listed on the poster or identified in the spreadsheet.
Ambulatory Services
Office of Improvement and Innovation
Information Systems
Healthcare Associates
Orthopedics
Obstetrics and Gynecology (Needham)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
BID-Needham
Project Team
Amy Goldman
Chris Rodrigues
Sam Skura
Manu Tandon
Stacey Poltack
Geoff O’Hara
Michael Monroe
Jing Ji
Larry Markson
Qiang Wang
Ellen Volpe
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
Patient Self Scheduling
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/42cc81f41c4f115e2c2826d97bfa7a66.pdf?Expires=1712793600&Signature=A0evE8Ron52vHBobdFuIH%7EvJ%7EEeQPOhfgT8duMTL0b%7E1E2Z40A2C8hjP7r4CnjX2Rh4VFcu5XZfQF3mVJwjGkbmw-CTxbvaaj8fEjMLq7Pe-S1JoZsbxH-5fjmDyigg0GuTi1nPTqxJjAKTt0FoidPyFrc8713qdIR%7ERt1nfa6eNihDxKsCLz013W8whO3TrBV4USAvqyfz53LLwOgPr8I0ac%7EqqBr%7EA4f%7EuDYeqeSdnhkwDVbalwK1r54spaGaWYqdBUlqP7BunzAQT%7EquiNYZahX6DrHuMT1PEeMjTX5ACojyZbqeJwko02WDCJHbWi2Uq0CFlsZR%7EmgqXZWURXQ__&Key-Pair-Id=K6UGZS9ZTDSZM
0d64ef95fedb9ff8ff4688b965c95f68
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Text
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Patient Progression Rounds 2.0
Introduction/Problem
The Interventions
BIDMC is continuously striving to improve the quality of care, patient safety and timely access to care
without increasing pressure on staff. With high demand and a fixed number of beds the best approach to
improving care is to reduce unnecessary hospital days. Excess hospital days are not in our patient’s best
interest in terms of either safety or quality, nor in the interest of patients who are unable to access our
services when our inpatient beds are full.
In May 2018, BIDMC partnered with Goldratt Consulting to pilot Patient Progression 2.0 on 12 Reisman, Rosenberg 6,
Rosenberg 7 and Farr 7. A key concept in this approach is the Planned Discharge Date (PDD), which is based entirely on
the expected clinical needs and recovery of the patient. The PDD is used as a marker to distinguish between appropriate
clinical variation and true (non-clinical) disruption and delay. In addition to daily task and progression management, the
approach offers insights into the top constraints causing the greatest disruption and delay across the hospital. As a result of
the pilot the Case Manager role was identified as critical to patient progression Additional staffing has been approved to
address this constraint, including additional RN Case Managers and a Community Resource Specialist to focus on
challenging guardianship issues.
Aim/Goal
If successful this work will result in:
• Well-coordinated plans leading to higher
quality care
• Improved bed availability and reduced length
of stay
• Earlier discharge on the day of discharge
• Improved teamwork
A reduction in length of stay as measured by
the CMS Length of Stay Index
Specific targets:
• Internal Medicine LOS Index 1.05
• Cardiology LOS Index 1.05
• Hem/Onc LOS Index 1.25
The Team
Project Sponsors: Tony Weiss and Marsha Maurer
Project Leader & Manager: Improvement and Innovation (i2) and Goldratt Consulting
Team Members: Representation from Nursing, Social work, case management, IS, i2, APP leadership,
Physician leadership, Hospital Senior leadership
In addition to understanding the need for additional resources, some other key learnings and additional areas of
opportunity were identified by frontline users. These were further explored at a PPR Summit in early January, attended by
90 BIDMC team members.
The three key areas for additional refinement are:
•
Creating a plan of care, both clinically and logistically focused
•
Getting a Day Ahead
•
Enhanced surveillance and management of complex patients
Design teams were then formed to address each topic and create some solutions to implement.
Results/Progress to Date
1. Implementation of the Task Manager Tool on 4 units:
• Farr 7
• 12 Reisman
• Rosenberg 7
• Rosenberg 6
2. Buy in and engagement from multidisciplinary
teams across the organization
3. Identification of highly motivated, skilled resource
nurses to utilize as trainers for the next phases of the
rollout
For more information, contact:
Kristin O’Reilly, RN BSN MPH
koreilly@bidmc.harvard.edu
�Patient Progression Rounds 2.0
Next Steps
Rollout Schedule for Remaining Units:
Each floor will use a redesigned structure for
Patient Progression Rounds, that utilizes a
meeting “chair” to facilitate cohesive
plans of care
In addition, the complex case management team
has undergone some restructuring and now
conducts daily surveillance of potentially
high risk of delay patients. Clinical advisors
then support floor case managers to identify and
remove potential barriers.
Work with IS to streamline the Discharge
Paperwork process
Lessons Learned
In order to create a cohesive plan of care for patients, both the clinical and logistical needs must be
considered. This is only possible when each member of the care team supplies key information from their
subject matter expertise to the discussion.
For more information, contact:
Kristin O’Reilly, RN BSN MPH
koreilly@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.
Kristin O'Reilly (<a href="mailto:koreilly@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">koreilly@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Improvement and Innovation
Nursing
Social Work
Case Management
Information Systems
Goldratt Consulting
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kristin O'Reilly
Tony Weiss
Marsha Maurer
Physician leadership
Hospital Senior leadership
Advanced Practice Provider (APP) Leadership
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
Patient Progression Rounds 2.0
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/367244f8e030684a4f944ac15a3cb5e8.pdf?Expires=1712793600&Signature=GZl%7EoFkkOTzw-ndnE8dZ04qRVj-ehwklPtQ9NPEQaFfykjvFFsXPeHp1jOc5uUGzK0elhZRdS9c-r07Di5T3AlT-QjogFWB8vbSTajRZDuunfTp1dHjAToiRtbfUFj4SfCr5AxZHsOaXlDKMcseh1nJe5wWp08rwNan1sGZ0T6EdFBFO-bINh4LYQO4wNF9aoG4iVbHeWqx-VKkJC0ThLylJdRMm8ZhotwJtzZUbvJI%7EzPSbMdLDuwxGG9ekuBvj1yiaTObsqEkmkk1kgwuh5FV-GKOPsQbjmoNKaqaL2zKo%7EgWzP4qyWKUAAFJ1WFlBIG26vdTezjQdwrVleCDpCQ__&Key-Pair-Id=K6UGZS9ZTDSZM
d33b82ecf3bf582c1fd65effd60fab99
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Text
Medications and Solutions Appropriate for Midline Infusion
Isabel K. Hopper, RN, VA-BC
Monica V. (Golik) Mahoney, PharmD, BCPS-AQ ID, BCIDP
Introduction/Problem
• The Venous Access Team (VAT) has been the resource for medications appropriate for midline use.
This information was not available on the intranet .
• Venous access options for clinicians is now streamlined with this tool that identifies medication
appropriate for peripheral IV (piv), midline and PICC. The medications requested for midline infusion
has been increasing, making it difficult for the VAT to have that information readily available to the
clinical team.
• Medications and solutions can be given via a PIV and/or central line but not through a midline.
• An on-line search will not yield a midline infusate list consistent with BIDMC policy.
• Options for patient vascular access have increased with new technology. Often a patient’s access is
diminished with long hospital stays; this has changed the reason/volume for midline requests.
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The Interventions
•
The venous access team had been working with a list of antibiotics appropriate for home infusion for midlines requested for discharge. The
list became incomplete as the indications for midlines increased ie difficult venous access, frequent lab draws, out-patient contrast bolus
injection.
•
The pharmacy department was consulted when the midline list did not include the specific medication or solution on the midline list.
•
The Vascular Access nurses kept a list of the added medications; the list needed to be validated by the pharmacy department and made
available to BIDMC clinicians and nurses.
•
The vascular access nurse worked closely with pharmacy to develop a tool listing the most common infusates used in the medical center.
•
Creation of a quick reference tool on the portal for all to access when patients have a midline or require selection of appropriate vascular
access device when medications are ordered.
The Results
50
Aim/Goal
45
40
Midline Use Over 5 Years
35
30
• Provide an intranet resource identifying commonly requested medications for midline placement
requests.
• Utilize tool to appropriately identify patients where a midline would help to decrease number of repeat
PIV insertions throughout admission
The Team
➢
➢
➢
➢
➢
Isabel K. Hopper, RN, VA-BC, Venous Access Team
Marie Horgan, RN, Venous Access Team
Andrew Mackler, RN, MHA, CNIV, VA-BC Venous Access Team
Monica V. (Golik) Mahoney, PharmD, BCPS-AQ ID, BCIDP
Blanche Murphy, RN VA-BC, CNIV, BSN, Venous Access Team
25
20
15
10
5
-
west
east
• Increased compliance with less risk of inappropriate medications being infused via midlines.
• Less delay in treatment of patients with ability to quickly validate proper access.
• Increased use of midlines on both campuses (see Chart: Blue=West Campus/Orange=East)
Guidelines for Midline Catheter Medication Administration added to Pharmacy Clinical Guidelines (2019)
after approval by Pharmacy Committee and Nursing Practice Council
For more information, contact:
Isabel K. Hopper, RN VA-BC Venous Access Team 617-632-0952
�Medications and Solutions Appropriate for Midline Infusion
Isabel K. Hopper, RN, VA-BC
Monica V. (Golik) Mahoney, PharmD, BCPS-AQ ID, BCIDP
More Results/Progress to Date
Midline Appropriateness Chart for use by Clinicians (Found on the Portal)
Lessons Learned
50
45
Midline Use Over 5 Year Period
➢ Working with a collaborator from a different department brings depth to a project.
40
35
30
25
20
Next Steps
15
10
➢ When a medication revision is due the Pharmacy Policies & Procedures Manual (Pharmacy)
midline appropriateness will be added.
5
-
west
east
Chart demonstrating increased use of midlines over 5 year period
For more information, contact:
Isabel K. Hopper, RN VA-BC Venous Access Team 617-632-0952
�
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.
Isabel Hopper (<a href="mailto:ihopper@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">ihopper@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Venous Access Team
Pharmacy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Isabel K. Hopper
Marie Horgan
Andrew Mackler
Monica V. (Golik) Mahoney
Blanche Murphy
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
Medications and Solutions Appropriate for Midline Infusion
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/706209f835cdce896280ed56036b9a17.pdf?Expires=1712793600&Signature=dmtDlcTLJy4QQ0iv9g8mW-Rl5BqUDpYwUJT4oB0hrZWVegAGRcqB6%7E-pWoS1LaV1aTdYCQ11fnKM8PfNJ9VtDlsxiHyAQXZ9Wv0NiJ8rv9spEQjIav-oj9zSWMr1G%7EbHn4EFnxIU8PQd9ZLAItukt6tAS8ZHWiG3WgeUG-Wf1deTBtCzvq1CJItpX%7ESqeXiv3Zy6WzqY9jvATvpwlm9eGTFcPm8iSWNvCATdXUCrkGeybGMn0t2O9NJyY-0e%7EX0qm4mFzI6wWZ2wtuf8ztSIE-TDpzwcIXB8AUXsT9jj30O6wBl6-%7EO-nXFvseYf2njkLsJ-gGtjRxRd4kLFXNtr6g__&Key-Pair-Id=K6UGZS9ZTDSZM
0347202f6ec9554d71564ced6c95dac4
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Medical Equipment Service Contract Review Process
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Authors: Ahmad Ateyat, Will Balhorn, Bokang Motlotle, Avinash Konkani, Jeff Smith
The Process
Introduction/Opportunity
BIDMC spends $12.5M annually on medical equipment service contracts. Based on an analysis done by
an outside consultant, Clinical Engineering can potentially identify savings of up to 2-4% annually through
better management of vendors and bringing medical device repairs in house. When the Clinical
Engineering team was formed, one of the founding goals was to capitalize on those potential savings by
reducing service contract costs while maintaining or improving quality of care. Clinical Engineering
developed a standard process to collaborate with Contracting and clinical users to analyze service
contracts and identify opportunities for savings. This process directly relates to most of the IOM
Dimensions of Quality Care because the contracts in place to ensure effective, efficient, and timely,
service for medical equipment so that we can provide high level quality of care and safety.
Goal: To provide the most economical service support while maintaining the appropriate level of
service for medical equipment at BIDMC.
Examples of Opportunities for Savings:
- Beginning to service equipment in house
- Removing contracts for devices that are no longer in use
- Aligning coverage times to clinical operation times
- Removing unnecessary or unused contract options
The Team
Top (left to right): Patrick Thomas, Capital Contract Manager;
Matt Wheeler, Director of Clinical Engineering;
April Palmquist, Contract Specialist;
Jeff Smith, CE Project and Resource Specialist;
Avinash Konkani, Sr. Clinical Engineer;
Bottom (left to right): Ahmad Ateyat, Clinical Engineer;
Bokang Motlotle, Sr. CE Manager
Will Balhorn, Clinical Engineer;
Juan DeJesus, CE Manager (not pictured);
Pam Dicapua, Technology Coordinator (not pictured)
Shellise Solomon, IS Admin Assistant (not pictured)
FY'17-19 Contracts Reviewed vs Savings Identified
$3,000,000
50
45
$2,500,000
40
35
$2,000,000
30
$1,500,000
25
20
$1,000,000
15
10
$500,000
5
$-
Cumulative Savings/Cost avoidance identified
Cumulative Qty of contracts reviewed
Aim/Goal
Results/Progress to Date
0
Cumulative value of contracts reviewed
Cumulative Qty of contracts reviewed
Figure 1: The results show a steady increase in the quantity of the contracts reviewed, cumulative value
of contracts reviewed, and savings realized overall. Substantial savings were realized in late 2017 as
these contracts were owned and managed by Clinical Engineering. Savings have increased at a slower
but still significant rate as Clinical Engineering reviews contracts owned by other departments.
For more information, contact:
Bokang Motlotle, Clinical Engineering
�Medical Equipment Service Contract Review Process
Authors: Ahmad Ateyat, Will Balhorn, Bokang Motlotle, Avinash Konkani, Jeff Smith
Case Study
Opportunity
Results
Five separate service contracts under a single vendor and across Description
multiple departments were expiring at approximately the same
Contract A
time. Clinical Engineering and Contracting identified this as an
Contract B
opportunity to reduce costs by:
Contract C
Contract D
1. Adjusting service contract coverage to better fit user needs.
Contract E
This being the focus of this case study. (Clinical Engineering)
Annual Contract Price
$121,992
$202,174
$85,062
$120,804
$113,506
Total = $643,539
Coverage changes and the consolidation of the five contracts resulted in $128,872 in annual savings (20%
of the previous total cost). Overall, Clinical Engineering identified coverage changes in two areas.
1. Coverage hours - General repair, PM, and emergency coverage hours can be reduced/increased to
better fit clinical needs and realize savings.
2. Estimated utilization coverage - The estimated utilization coverage of equipment can be
decreased/increased to better fit predicted clinical use.
Discovery
Contract A
Contract B
Clinical Engineering collected information from:
• Contracting’s Comply Track Database: Information on contract coverage, pricing, and terms/conditions.
• The Vendor: Five years of service history data and coverage offerings for all equipment.
Contract C
Contract D
• Clinical Users: Interviewed user departments to understand service needs and past satisfaction.
Contract E
Analysis
Contract Coverage Hours: M-F 8am-9pm & Emergency 24/7
Recommended Change: M-F 8am-9pm only
60
50
Cost Impact (+/-)
Emergency 24/7 Coverage
General Coverage: M-F 8am-9pm
PM Coverage: M-F 8am-9pm
Remove 24/7 Emergency Coverage
No Change
No Change
$121,992
$76,412
-$45,580
No Change
General Coverage: M-F 8am-9pm
PM Coverage: M-F 4am-8am, Sat 8am-5pm
Estimated Utilization Count: Unlimited
General Coverage: M-F 8am-5pm
PM Coverage: M-F 8am-5pm
No Change
PM Coverage: M-F 4am-8am
Estimated Utilization Count: 250k
No Change
PM Coverage: M-F 4am-8am
$202,174
$178,720
-$23,454
Estimated Utilization Count: 250k
No Change
$85,062
$85,053
-$9
Emergency 24/7 Coverage
General Coverage: M-F 8am-9pm
PM Coverage: M-F 4am-8am, Sat 8am-5pm
Estimated Utilization Count: 275k
General Coverage: M-F 8am-9pm
Remove 24/7 Emergency Coverage
No Change
PM Coverage: M-F 4am-8am
Estimated Utilization Count: 100k
General Coverage: M-F 8am-5pm
$120,804
$90,004
-$30,800
PM Coverage: M-Sat 8am-9pm
PM Coverage: M-Sat 8am-5pm
$113,506
$84,477
-$29,029
$643,539
$514,666
-$128,872
Table 2: The contract coverage changes and the savings associated.
Conclusion
30
20
10
0
10/2015 to 10/2016
10/2016 to 10/2017
10/2017 to 10/2018
Clinical Engineering and Contracting worked closely together with user departments to realize $128,872 in
total annual savings across these five contracts.
• Clinical Engineering made recommendations to users on more efficient coverage options.
• Contracting consolidated these contracts and negotiated higher discounts.
Year
Contract D: Actual Equipment Utilization
350,000
Utilization Coverage(Count)
Contract Utilization Count Coverage Tier: 275K
250,000
200,000
150,000
Recommended Change: M-F 8am-9pm only
100,000
50,000
Figure 2: Graphs on the right compare one contract’s
service data to current coverage.
New Annual Cost
40
300,000
Clinical Engineering created coverage recommendations
and reviewed these with user department leadership and
Contracting.
Previous Annual Cost
70
Labor Hours
Clinical Engineering analyzed the information above while
targeting potential savings opportunities. This included:
• Validating inventories.
• Projecting future service costs and needs.
• Matching service coverage hours to operational hours.
• Matching utilization coverage to department needs.
• Reviewing costs incurred outside of coverage.
Contract D: Actual Corrective Maintenance Labor Hours
Coverage Changes
Totals
Table 1: Annual prices for the five
contracts included in this analysis.
Current Coverage
Estimated Utilization Count: 150k
2. Consolidating the five contracts under a single Master
Agreement. (Contracting)
Description
0
2015
2016
2017
Year
2018
2019
For more information, contact:
Bokang Motlotle, Clinical Engineering
�Medical Equipment Service Contract Review Process
Authors: Ahmad Ateyat, Will Balhorn, Bokang Motlotle, Avinash Konkani, Jeff Smith
Lessons Learned
➢ Challenging to keep equipment inventories and contracting information databases up to date.
➢ Assistance was needed to submit initial RFI documentation to vendor/service provider
➢ Receiving quality RFI responses on time can be challenging
➢ Importance of having an analysis tool and standardizing the contract analysis process.
➢ Identifying opportunities where in-house maintenance will be more cost effective and this will reduce the downtime.
Next Steps
➢ Creating long-term business cases to bring service contracts in house.
➢ Data integrity through inventory verification and tying contracts to asset management tool.
➢ Continue bi-weekly review meeting with Contracting Department and update our progress of contract analysis.
➢ Requested a resource to assist with sending and receiving the RFI documents.
➢ Need to build and maintain the professional relationship with the manufacturers/vendors.
For more information, contact:
Bokang Motlotle, Clinical Engineering
�FY'17-19 Contracts Reviewed vs Savings Identified
45
$2,500,000
40
35
$2,000,000
30
25
$1,500,000
20
$1,000,000
15
10
$500,000
5
0
$-
Cumulative Savings/Cost avoidance identified
Back
Cumulative Quantity of contracts reviewed
50
$3,000,000
Cumulative value of contracts reviewed
Cumulative Qty of contracts reviewed
For more information, contact:
Bokang Motlotle, Clinical Engineering
�Contract D: Actual Corrective Maintenance Labor Hours
70
Contract Coverage Hours: M-F 8am-9pm & Emergency 24/7
Labor Hours
60
Recommended Change: M-F 8am-9pm only
50
40
30
20
10
0
10/2015 to 10/2016
10/2016 to 10/2017
Year
10/2017 to 10/2018
Contract D: Actual Equipment Utilization
350,000
Contract Utilization Count Coverage Tier: 275K
Utilization Coverage (Count)
300,000
Back
250,000
200,000
150,000
Recommended Change: M-F 8am-9pm only
100,000
50,000
0
2015
2016
2017
Year
2018
2019
For more information, contact:
Bokang Motlotle, Clinical Engineering
�Description
Current Coverage
Coverage Changes
Previous Annual Cost
New Annual Cost
Cost Impact (+/-)
Contract A
Emergency 24/7 Coverage
General Coverage: M-F 8am-9pm
PM Coverage: M-F 8am-9pm
Remove 24/7 Emergency Coverage
No Change
No Change
$121,992
$76,412
-$45,580
Estimated Utilization Count: 150k
No Change
General Coverage: M-F 8am-9pm
PM Coverage: M-F 4am-8am, Sat 8am-5pm
Estimated Utilization Count: Unlimited
General Coverage: M-F 8am-5pm
PM Coverage: M-F 8am-5pm
No Change
PM Coverage: M-F 4am-8am
Estimated Utilization Count: 250k
No Change
PM Coverage: M-F 4am-8am
$202,174
$178,720
-$23,454
$85,062
$85,053
-$9
Estimated Utilization Count: 250k
No Change
Emergency 24/7 Coverage
General Coverage: M-F 8am-9pm
PM Coverage: M-F 4am-8am, Sat 8am-5pm
Estimated Utilization Count: 275k
General Coverage: M-F 8am-9pm
Remove 24/7 Emergency Coverage
No Change
PM Coverage: M-F 4am-8am
Estimated Utilization Count: 100k
General Coverage: M-F 8am-5pm
$120,804
$90,004
-$30,800
PM Coverage: M-Sat 8am-9pm
PM Coverage: M-Sat 8am-5pm
$113,506
$84,477
-$29,029
Totals
$643,539
$514,666
-$128,872
Contract B
Contract C
Contract D
Contract E
Back
For more information, contact:
Bokang Motlotle, Clinical Engineering
�
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.
Bokang Motlotle (<a href="mailto:bmotlotl@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">bmotlotl@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Clinical Engineering
Contracting (Supply Chain)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Patrick Thomas
Matt Wheeler
April Palmquist
Jeff Smith
Avinash Konkani
Ahmad Ateyat
Bokang Motlotle
Will Balhorn
Juan DeJesus
Pam Dicapua
Shellise Solomon
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
Medical Equipment Service Contract Review Process
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d6fbe66e13a296fbf4bb14951cd3a254.pdf?Expires=1712793600&Signature=plOAtb2bS9vKoWJhzDXQtHrLI59SwxYPOnhrleV5IHSN7xtyH6Op1NO7kxf3Zko7xfjKXRhXPkvC0Z4V2xwfLN8kFwa4rrGULBTBoJfd4wUjcaWG0KYnxIl40rkZD525Az1FByadDMHoWKXmiekuFYhEELnBrBjNp3yeUnFGEaLiWUizvE8w-6sBxmssJyRzIXrv43-k6gz5GPGH%7ECM4iksC5xG-qJLSD%7EksO%7EqGbrXJiPq-W33oHNBGIgqI1J1pOhpoxV4CTaS0ZsKbwZHGtUFOkEqiIaem50M3x8bJAiIrcZcW7P9pHtMdod7SpSxIaspnwsQQykfZs8L1AXul7g__&Key-Pair-Id=K6UGZS9ZTDSZM
b6678dedae52550731fc7ce712026b30
PDF Text
Text
Managing ICU Capacity on the East Campus
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Susan Holland, EdD, MSN, RN, Nursing Director MICU/SICU East (Finard ICU)
Introduction/Problem
There is one adult ICU on the East Campus with 12 beds. We always should have at least one bed
available to admit a patient following a Code Blue and/or a “crash” from a med/surg unit, OB patient,
etc…
There has been an increase in frequency of times that the census has reached 12 patients , which results
in the PACU accepting a critically ill patient and/or the delay of transfer of a critically ill patient to the ICU.
ICU Capacity Alert Pilot- East Campus
Pilot:
Where do the MICU/SICU East (Finard ICU) patients come from?
Aim/Goal
To implement a process that is proactive in ensuring that there is always at least 1 “crash” bed available
in the MICU/SICU East , Finard ICU (FICU)
The Team
➢
➢
➢
➢
➢
➢
➢
➢
➢
Michael Cocchi, MD, Director of Critical Care Quality
Susan Dorion, BSN, RN, Nursing Director, PACUs
Mary Ellis, BSN, RN, Assistant Nursing Director East Campus PACU
Jane Foley, DNP, RN, Associate Chief Nurse, Critical Care
Susan Holland, EdD, MSN, RN, Nursing Director MICU/SICU East (Finard ICU)
Doug Hsu, MD, Director of MICU/SICU East (Finard ICU)
Sandra Sanchez, MSN, Director of the Transfer Center
Woodrow Weiss, MD, Chief of Pulmonary Critical Care and Sleep Medicine
Phyllis West, DNP, RN, Associate Chief Nurse, East Campus
Results/Progress to Date
Algorithm implemented as a reference for the Admission Facilitators, FICU Resource Nurses and FICU
Attending MDs.
When certain criteria is met, the Admission Facilitators, Medical Intensivist, Surgical Intensivist,
Healthcare Quality, ICU Nursing Directors, Associate Chief Nurses, PACU and Transfer Center Director
participate in conference calls for situational awareness, identification of call outs/ or facilitate throughput
and allocate resources to provide the best care to our patients. (continued on next page)
For more information, contact:
Susan Holland, EdD, MSN, RN, sholland@bidmc.harvard.edu
�Managing ICU Capacity on the West Campus
Susan Holland, EdD, MSN, RN, Nursing Director MICU/SICU East (FICU)
Problem
There are 65 ICU Beds on the West Campus. We always should have at least one bed available to admit
a patient following a Code Blue and/or a “crash” from a med/surg unit AND one Trauma bed available in
the TSICU.
There has been an increase in occasions when it is difficult to identify an ICU “crash” bed.
ICU Capacity Alert Pilot- West Campus
Pilot
Aim/Goal
To implement a proactive process to ensure that there is always at least one “crash” bed and one trauma
bed available on the West Campus
Building on the East Campus ICU Alert Pilot, a larger group met to discuss expanding the pilot to include
criteria to include the West Campus ICUs .
The Team
Kirsten Boyd, DNP, RN, Associate Chief Nurse, Ambulatory and Emergency Services & Transfer Center
Pam Browell, MSN, RN, Nursing Director, CCU and Farr 3
Elena Canacari, MSN, RN, Associate Chief Nurse, Perioperative Services
Michael Cocchi, MD, Director of Critical Care Quality
Susan Dorion, BSN, RN, Nursing Director, PACUs
Mary Ellis, BSN, RN, Assistant Nursing Director East Campus PACUs
Jane Foley, DNP, RN, Associate Chief Nurse, Critical Care
Mary Grzybinski, MSN, RN, Assistant Nursing Director West Campus PACU
Margaret Hayes, MD, Director of MICU B, West
Susan Holland, EdD, MSN, RN, Nursing Director MICU/SICU East (FICU)
Doug Hsu, MD, Director of MICU/SICU East (FICU)
Suzanne Joyner, MSN, RN, Nursing Director, SICU, Neuro ICU and NIMU
Kristin Russell, BSN, RN, Nursing Director, MICUs and ICU Float Pool
Sandra Sanchez, MSN, RN, Director of the Transfer Center
Margie Serrano, MSN, RN, Nursing Director , CVICU and Farr 8
Alison Small, MSN, RN, Nursing Director, TSICU and Rosenberg 6
Woodrow Weiss, MD, Chief of Pulmonary Critical Care and Sleep Medicine
Phyllis West, DNP, RN, Associate Chief Nurse, East Campus
Lessons Learned
➢ Criteria for initiating a conference call adjusted since the pilot began and will continue to be reviewed.
➢ Even when patients who are called out of the ICU are assigned beds, there can be barriers for this
process to occur in a timely manner
Next Steps
➢ ICUs will track call-outs and identify any barriers encountered in the process
➢ ICU Capacity Workgroup will meet to review data recorded by the ICUs and any data available from
Teletracking
➢ ICU Capacity Workgroup will continue to meet to identify any areas for improvement for the algorithm
For more information, contact:
Susan Holland, EdD, MSN, RN, sholland@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.
Susan Holland (<a href="mailto:sholland@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">sholland@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Critical Care Quality
Pulmonary Critical Care and Sleep Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kirsten Boyd
Pam Browell
Elena Canacari
Michael Cocchi
Susan Dorion
Mary Ellis
Jane Foley
Mary Grzybinski
Margaret Hayes
Susan Holland
Doug Hsu
Suzanne Joyner
Kristin Russell
Sandra Sanchez
Margie Serrano
Alison Small
Woodrow Weiss
Phyllis West
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
Managing ICU Capacity on the East Campus / West Campus
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/a943dae26d60194955d7e12b6f1fb263.pdf?Expires=1712793600&Signature=NOJDTPe6Mu7jeaUeuPFrGU0-nxUY1GEoyeNetP3PhZL0BshfJE47UYBrQXKBuRX6P4B9AitvuZR9pqnXR%7E%7EwNOtA21kbfVWkj787yuAkiEij0IkIIMNA0qQbKHhkE5joKjka%7EhRyZFC0w4kBNkuH-YkUDLkwVTDIv%7ERRvDsV6Af9dWSzpyyRFH9SAoaf4uvGkBYVQb0H7q5tBpFfvZKkXjYaWo2weydFD15aH7jGzXS-SZIcKKBnz2858A9FUKNLgSUESa0hTzAWOPmDz6K-UDVNEEtn%7EHtimEWsJFT7K1EE8oPY10jtU8U9d4LNCdkp6XEAA8JigCou1WHojHEEWw__&Key-Pair-Id=K6UGZS9ZTDSZM
052042efd1b503d4c29a2efac4ea59a9
PDF Text
Text
Inpatient Stroke Stat Process Improvement
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Suzanne Joyner, MSN, RN Nursing Director Neuroscience and Surgical Critical Care
Introduction/Problem
The Interventions
Inpatient Stroke STAT policy CP-61 was created in March 2017, in review of cases where t-PA was
indicated areas for improvement were identified; specifically around communication, IV access, bed
placement and safe administration.
2018:
2019:
198 total activations (139 West / 59 East)
38 activations (27 West / 11 East) thru 3/14/19
3 t-PA administrations
2 t-PA administrations
No Thrombectomy cases
3 Thrombectomy cases
Aim/Goal
Prevent patient harm due to a delay in t-PA administration (time is brain) and / or an error in the
administration of the t-PA which is a high risk, low frequency drug that requires a safe and protocolled
approach for administration. The process must be functional on both East and West campuses and
applicable in all inpatient practice areas.
Addition of the following to the Inpatient Stroke Stat Activation Page: Admissions Facilitator, West
Campus t-PA RN, Finard ICU RN (via the code STEMI pager), Venous Access team East and West
Campus, Jillian Tellier CSC Program Coordinator
Creation of a West Campus t-PA RN Pager: Identifies one RN responsible for the administration of tPA on the West Campus 24/7. East Campus all inpatient stroke stat patients requiring t-PA would go
to Finard ICU, RN notified via code STEMI pager
Creation of a t-PA Action Group Virtual Page and Process: Admissions Facilitator, West t-PA RN,
Finard ICU RN , Neurology Pharmacist, Neurology West and East Consult, Stroke Neurology Fellow
Purpose: Direct communication to key providers of t-PA order, immediate bed assignment,
expeditious pharmacy order approval, and activation of RN to assist with t-PA administration.
Process Improvements went live March 4, 2019
NMED and RN Badge Cards
The Team
Natalya Asipenko, PharmD, BCPS, BCCCP, Clinical Pharmacist IV Neurocritical Care
Joanna Anderson, BSN, RN, CNRN, CCRN Unit Based Educator NSICU / SICU
Jacqueline Bentick, RN, Clinical Advisor Neuroscience and Surgical Critical Care
Michael J. Carr MSN, ACNP-BC, GNP-BC, Clinical Manager Division of Neurosurgery
Michael Cocchi, MD, Director Critical Care Quality
Maureen Cunniffe, MSN, RN, Manager Staffing Office and Venous Access Team
Jacqueline FitzGerald, RN, MICU/SICU East (Finard ICU)
Mary Grzybinski, MSN, RN, Assistant Nursing Director PACU West
Lisa Hird, MSN, RN, Nursing Director Interventional Cardiology
Susan Holland, EdD, MSN, RN, Nursing Director MICU/SICU East (Finard ICU)
Suzanne Joyner, MSN, RN, Nursing Director Neuroscience and Surgical Critical Care
Vasileios-Arsenios Lioutas, MD, Department of Neurology, Division of Cerebrovascular Diseases
Sandra Sanchez, MSN, RN, Nursing Director Bed Management and Transfer Center
Lauren Sullivan, BSN, RN, CNRN, SCRN Unit Based Educator Neuroscience Intermediate Care Unit
Jillian Tellier, BSN, RN, Clinical Program Coordinator Comprehensive Stroke
Next Steps
Compare pre / post intervention data showing time TPA ordered to time TPA administered
Case review to continue to look for ways to improve the process
Update NMED badge cards and Neurology team members once action group page is automated
through POE
For more information, contact:
Suzanne Joyner, MSN, RN sjoyner@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.
Suzanne Joyner (<a href="mailto:sjoyner@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">sjoyner@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Neurology
Neurosurgery
Nursing
Venous Access Team
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Natalya Asipenko
Joanna Anderson
Jacqueline Bentick
Michael J. Carr
Michael Cocchi
Maureen Cunniffe
Jacqueline FitzGerald
Mary Grzybinski
Lisa Hird
Susan Holland
Suzanne Joyner
Vasileios-Arsenios Lioutas
Sandra Sanchez
Lauren Sullivan
Jillian Tellier
Dublin Core
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Title
A name given to the resource
Inpatient Stroke Stat Process Improvement
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/6e3f400370b56e20938a66e6df79b5c6.pdf?Expires=1712793600&Signature=eVeMY-iMp%7E8Exb3J-D9ZWImRaz8d3flxRvRhtplmKz6R%7Em2xHXHsY8UoNpog2eWeTRMvUSZJgIcPD4JafbIszhCGx9zv1l2-lzZALDGlF74p0Bp%7E32cqkIZzv-ny3MY8qeKa%7EquzXEZYP-Wk0KwkE2OCm1WSL261arDer9Szj4UrqZpgAS%7E52jhH4oqIhulbpEsxRQ36g85mBwFQjGtubJY3JRSL8hGTwlrah3FRr5BZ02umPyt3TS1u2fqYpwlFGYVhznLtPZWEpRuA3dh9RFWKG6Zc6T3G0f-o35Le1wnaFCBfBi8n8ASo5sWKsQeTTNGbGoGOx3nwL5mRLQGm2w__&Key-Pair-Id=K6UGZS9ZTDSZM
4b0e672492f311122884655cb95cf751
PDF Text
Text
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Increasing OR Throughput
Steps Taken
Next Steps
Change “Close” time event to “Closed” - it was previously unclear to staff what event
we are trying to capture, this led to confusion for the floor managers. This new
timestamp is more reliable and allows floor managers to make decisions based on
when it is triggered.
Send automated page to anesthesia and surgical staff when pre-procedure verification
by nurse, surgeon sign-off, and “room ready” are triggered. Staff is now immediately
aware when the patients is ready to be moved from the holding area to the OR.
Replace “all required equipment and implants are available in room” checkbox with
“Room Ready” button. Add visualization when “Room Ready” is triggered. It is now
immediately clear to floor managers if room set-up is causing delays.
Install new monitors in OR for dashboard and assignment view (Feldberg, Shapiro,
Rosenberg). Allows floor managers to view all rooms at the same time (no need to wait
45 seconds for screen to flip).
Create “Initiating Closure” time event. New time-events will give floor managers a
better sense of when cases are going to end.
Alert relevant staff members when “Closed” time event is triggered (attendants on
East and West campus). Today attendants are supposed to be called at “Closed,”
but there is usually a delay because staff tends to by busy at this time. Automation of
this process will insure that attendants are called as soon as at patients is closed and
will allow staff to focus on patients.
Results
Goal
The goal of this project was to Increase OR Throughput by improving patient flow and
empowering floor managers.
The Team
Jane Cody
Deborah Tassone
Kevin Afonso
Michelle Ucci
Kelly Gamboa
Mary Cedorchuk
Cullen Jacson
Eswar Sundar
Adam Nahari
Sarah Moravick
Larry Markson
Elena Canacari
Consistent reduction of over 1 min in wait between clean room to start set-up time and in
complete set-up to wheels in time, since changes were implemented.
For more information, contact:
Adam Nahari, Office for Improvement and Innovation, anahari@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.
Adam Nahari (<a href="mailto:anahari@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">anahari@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Office of Improvement and Innovation
Anesthesia
Nursing
Surgery
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jane Cody
Deborah Tassone
Kevin Afonso
Michelle Ucci
Kelly Gamboa
Mary Cedorchuk
Cullen Jacson
Eswar Sundar
Adam Nahari
Sarah Moravick
Larry Markson
Elena Canacari
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
Increasing OR Throughput
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Timeliness