1
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cd59f57bdfdfebe3f215bc4549b0e620
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Beth Israel Deaconess Hospital-Milton
Achieve Leading Practice Designation in Operating Room Turnover Times
The Problem
The Results/Progress to Date
In May 2013, an onsite audit was performed by an external vendor specific to
peri-operative services at Beth Israel Deaconess Hospital-Milton. The objective
of this internal audit was to review the hospital’s Operating Room (OR)
scheduling process and staffing, as well as to evaluate opportunities to enhance
OR efficiency and utilization. The measurement period for this audit was from
April 2012 through March 2013.
LOWER IS
BETTER
Audit
completed
Interventions
implemented
From this audit, one of the opportunities for improvement identified related to
the timeliness of OR turnover between operative cases. The established industry
standard for this process is <25 minutes, however the actual time for BID-Milton
was 43 minutes.
G
O
L
Aim/Goal
Reduce OR Room turnover time between surgical cases to achieve leading
practice goals, i.e., 20-25 minutes for inpatient surgeries.
The Team
OR Staff
Environmental Services
Department of Anesthesia
Department of Surgery
Lessons Learned
The Interventions (Select Actions Taken)
Reviewed AORN recommended practices on room cleaning to expedite
room turnover and terminal cleaning of ORs – no opportunities identified
Considered eliminating the OR RN in the patient transport process from
the PACU – could not be implemented
Allowed for patient early entry into the operating room (prior to completion
of room setup) to maximize effects of parallel processing (LEAN – optimize
‘External Setup’)
Led by a new Interim Director of Surgical Services in November of 2013,
performance expectations set with staff as a means to modify historical
behavior/practices
Staff held accountable for performance – times tracked and shared with
staff – overall, by OR room and by responsible individual staff member
OR Manager performed daily rounds
Worked collaboratively with Anesthesia at start-of-day “flow” meeting
Engagement and education of CSR staff on their role in OR flow
Decreased OR room turnover times allowed for daily “add-on” cases to be scheduled
during normal OR hours – i.e., decreased incidence of OR day being extended beyond
normal close time (decreased use of overtime)
Accountability and data transparency drove changes required to improve OR
utilization and efficiency
Next Steps/What Should Happen Next
Celebrate leading practice achievement in room turnover time with staff
Continue with interventions and monitor ongoing success relative to goals
Build on this success through other in-progress PI initiatives to address additional
opportunities identified as part of audit, e.g., first case start times, block booking,
OR room utilization etc.
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Operating Room Staff
Medical Staff
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Operating Room Staff
Environmental Services
Department of Anesthesia
Department of Surgery
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Title
A name given to the resource
Achieve Leading Practice Designation in Operating Room Turnover Times
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
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a1167cd06175d98dbb5f4c9cbba4ae95
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Re-designing the Division of General Surgery’s General Appointment Line
The Problem
The Results/Progress to Date
The General Surgery Line (GSL), a resource intended to streamline the appointment
scheduling process for referring provider and non-directed referral patients, was not
meeting the intended need. Schedulers could not schedule appointment without
physician office approval, causing delays and frustration. Many of the patients
scheduled often missed appointments or arrived at the wrong time. Surgeons
questioned the appropriateness of the referrals and referring provider offices were
often frustrated with the length of time it took to obtain an appointment.
The creation of the GSL and Doc-to-Doc appointment types allowed us to track and
report results. In FY13 a total of 417 new patients entered the Division via GSL
(kept appointments). Of those patient, 45 outpatient procedures were performed
(11%), and 151 OR cases completed (41%).
Aim/Goal
To improve access and communication within the Division of General Surgery,
thereby, improving customer service.
The Team
Mark P. Callery, MD- Division Chief, General Surgery; Yaramalies Davila,
Administrative Manager, Divisions of Acute Care Surgery and General Surgery;
Ailicet Montilla, Program Administrator, Division of General Surgery; Jazmin Vega,
Administrative Assistant, Division of General Surgery; all Surgeons and administrative
staff within the Division of General Surgery.
The Interventions
Creation of The GSL Guidelines and Protocol, which outlined
expectations and provided guidance on dealing with different situations
and clinical resources.
Cross training administrative staff and establishing a coverage plan for
unexpected and expected staffing shortages.
Creation of appointment intake sheet for internal communication.
CCC template review and standardization.
Reserving slots for open booking.
Surgeon support and engagement.
Creation of GSL specific reports to track DNK, patient distribution,
booking diagnosis, and surgical and procedural intervention, allowing us
to track resource volume and effectiveness.
Lessons Learned
General Surgery clinics are held on the East and West campus along with
Chelsea, Lexington, Milton and Needham; given our scope, physician support and
engagement was very important to our success.
Training and physician engagement are on going. Administrative and Faculty
meetings, along with combined bi-annual meetings are forums by which we
communicate and re-enforce our commitment to access and service excellence.
Next Steps/What Should Happen Next:
Work towards open-access booking across more sites.
For More Information Contact
Yaramalies Davila, Administrative Manager
Divisions of Acute Care and General Surgery
ydavila@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Yaramalies Davila (<a href="mailto:ydavila@bidmc.harvard.edu">ydavila@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
General Surgery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Mark P. Callery
Yaramalies Davila
Ailicet Montilla
Jazmin Vega
Dublin Core
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Title
A name given to the resource
Re-designing the Division of General Surgery’s General Appointment Line
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
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35b0a6360220f6881d24352b05791bad
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Text
BIDMC: BECOMING A NETWORK
by Integrating the Supply Chain at Affiliate Hospitals
The Problem
BIDMC is a fast growing network of hospitals. To achieve the benefits of an affiliation,
the supply chain at the Boston campus must work closely with the affiliates to align
products, purchases and processes. Some of the problems encountered were:
Different material management information systems not permitting access to
item file information which made standardization opportunities difficult.
Various processes for approving new products and initiating saving initiatives.
Different supply distributors for medical surgical supplies.
Lack of standard supply chain communication processes between facilities.
The Goal
The goal was to streamline communication and processes throughout the supply
chain network to include contracting/purchasing, materials management, the Group
Purchasing Organization (GPO) and Clinical Quality Value Analysis (CQVA).
The Interventions
The “Team” traveled to Needham and Milton hospitals monthly having
meetings to include key leadership within supply chain and administration.
Purchasing and contracting personnel were incorporated in weekly roundtable
contracting meetings in Boston.
Needham converted to a “Just In Time” distribution model with our Med Surg
Distributor with close oversight and assistance from Bill Pyne
Milton also converted to the same Med Surg Distributor to provide continuity at
all three campuses.
Novation reviewed potential contracts, conversion opportunities, monitored
pricing, and tracked results.
CQVA is an embedded process at each facilities product committees, to guide
initiatives and monitor savings.
The Results and Progress to Date
The Team
Bob Cherry, SVP Support Services
Steve Cashton, Director of Contracting and Purchasing
Shane Egan, Director of Finance for Support Services
Chip McIntosh, Director of CQVA
Nancy Miller, Sales Executive On-site for VHA/Novation GPO
Bill Pyne, Director of Materials Mgmt.
In FY’13, $643,402 in supply costs were attained for Needham and Milton
hospitals. BIDMC is on track to save $1.6 million in FY’14 for all three of our
affiliates.
Needham and Milton experienced a successful implementation of a “Just In
Time” (JIT) program for delivery of medical surgical supplies reducing
warehouse space.
Purchasing silos were reduced as each facility now has access to the same
contracts and pricing.
Collaborative relationships were built to foster trust and further engage in
streamlining processes which further integrated all three facilities.
The Lessons Learned
Executive support at each facility is paramount.
Community hospitals have unique needs, they are quicker to redesign
processes, but they may not have the resources to make those changes
happen without support from the Boston campus.
Next Steps
Review a process to integrate the affiliates master item file and purchasing
history with the Boston campus
Implement a process to track initiative conversions at affiliate sites.
Review the supply chain and purchasing structure with affiliates to be
consistent with Boston campus leadership
Continue same process with new affiliates
Request further standardization and price reduction from vendors as our
physicians from BIDMC practice at our affiliates
Focus on moving outsourced purchased services at affiliates to an in-sourced
BIDMC model.
For more information, contact:
Chip McIntosh, NP, PhD
Director Clinical Quality Value Analysis (CQVA)
amcintos@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.
Chip McIntosh (<a href="mailto:amcintos@bidmc.harvard.edu">amcintos@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Support Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Bob Cherry
Steve Cashton
Shane Egan
Chip McIntosh
Nancy Miller
Bill Pyne
Dublin Core
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Title
A name given to the resource
BIDMC : BECOMING A NETWORK by Integrating the Supply Chain at Affiliate Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/f7fa6013dd925a3eb857ff8d6401edd1.pdf?Expires=1712793600&Signature=peeqdGETxLXNbnrIL4LUBxBP2CJcTbbFZj3UIabPcVrlNaV3PnSUcDJDVlMV7PvKMzhnhhe%7EUD-rLxJZQpzr9bTzf2HC%7EZ4-wrlcKq1LRf5vg6XPpu0A3fhuBxJONXeRT5UxdGHadb-9z9mC8PtJojFmlwTFsNwX4zXKBMJGod37IeGbqfHPQAY%7EITU1M9DZNTXDlXifP7cAjs-KGGbJLErH2VJVRkh1MD3gk%7Ewva6uQB0FZA1qY1t5q7SAyQkWUGmR6KeXr0iODEGCmAsDTD0i5iAjeUd628doA3t0wzIm2a-%7E60Ie0sg7kQ%7EpY-4YP0Uiw-DH9SfrL6Jb1LEu29g__&Key-Pair-Id=K6UGZS9ZTDSZM
3f296ae6b934e28b4d97c5f30f2b6780
PDF Text
Text
Effective Staff Communication in Patient Transitions from ED to OR
The Problem
The Results/Progress to Date
Transitions in care from one site or caregiving team to another can
increase risk for errors and delays if an effective and standardized
communication process is not ensured.
Current system allows for transfer from ED to OR of both critically ill and
stable patients from one physician to another without sign‐out.
Flagging non‐critical patients in the ED Dashboard as ‘on‐call’ to improve
sign‐out for ED nurse and ED resident, facilitate more timely patient
preparation for ED to OR transfer
Holding Area/PACU West started to utilize ED dashboard for all non‐critical
patients on‐call from ED to OR, to decrease work duplication
Anesthesia residents have access to ED Dashboard and can be trained to
routinely review content for both critical and non‐critical patients
Aim/Goal
Anesthesia attending receives pertinent sign out re: critical cases
Improve communication when stable patients are put on‐call to OR
Reduce # of unexpected transports from ED
Increase # of timely reports received in Holding from ED
Process Flow – Stable Patients
Pt Arrives ED;
May need
same‐day
Surgery
Surgical
Consult
Request via ED
Dashboard
Consult &
Decision for
Add‐on case
Data Gathering
Waiting Period
Data Gathering
Start
Waiting Period
The Team
Add‐on Case
Booking
Requested by
Surgery
Resident
Transport
Booked
Brian Ferla, MD, Anesthesia, Co‐Leader
Michael Cahalane, MD, Surgery, Co‐Leader
Anne Bonner, RN, Nursing, Co‐Leader
Carrie Tibbles, MD, Emergency Medicine
Gabriel Kleinman, MD, Anesthesia Resident
Deborah Reynolds, MD, Anesthesia
Andreas Pleumann, MBA, Facilitator
Erin Springer, MD, Surgery Resident
Shelley Calder, RN, MSN, ED Clinical Nurse Specialist
Christopher Awtrey, MD, OB‐Gyn, Sponsor
Patient Transfer
Prep work
ED Nurse
OR Puts
Patient On‐call
Report
Holding Area
Nurse
Room Prep
Patient in
Holding
Patient moved
to OR
Data Gathering
Waiting Period
End
5
Lessons Learned
Complex process cutting across multiple departments
Proliferation of IT systems (ED Dashboard, AIMS, PIMS)
Communications across departments inconsistent and ad‐hoc
Redundant data gathering by Pre‐Op nurses and Anesthesia Resident
The Interventions
Next Steps/What Should Happen Next
Utilize existing technology systems to communicate status change more
quickly
Create virtual pager to inform Anesthesia about critical patients
Reinforce efficient usage/leverage of existing patient data
Fully implement virtual pager solution to inform Anesthesia Floor
Manager/Night Attending about critical patients
Follow‐up if changes have been sustained
For more information, contact:
Gabe Kleinman, MD, BIDMC, Department of Anesthesia, Critical
Care, and Pain Medicine, gkleinma@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.
Gabe Kleinman (<a href="mailto:gkleinma@bidmc.harvard.edu">gkleinma@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Surgery
Nursing
Emergency Department
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Brian Ferla<br />Michael Cahalane<br />Anne Bonner<br />Carrie Tibbles<br />Gabriel Kleinman<br />Deborah Reynolds<br />Andreas Pleumann<br />Erin Springer<br />Shelley Calde<br />Christopher Awtrey
Dublin Core
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Title
A name given to the resource
Effective Staff Communication in Patient Transitions from ED to OR
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4847c77067f67575858b65657bddf98a.pdf?Expires=1712793600&Signature=kEHFbUxbZLKhFLUjghZXeNYhzJZXhCcFXp2hv70m5DtCgIH-6%7EpVlyKTZkkoeH5GRd70tL54bJi0j80-8rsL5ZdLsuHB-VUcYOnsy8pN2RytyqE5RQePsSgoudelK0NN6JfP-k3Wh9e1FYM-vU23VJKBy0ogtYMg1Yx-JzhdtcPkpgRZczq1dtFm6AW3M5xvnhgr%7Ej%7EiYFgK-jgTBp1alBGByJddvhiJ1gZGJ9i2lxfSVKgvIiShfIx0Q2BzpKnu-wCtF5yEQODyOCt6KEcJwa-YUM5FburWe-yss2ln%7E0mgh5QSgcPij4YgkTnAsLh7mWhGdq6OesOUxyGZnClvng__&Key-Pair-Id=K6UGZS9ZTDSZM
60db7bd2bc1ff66bd18e5a863ff95474
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Text
Expansion of Outpatient Nutrition Services
The Problem
The Results/Progress to Date
Medical Nutrition Therapy (MNT) provided by Registered Dietitians (RDs) has been
demonstrated to result in improved health outcomes for patients with a variety of
medical conditions (including diabetes, pregnancy, CKD, obesity, and more). MNT
also reduces overall healthcare costs- current research shows that for every $1
invested in lifestyle-based MNT provided by an RD, a return of $14.58 was shown.
The BIDN Outpatient Nutrition Clinic had 12 RD hours per week in the beginning of
2013, with an appointment wait time of several weeks and sometimes months. BIDN
and the Food and Nutrition department identified an opportunity to expand the OP
Clinic hours to better meet patient needs, reduce overall healthcare costs, and
increase revenue for the outpatient department as well as spend more time marketing
and in the community.
Aim/Goal
Two central goals existed for the expansion of the OP Nutrition Clinic. One was to
increase the availability of outpatient nutrition appointments to 40 hours/week with
clinic hours flexible and based on patient request. The second was to observe an
increase in number of patients seen and total revenue, measured on a monthly basis.
Lessons Learned
The Team
Shana Sporman MS RD Sodexo
Food Service
Jeanine LeDoux MS RD Sodexo
Food Service
Michele Morgan RD LDN- Sodexo
Food Service
Katie Laycock – Sodexo Food
Service
Helen Chan – Finance, BIDN
Chip McIntosh – Support Services
CQPA Director
The Interventions
BIDN OP Nutrition Clinic Estimated Monthly Revenues, based on weekly Clinic hours.
Note the continued increase in revenue as OP Clinic hours were increased, with a small
dip when the Clinic fax number was changed in November. Communication by fax
provides a large percentage of patient referrals from BI-affiliated physicians.
In June 2013, hired .8FTE RD to staff the OP Nutrition Clinic, as well as
support inpatient nutrition, community outreach, and marketing efforts
Gradually expanded OP Nutrition Clinic to be open 40 hours/week by
November 2013, as office space became available within the hospital
Tracked RD productivity, number of patients seen, and estimated revenue
from the OP Nutrition Clinic
Tracked RD productivity in non-revenue generating tasks, such as
administrative work and scheduling, staff training, marketing, community
outreach, inpatient coverage, and employee wellness programs
Tracked patient satisfaction with OP Nutrition appointment using
anonymous surveys
As we expanded the hours of the OP Nutrition Clinic, we found a % increase in
estimated revenue and a % increase in number of patients seen per month. After 7
months, we have increased OP Nutrition Clinic revenue by … %.The wait time for
appointments was reduced from 6-8 weeks to 1-2 weeks. Patient surveys indicated
that patients were very satisfied with OP Nutrition services intended to follow up with
the OP RD with regular appointments.
While it took several months to expand the Nutrition Clinic, due to physical space and
time constraints, we were able to achieve 40 hrs/week availability for patients. After
the first 2 slow months of revenue increase, we discovered the importance of
providing advanced notice of changes and availability to patients, OP Clinic staff, and
referring physicians. We utilized the extra time by involving the OP RD in several
projects, including leading customer service training for Food and Nutrition staff,
developing employee wellness programs for BIDN staff, being involved with
community outreach events, and providing inpatient coverage as needed.
Next Steps
Increase marketing and community efforts in order to increase maximize
revenue and productivity at 40 hours /week
Continue to track revenue- and non-revenue generating productivity
Better understand reimbursement rates and track inefficiencies in
For more information, contact:
reporting.
Jeanine LeDoux, MS RD LDN
BIDN Outpatient Nutrition Clinic
jledoux@bidneedham.org
�
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.
Jeanine LeDoux (<a href="mailto:jledoux@bidneedham.org">jledoux@bidneedham.org</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.
BID-Needham
Project Team
Shana Sporman
Katie Laycock
Jeanine LeDoux
Helen Chan
Michele Morgan
Chip McIntosh
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
Expansion of Outpatient Nutrition Services
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Timeliness
-
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9d7467052249cf4982f5342ade482288
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Text
Eye Instrumentation and IUSS Reduction Team
III. Methodology (cont.)
I. Background
Instrument kits are not standardized – having unused instruments in kits leads to wasted time spent on
processing, set‐up and counting. In addition, the inventory level may not be adequate to support case
volume. By eliminating unused instruments from kits and establishing an adequate instrument/kit
inventory, we have an opportunity to reduce excessive IUSS. This team will establish the methodology,
specifically addressing the problem in the Eye Service. Future similar teams will address the problem in
other services, using the methodology established by this team.
5. Using values calculated, map out the process to determine number of
kits needed :
Goal:
Reduce the rate of IUSS from the existing 61% to 2‐5%
Project Team
Sponsor: Elena Canacari
Charlotte Guglielmi (Co‐Leader) Marie Pierre
Alma Martin
Ross Simon (Facilitator)
Deb Martinez (Co‐Leader)
Kristey Smart‐Ladd
Rick Caswell
Beverly Fuller
Barbara DiTullio
II. Methodology
3. Calculate average turnover time
0.12 SUTURING FCP STR
1
Katena K3‐2120
VMueller OP0910‐651
Katena K6‐1000
Katena K5‐5081
Katena K4‐5020
Katena K3‐4100
Katena K1‐8200
Pilling 456005
Pilling 182310
Pilling 144352
Katena K5‐3500
Katena K4‐5000
Katena K3‐6810
Katena K3‐5522
Katena K3‐5192
VMueller OP3515
Storz E1815S
Pilling 463930
Pelion Surgical 6‐114
Wheeler Spatula D/E
0.12 Suturing Fcps (McPherson) Str
McPherson Needle Holder Str w/lock
Utrata Capsulorrhexis Fcps w/marks @ 2.5 & 5mm
Vannas Capsulotomy Scissors Sharp 5mm Ang Fwrd
Wescott Tenotomy Scissors 4 1/4" CVD RT
DesMarres Lid Retractor Size 0
Round Knife Handle 3" (7.5cm BEAVER)
Halstead Mosquito 5" Cvd
Stevens Tenotomy Scissors 4 5/8" Cvd
Bishop‐Harmon Tissue Fcps 1x2 Teeth delicate
Vannas Capsulotomy Scissors Str 5mm Sharp
Jameson Muscle Hook LG
Kuglen Iris Hook & Lens Manipulator 4 1/2" Str
Sinskey Lens Hook Str 0.25mm Blunt Tip
Bonn Peripheral Iridectomy Fcps 2 7/8" 1X2 Teeth
McPherson Tying Fcps 3 1/4" Str 5mm
Iris UltimateCut Scissors 4 1/2" Str Sharp
Kim Chopper Opposite Drysdale Nucleus Rotator
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
1
1
1
1
Surgeon J
Surgeon I
Surgeon H
Surgeon G
Surgeon F
Surgeon E
6. Purchase additional kits as required.
IV. Results
1
Katena K5‐2020
Surgeon D
QTY
JEWELER'S FORCEPS #1 Str
Surgeon C
DESCRIPTION
Katena K5‐6510
Surgeon B
CATALOG
Surgeon A
1.Standardize /lean kits
• Identify which instruments
actually used
BDFGH
DFGI
CI
GH
C
BDI
ABDI
CD
BCDFGI
C
FGHIJKM
GJ
BCDJKM
ABDJMN
• Review with surgeons
• Remove from kits instruments
not used.
2.Calculate average case time using
data from PIMS.
4. Determine time necessary to
properly clean, sterilize and wrap
kits.
For More Information Contact
Charlotte Guglielmi, RN, CNOR, cgugliel@bidmc.harvard.edu
Debra Martinez, dmartin8@bidmc.harvard.edu
V. Next Steps
• Trend instrument usage over time and continue to remove unused items
• Incorporate IUSS rates review into daily metrics to address excursions in real time
• Service-by-service review of IUSS rates
• Apply methodology to requests for additional instruments not budgeted
• Apply methodology to projected service line growth
�
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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.
Charlotte Guglielmi (<a href="mailto:cgugliel@bidmc.harvard.edu">cgugliel@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Elena Canacari
Rick Caswell
Charlotte Guglielmi
Marie Pierre
Beverly Fuller
Alma Martin
Ross Simon
Barbara DiTullio
Deb Martinez
Kristey Smart‐Ladd
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Title
A name given to the resource
Eye Instrumentation and IUSS Reduction Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
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d6fb1f62026c6bff094db017c3ed5422
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Health Care Leaders from Across North America
Learn from Lean Improvements at BIDMC and Atrius
Background
Lean thinking strategies brought national attention to BIDMC and Atrius Health during
a visit from a group of more than 50 nationwide health care leaders last week.
BIDMC and Atrius are proud members of the Healthcare Value
Network (HVN), an organization that unites health care leaders
sharing a commitment to Lean concepts. HVN members from
around the country spent three days observing patient care
improvements that have fostered high quality and efficiency at BIDMC and Atrius.
The visit also showcased lean practices achieved through collaboration between the
two organizations.
Day 1: Atrius Health Improvement Work
Participants started their visit by touring a newly-built Atrius medical practice, Harvard
Vanguard Medical Associates in Concord, MA, which utilized Lean concepts in
designing the building. They started with a
vision for what a better patient-centered
facility could be and we saw first-hand the
many design elements made both in the
processes and facility to support flowing
value to the patients. The layout allows
staff to better communicate and coordinate
timely and efficient care. The building was
featured in Healthcare Design Magazine in
November 2012.
Lean gurus from the Lean Enterprise Institute,
John Shook (left) and Jim Womack (right)
joined Alice Lee (middle) at this landmark visit
Day 2: BIDMC Improvement Work
Gemba walks, in which participants visit work environments to observe and ask
questions, continued at BIDMC during the second day of the visit. Alice Lee, Vice
President of Business Transformation, told visitors, “Lean thinking at BIDMC has
created a cultural shift in performance improvement. We’re figuring out ways to
coordinate and synchronize processes
so that patients get the care they need
as soon as they need it – safely and
efficiently – every single time.”
Staff involved in GI’s improvement work showed
guests the new visual board used to
coordinate patient flow through the unit
BIDMC’s Business Transformation team
led guests on three different walks to
see and learn from continuous
improvement efforts happening across
BIDMC. Visitors observed and
interacted with staff and physicians to
understand how the patient experience is
improved every day.
The group studied a standardized room entry process in the Medical Intensive Care Unit
(MICU) on West Clinical Center 7, learned how staff are working together to optimize
patient flow in the Gastrointestinal
Endoscopy Unit and spoke with employees
in Food Services about how a new inpatient
tray delivery system dramatically improved
patient satisfaction.
Later, visitors learned and practiced a new
technique for identifying safety behaviors
by going to 12 different locations
throughout BIDMC. The technique was
recently piloted in the operating rooms to
support employee safety and mitigate
harm.
Closing out day two, a physician panel
highlighted the BIDMC medical staff’s
reputation for active participation in Lean
thinking.
Day 3: BIDMC
Improvement Work
Anjala Tess (left), MD, Associate Director of the Internal Medicine
Training Program
Kevin McGuire (middle), MD, Chief of the Orthopaedic Spine Service
James Heffernan (right), MD, Primary Care Section Chief,
Healthcare Associates
“We designed the ideal workflow with the
best technology to create an integrated
medication management system which is
safe, effective, respects our staff, and
provides the best care to our patients.”
– Rachel Hutchinson
The visit concluded on Friday with
presentations to spotlight two
collaborative achievements between
BIDMC and Atrius, including an effort to
reduce emergency admissions for cellulitis and a plan to
redesign the BIDMC perinatal service line based on Lean
principles.
Feedback from guests on the third day was
overwhelmingly positive and many mentioned how
powerful it was to hear about collaborative Lean work
between BIDMC and Atrius.
“BIDMC and Atrius have a lot of confidence in each other
because we share a commitment to patients, to Lean
principles and to the ‘triple aim’ [improving the care
experience, improving population health and reducing health care costs],” said Abby Flam,
Senior Liaison Officer for Atrius, BIDMC and Harvard Medical Faculty Physicians.
Lessons Learned
Sharing across the Healthcare Value Network organizations has been invaluable in
accelerating our learning. Lean performance improvement can be a collaborative effort
between organizations.
For more information, contact:
Alice Lee – VP, Business Transformation, Health Care Quality, alee1@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kimberly Eng (<a href="mailto:keng@bidmc.harvard.edu">keng@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Business Transformation
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kimberly Eng
Alice Lee
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Title
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Health Care Leaders from Across North America Learn from Lean Improvements at BIDMC and Atrius
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
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05580a8a24d1d34949d23658971d85d1
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Hide and Seek: Searching for EMS Run Sheets
The Problem
The Interventions
When trauma patients are brought to BIDMC, the EMS team rarely leaves behind the
“run sheet” – a data rich log of care and treatment performed in the field and
necessary pre-hospital information for the BIDMC Trauma Service. This data is
required by the MA DPH and National Trauma Data Bank (NTDB). Referring EMS
agencies currently batch send their run sheets after the fact to the Health Information
Management (HIM) Department. As presented in the American College of Surgeons’
Green Book (standards and elements of performance for accreditation), EMS patient
care records are important for building and maintaining trauma registries. The BIDMC
Trauma Service notes that approximately 5% of all run sheets are found in patient
records. Multiple problems and inefficiencies ensue, including:
Lack of trauma patient labeled EMS run sheets, thus requiring further
resources for HIM to reconcile patient identification and record storage; and
HIPAA limitations on the Trauma Registry having direct access to EMS
databases, thus requiring EM/EMS collaboration to relay this data request;
and
Trauma Administrative Coordinator’s responsibility to track EMS trips,
generate reports, and in conjunction with EM/EMS, they communicate said
requests with various EMS companies on a bi-monthly basis; and
Delay in Trauma Registry abstracting data points/reporting to state and
NTDB due to lack of information and detail; and
The increase in trauma patient volume; this requires additional collaborative
resources between EM/EMS and the Trauma Service to retrieve EMS run
sheets.
Chronic deficiencies in obtaining EMS run sheets are a major problem in the state of
Massachusetts.
BIDMC Emergency Medicine created an innovative solution. The BIDMC
Emergency Department Dashboard is electronically linked to the Boston EMS
electronic medical record. EM is currently refining the algorithm for matching
records so that there is real time access to the EMS run sheets.
In addition, we established an electronic method of obtaining EMS run sheets
directly from Boston EMS, and our other major EMS agencies.
We also created a Trauma Outreach Committee to specifically follow this
problem, and Committee members are in direct contact with EMS to ensure that
we are able to have the run sheets directly sent to the Trauma Service.
We are working with HIM to ensure EMS sheets ultimately make it into the
online medical record (OMR).
The Results/Progress to Date
We increased compliance and now capture an average of 40.80% of all EMS run
sheets through the various efforts described above.
Aim/Goal
Within the next nine months, our goal is to reduce the amount of missing run sheets
generated by EMS, and ultimately receive an average of 75% of EMS patient care
records direct to the Trauma Service within 30 days of admission without prompts
from BIDMC.
The Team
Lessons Learned
Bradford Cohen, EMT-P
Ronda Clifton, Trauma Registrar
Jonathan Fisher, MD, MPH, Vice Chair, Emergency Medical Services
Carl J. Hauser, MD, Trauma Medical Director
Amy Hersom, Trauma Registrar
Tyler Howrigan, RN, Education, Outreach and Injury Prevention Coordinator
Monica Nasser, Trauma Administrative Coordinator
David Schoenfeld, MD, Emergency Medical Services
Darlene Sweet, RN, BSN, Trauma Program Manager
Next Steps/What Should Happen Next
Missing EMS run sheets is a systemic issue affecting not only BIDMC, but is observed at
other Massachusetts hospitals. By approaching the problem in an integrated manner, we
are working to improve communications, accessibility, processes, and outcomes.
This problem may improve as more agencies move to electronic medical records. An IT
based solution linking theses records to OMR may be useful. In the meantime, the
Trauma Service will work with EMS contacts on a bi-monthly basis to retrieve EMS run
sheets, and strengthen the communication pipeline. Efforts at the system level to resolve
missing EMS run sheets will be taken on by way of BIDMC EM/EMS and Trauma Service
with the help of Information Services and HIM. In addition, efforts at the state level to
develop solutions through representation at Massachusetts Emergency Medical Care
Advisory Board (EMCAB) meetings are taking place.
For more information, contact:
Monica Nasser, Trauma Administrative Coordinator:
mnasser@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Monica Nasser (<a href="mailto:mnasser@bidmc.harvard.edu">mnasser@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Trauma Surgery
Emergency Medicine
Emergency Medical Services
Health Information Management
Information Systems
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Bradford Cohen
Ronda Clifton
Jonathan Fisher
Carl J. Hauser
Amy Hersom
Tyler Howrigan
Monica Nasser
David Schoenfeld
Darlene Sweet
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Title
A name given to the resource
Hide and Seek: Searching for EMS Run Sheets
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Efficiency
Safety
Timeliness
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a4dbf40548009911b8e8b082607aa5d6
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Text
How do you problem solve on a busy inpatient unit?
The Problem
Progress to Date
Everyday life for our inpatient staff consist of multiple competing priorities, a lot of
pressure, things feel scattered and are constantly changing. And yet, the things we have
to do aren’t going away.
.
Learn &
Spread
CC6
Green or Red
“How can we go about this work in a different way? One that is
more effective and is actually more supportive to all of you. I
believe that way is by implementing a Daily Management System.”
Are we meeting our goal?
OR West
Trend Chart
– Marsha Maurer, Chief Nursing Officer,
Senior Vice President, Patient Care Services
How are we doing
compared to goal?
If not meeting goal —
What was the reason?
Goal
Create a supportive environment to solve problems and improve performance locally
Feldberg
7
Action Plan
Farr 3
What are our next steps?
The Team
Sponsors
Project
Steering Committee
Directors
Marsha Maurer Kimberly Co-Chairs: Elena Canacari,
Eng
Cindy Phelan
Alice Lee
Members: Anissa Bernardo,
BB Wood
Laurie Bloom, Mary Jo
Brogna, Jane Foley, Jaime
Levash, Kim Sulmonte,
Phyllis West
Standard Calendar Team
Daily Metrics Components
Team Leader: Alison Small
Team: Jenn Barsamian, Pam Browall, Elena Canacari,
Mary Francis Cedorchuk, Sue Dorion, Jane Foley, Chris
Garabedian, Tracey Lee, Jaime Levash,
Michelle Mercurio, Cindy Phelan, Kristin Russell, John
Ryan, Michelle Sheppard, Connie Shulkin-O’Brien, Kim
Sulmonte, Phyllis West, Allison Wang
Daily Management
System on CC6
(began 1/13/2014)
Expanding to 3 additional units to learn
and improve the standard package
before rolling out to all of PCS
Lessons Learned
Step 2 –Daily Metrics
Track metrics daily to make problems visual and facilitate problem solving
Start with 1 ‘People’ metric that is meaningful to staff and 1 ‘Quality’ metric
that can improve care for patient
Fresh daily metrics vs. old rolled up data
What staff remember within the last 24 hrs
Metric in staff/unit control
Metric important to the staff
Did every PCT
receive report
from RN
Is your patient
assignment
manageable/
safe?
Did each PCT
get an RN
report
Engage staff through the manual process of filling in the metrics by hand
Make problems visual to help facilitate problem solving
Once goals are reached, change the target or measure to keep metrics fresh
Standardize calendars to create space for
dedicated improvement time
2 hours, 3 days per week
No meetings booked during this time
Who? Nurse Manager, Clinical Nurse
Specialist, Resource RN
Management commitment and support of problems that are important to staff
Step 1 – No Meeting Zone
Select metrics that are meaningful to staff
The Interventions
Regular huddles make a new routine to teach a new way of thinking
Did you get a
meal break
today?
Next Steps
Were you
paged for
Rounds today?
Did you
get out
on time?
Step 3 – Huddles
Create a disciplined problem solving culture where root causes are found and
systemic process based improvements are implemented
Huddle and problem solve around metrics at a predicable time for 5 – 10 minutes
Situational awareness and improvement focus
Planning
Design
(30 days)
Dec 1
2013
Complete
Team Kickoff
Design Work
Sessions start
Logistics
Post Go-Live
Feedback &
Revisions
(60 days)
Jan 1
2014
Complete
Create a standard PCS calendar
Create a standard 'Daily
Management System' package
Rollout
(30 days)
Mar 1
Complete
4 pilot areas
tracking
metrics
In Progress Apr
• Implement
standard huddle
• Design feedback
loop
• Revise & improve
standard package
1
• Use standard
package to
implement in
all PCS areas
Oct 1
For more information, contact:
Marsha Maurer, RN – CNO, SVP Patient Care Services mmaurer1@bidmc.harvard.edu
Alice Lee – VP, Business Transformation, Health Care Quality alee1@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Kimberly Eng (<a href="mailto:keng@bidmc.harvard.edu">keng@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Patient Care Services
Business Transformation
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Marsha Maurer
Alice Lee
Elena Canacari
Kimberly Eng
Cindy Phelan
Anissa Bernardo
BB Wood
Laurie Bloom
Mary Jo Brogna
Jane Foley
Jaime Levash
Kim Sulmonte
Phyllis West
Alison Small
Jenn Barsamian
Pam Browall
Mary Francis Cedorchuk
Sue Dorion
Chris Garabedian
Tracey Lee
Michelle Mercurio
Kristin Russell
John Ryan
Michelle Sheppard
Connie Shulkin-O’Brien
Allison Wang
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
How do you problem solve on a busy inpatient unit?
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/a3f79c0780526170b3cb0516c264de91.pdf?Expires=1712793600&Signature=ki8C%7E67RUQgjs9VpA01M2xSxiETExwvdRbFTyZEJUqLUL%7ExwbcboZ6MvzfE4-XDmM8IG7F3G9oUZ08EPp5PsYhRCLLUWl0e0dzZqs%7Ea4rtMdd0HG7sty7eegsORn6nBLXnJ%7Eh8BIoaWRxMynEtJuxFJr71beHmTwkjgxee1dB9wpOQneGbdby6WVWaBQR8FEtxq3%7Ehd7VosKKuwL3lNdFQ6lUA6wGKEKzcfOKVor2ayF%7Ez02%7EsdFGMAwFjUyE6s0SzWehwh5z38EFT7kI76qFcxzx1MiLimkdDRx6q7xNi2lo%7EhEf3u1ShLADvmN7YSI44KEBmV1pNluOufxDoKWhg__&Key-Pair-Id=K6UGZS9ZTDSZM
bd9b7534ca5756068a7f49a4509fbca3
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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.
Amy Evenson (<a href="mailto:aevenson@bidmc.harvard.edu">aevenson@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Transplant
Nephrology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Robert S. Brown<br />Mark Williams<br />Amy R. Evenson<br />Kristin E. Raven<br />Khalid Khwaja<br />Louise C. Riemer<br />Clare Sullivan<br />Yael Vin<br />Cyndy Diluigi<br /> Kathleen Smith
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Title
A name given to the resource
Improving Dialysis Access Services at BIDMC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/6d90d3112de32cf06ff1b6ff5eb99f59.pdf?Expires=1712793600&Signature=iG-8QRReaBcO7%7EkAwJJx6taAQ1-6L5v4Tnm9SvwoP2UVkNKIHmXelXF4ZhejTVdletvWejigc5YbjSBk9BqZN1saFkJbDcEDzv1F8TKfAHkc7ieQPKkpTSffBxwU1puQCjl7Be7wJpdxK0cE0-quIJ7Mw4msGUaHEmOXvvTDeLcJN0xY%7EHSOVXCI0dkO1EUSt3tJ4yQbC2rJZ1H70Z7pIXG3CqnZSeMITIgrn3yNWSyx6QQAWyP%7E1NsitemPEOsc4tZaHX6lsz3u1EZ4rPVojNVt3CXJ1FE2XIlGFqyzmMIHOKinBJHrKyjm6w0x7F3sUYj7OKSWYz2f1NY9gW2ijw__&Key-Pair-Id=K6UGZS9ZTDSZM
80cc03128d623a26efebd6dd28384fd5
PDF Text
Text
Beth Israel Deaconess Hospital-Milton
Improving Patient Care Transition Communications between BIDM and Atrius PCPs
The Problem
Competition in the market place and service expectations of PCP’s demand
optimum communication of patient information across care transitions. Due to
electronic system failures, provider knowledge deficits and lack of process
surveillance, the following problems were identified:
Atrius Primary Care Physicians were not reliably receiving inpatient
summaries from BIDM, resulting in the perception of poor collaboration on
care coordination
In addition, BIDM physicians (primarily ED and Hospitalists) were not
consistently accessing Atrius records as a means to acquire meaningful and
key patient information to better manage care during the patient’s
hospitalization, negatively impacting the BIDM-Atrius relationship
Electronic 1-click access to Atrius charts from PCI (BIDM’s electronic MR)
Visual Management: Practice affiliation posted to inpatient Rounding and Consult
Lists
Visual Management: Atrius logo magnets created for I/P unit whiteboards
The Results/Progress to Date
Aim/Goal
Improve inter-agency communication by addressing system failures and by
establishing provider expectations for the use of a bidirectional electronic
medical record access portal, thereby improving patient care and perception of
Atrius PCP providers relative to the hospital’s commitment to collaboration and
communication.
The Team
Ashley Yeats, MD, FACEP: Chief Medical Officer
Lynn Cronin MSN, RN, CNL: Interim Chief Nursing Officer
Andrea Connors: Manager, IT Applications
Jason Bouffard: Manager, Public Relations
Lessons Learned
The Interventions (Select Actions Taken)
Tracked access by BIDM Hospitalist and ED Physicians to Atrius electronic
patient records – transparent sharing of data - provider education provided
Developed process to monitor and ensure flow of reports to Atrius PCPs
Eliminated duplicate Atrius physician mnemonic entries into Meditech
dictionary
Visual Management: Practice affiliation posted to main ED Tracker so RN’s
can access both Medication & Problem Lists in Atrius record
Regularly scheduled conference calls between BIDM team and Atrius
representatives as a means to address identified opportunities for
improvement
No complaints received regarding communication with Atrius PCP’s and within
network follow-up appointments/referrals since 5/2013
Next Steps/What Should Happen Next
Continue to monitor compliance and respond to outliers/decreases in
performance/activity.
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Information Systems
Nursing
Medical Staff
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Ashley Yeats<br />Lynn Cronin<br />Andrea Connors<br />Jason Bouffard
Dublin Core
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Title
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Improving Patient Care Transition Communications between BIDM and Atrius PCPs
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/7f33220fa9eb8d136800fc9bd3eaeb2d.pdf?Expires=1712793600&Signature=DhkJC5%7E8MwJKQeqWz9KK3OiOVQtlXiB-G5FyfvePkOSvrAHlOY5arqWjg0MNr-yvshmhfQx0so%7ElKbqmp6EkRx7uL62t9ojA5vPkjbWWiT2fBXQ5aR4CMAyfDIoTkdqqBMELYz2dPSvMMTwiGTxGJ9otP9Tvt8EJIQ11ln4GFUjWGi2b3cP2XPzMY-VkyH6-XNkrn9qOPgmyY6ZNx-qbPhbEUwy0E2EbycUK3Hg17v2BSd02GKlATbWuAvEyBgkG99CccA0qJPw9MIDgpV3gFMxZ2V-Jex3XQjG2efhoDJTmnuA430Noxen7iURX4hFH%7Eq6FPzZplFpwfrFHk9P1NQ__&Key-Pair-Id=K6UGZS9ZTDSZM
ac46b5ac6f3b7270cfe1e746aee9b2d3
PDF Text
Text
Improving Reliability in the Histology Laboratory: iFREEZE
The Problem
Labeling Quality Improvment Data Collection - Total
Errors
April 2012 - December 2013
SoftPath
Aim
Month
To study the occurrence of incorrectly identified histology specimens, perform a root cause
analysis to dissect specific workflow vulnerabilities, and design an innovative frontline solution
to identified problems based on known quality principles and subject expertise.
Comparison of Errors
6 Months Prior to SoftPath (February 2013 - July 2013)
and 6 Months After SoftPath (August 2013 - January 2014)
Number of Errors
120
100
80
60
40
20
0
Ap
ri
M l
a
Ju y
ne
Ju
Se Au ly
gu
pt s
em t
O b
N cto er
ov be
D em r
ec b
e m er
J a be
n r
Fe ua
br ry
ua
M ry
ar
ch
Ap
ri
M l
a
Ju y
ne
Ju
Se Au ly
gu
pt s
em t
O b
N cto er
ov be
D em r
ec b
e m er
be
r
Total Errors
Although efforts have been made to improve patient identification in the clinical labs with bar
coding and point of care timeouts, in anatomic pathology, the nature of the work makes it
impossible for patients to self identify. Incorrect tissue identification can lead to significant
patient harm, including incorrect diagnoses, wrong surgery, inappropriate therapy, and emotional
distress for patients and providers. Nationally, histology laboratories have been aware of this
vulnerability but the rate and nature of mix-ups have not been rigorously studied or reported.
140
120
100
80
60
40
20
0
February-July Errors
August-January Errors
2
13
15
26
27
28
Step Error Occurred
2=Block Grossed 13=Slide P rinted
15=Block Cut/ Tissue P icked Up
26=Recut Block P ulled 27=Recut Slide P rinted
The Interventions
Process mapping for histology workflow
Development of a novel Numerical Step Key (NSK)
Identification of vulnerable steps in workflow
Design and implementation of solutions
Additional patient identifier on block
New information system rollout with partial bar coding
Coming soon: single piece workflow at the microtome
(iFreeze)
The Team
Histology Quality Improvement Committee (Department of Pathology)
Christine Spiliakos, Administrative Assistant for Quality
Michael Hallett, Laboratory Support Assistant
Benjamin Edwards, Histotechnologist
Shaelyn Casey, Histotechnologist
David Bowman, Supervisor, Histology Laboratory
Donna Fayad, Manager, Anatomic Pathology
iFREEZE
Gina McCormack, Operations Director
Sergey Pyatibrat MD, Senior Resident
Potential Issue
Jeffrey Goldsmith MD, Director, Surgical Pathology
Batching
Yael Kushner MD, Director, Quality Improvement
No standardization
The Results
Case #s not visible
Total Number of Cases Reviewed: 104,623
Total Number of Errors: 872
Average Histology Error (April 2012-July 2013): 1.03
External Errors: 741
Internal Errors: 131
Total Time Wasted (Re-Work): 10,163 Min (~169 Hours)
461 Min/Month (~8 Hours/Month)
Block and slide
separate
DESIGN
What should happen next?
iFREEZE:
Innovative Framework to Engage and Effect Zero Errors
March 4, 2014 – Roll out of iFREEZE
Continue to collect data
Monitor microtome step
Visual cues and weekly PDSA cycles
Watch for unintended consequences
BEFORE
iFREEZE: AFTER
Resolved
YES
YES
YES
YES
For more information, contact:
Yael Kushner MD/ykushner@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Yael B. Kushner (<a href="mailto:ykushner@bidmc.harvard.edu">ykushner@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Histology Quality Improvement Committee<br />Christine Spiliakos<br />Michael Hallet<br />Benjamin Edwards<br />Shaelyn Casey<br />David Bowman<br /> Donna Fayad<br />Gina McCormack<br />Sergey Pyatibrat<br />Jeffrey Goldsmith <br /> Yael Kushner
Dublin Core
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Title
A name given to the resource
Improving Reliability in the Histology Laboratory: iFREEZE
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/66de3172174f97c91db3d98b29f88721.pdf?Expires=1712793600&Signature=LUfl8z2cTsCk0uIMLbuGBneBaLQ-zVRT2ExVQXbIMN%7E4Fbfep8MAeFpJl0A%7Euzovabpbmmrif1LDmw1Kxy%7EQxShfAbz66CXKlMyeqmwWK3UIwnsU0gmceQucNG9cfsS3RR00LvjZI2z92FH5lGZpquiLzgD1mCzHvwysphOKCay3jhBIcvxPbfHUW7lQNGN-5iAX6quqUOX5bjoJkskDcx9wC1i9xRY5DbspvRHDXdlHDOw6lDNzFmMELI2zB8qvL5OuhAYNcE%7ELQHxhgqU8WDDV83d6bO7VTsxtFk1bnBvhTkp78LIvXYDeWVVaVj%7EKWKFlEJEUlL0uXDEQv6biTw__&Key-Pair-Id=K6UGZS9ZTDSZM
b4f5ab44bed6919286f1c512334fbb76
PDF Text
Text
Improving Safety for the Emergency Cesarean
The Problem
The Results/Progress to Date
The coordination of care has been standardized:
Emergency cesarean delivery is one of the most dangerous events for a
mother and her fetus.
During emergency cesarean delivery providers generally focus on their
individual role rather than on the coordination of the team.
Work is not standardized
Safety practices that are used during routine care may be overlooked or
bypassed when clinicians are focusing on emergency care.
Safety requires a team effort.
A single nurse is now assigned to initiate instrument count upon entering the
OR to allow for enough time to complete the count successfully.
A single nurse is now assigned to perform a chloraprep cleansing of the
incision site immediately on entering the room to allow the 3 minute drying
time.
The ‘Time out’ Script was modified to ensure maximum efficiency and
safety. Components focus on considerations that would result in harm to
the patient. After the fetus is delivered, the team can refocus on nonemergent components.
As part of the re-designed coordinated process, a nurse is assigned to
applying compression boots to the patient for DVT prophylaxis
Advanced emergency airway equipment was relocated to accessible areas
and large, visible signage was placed.
Observations made during drills included RN lack of knowledge with opening
of instrument kit, importance of immediate count with ST, physicians unaware
of need to self-gown and use of chloraprep instead of betadine, poor
communication of notification to NICU, poor organization of tasks required
causing confusion, noise and crowds.
Aim/Goal
To develop a standardized coordinated team practice for emergency cesarean
delivery that incorporates the best practices for patient safety.
The Team
Tracey Pollard RNC, BSN –Labor & Delivery
Susan Crafts MS RN- Labor & Delivery
Toni Golen MD- Labor & Delivery
Philip Hess MD - Anesthesia
Amanda Russell RN- Labor & Delivery
Leslie Guglielmo RN- Labor & Delivery
Tom Laws- Media Services
Lessons Learned
The Interventions
We developed a process improvement project for emergency cesarean
delivery, focusing on iterative cycles and plan-do-study act methodology.
Simulated emergency cesarean deliveries were filmed by Media Services and
reviewed. Drills were repeated at regular intervals using plan-do-study-act
methodology.
Staff involved in the simulation debriefed immediately to capture lessons
learned
Opportunities for improvement were identified::
o Surgical counts – emergency cesarean delivery is a high risk time for
retained surgical items.
o Infection control – incorporation of the best practices to reduce surgical
site infection.
o Streamlined “time out”
o Anesthetic Failed airway – high risk event for loss of airway during
induction of general anesthesia.
o Deep vein thrombosis prophylaxis (DVT) – application of compression
boots to prevent DVT and its consequences.
Safety does not have to take a back seat to speed! By improving the
efficiency and coordination of the team, safe practices can be standardized as
part of the process of emergency care
Process improvement of a complex task and a slow process requiring
iterative cycles.
Participation of the staff in both practicing and developing improvements is
paramount.
Next Steps/What Should Happen Next
We will continue simulation and process improvement events at regular
intervals to ensure effective training of all staff in a plan-do-stay-act
fashion.
Simulated events will be evaluated for opportunities for additional safety
initiatives.
Actual clinical events will be audited to evaluate the improvements in
care.
For more information, contact:
Tracey Pollard RNC, BSN L&D
tpollard@bidmc.harvard.edu
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tracey Pollard (<a href="mailto:tpollard@bidmc.harvard.edu">tpollard@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Labor and Delivery
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Tracey Pollard<br />Susan Crafts <br />Toni Golen <br />Philip Hess <br />Amanda Russell<br />Leslie Guglielmo <br />Tom Laws
Dublin Core
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Title
A name given to the resource
Improving Safety for the Emergency Cesarean
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/53d1a25e1ce8bcce78cf6c62af2e877f.pdf?Expires=1712793600&Signature=SX8wo3EkbUwbLAmSRWnVntlYYBuSHumraUCtiNcXR9hd2%7E6KENLKPYr5ONFV-OgjD3q%7EJ06y2gaBDpSuF%7ELdulWNT4AtqydyR-bX28jc7yWle-bnkUgxRsb5JoDzprrDufQskg3OCGdV%7EEwFR6Db43aS-kb1jkWDChWk6AZILfZLzWRcSHpuuYnwhJZbHkb-U5Z023x8KMnwHwo79wlx8OEnJLV5MATRfGN2TYLGQCuLeo-f5xFp5wXClxnzZAsVHI84GkvbIzNXpc2wLqi9U9RpwBKLr9NIYzSUmQlHhRworpAKBh%7E1WjBUb9VS6XWe3veB4u-Uz%7EDqhtrO6fr5Kg__&Key-Pair-Id=K6UGZS9ZTDSZM
aa3552aa4abaaf7fa6fe05247e079591
PDF Text
Text
Team: Anjala Tess, MD; Julius Yang, MD, PhD;
Joseph Paonessa, MD; Andrea Branchaud, MPH
Improving the Direct Admission Process at BIDMC
Reason for Action
Target Condition
The direct admission process represents an important opportunity for BIDMC and Atrius to jointly achieve
the best clinical outcomes, at lower cost, with an outstanding patient experience - and can serve as a model
for improving the direct admission process between all of our affiliated hospitals and outpatient practices.
Problem Statement: Our current direct admission process from HVMA Kenmore to BIDMC is inefficient,
error-prone, and difficult for both providers and patients, at times threatening the safety and comfort of our
patients while challenging the workflow of both HVMA and BIDMC providers. As a result, relatively stable
patients are sometimes directed to the Emergency Department simply to “wait” for an inpatient bed,
resulting in avoidable costs to the healthcare system, inconvenience for the patient, and contributing to ED
over-crowding.
Current Condition
Cause Analysis
Process tracking
Countermeasure Implementation Plan
Countermeasures
Monitor both Results & Processes
Use of performance manager will allow tracking:
‐ Direct admission request volume
‐ Admissions provided
‐ Time stamps of critical steps
‐
Type here….
Further analysis could include review of:
‐ ICU admissions within 24 hours admission
‐ Codes or other adverse events
‐ Patient satisfaction by survey data
With increased tracking, our goals will be to:
‐ Identify rate limiting steps
‐ Continue to measure as steps are implemented
Standardize and Spread Processes
We will pilot our model via the HVMA Kenmore
clinic with the intent to standardize our approach
to all direct admissions in order to improve the
transparency and reliability of this transition of
care for both patients and providers.
�
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.
Anjala Tess (<a href="mailto:atess@bidmc.harvard.edu">atess@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Department of Medicine
Patient Care Services
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Anjala Tess<br />Joseph Paonessa<br />Julius Yang<br />Andrea Branchaud
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
Improving the Direct Admission Process at BIDMC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c1bbabe6ff0b65fa2278bb96928bae09.pdf?Expires=1712793600&Signature=p1GEmBR6KcrLbHt33BAG-ZnTWl5P-FJPs1FV81%7E7JzFyoQib8xz9vlo-3WPIUtQNJhMOnBWDXFKOj6KL9xXFt%7EOiqnpJgiVauh-Zl205FRQgw%7EQzLz9R76PyNvaDQorFxYLlQCmLtEF-JNRjYFFXFxqklgcvlHPQ8%7EZY3GVvADWYb6TVZVbv7azntKRoJyG82UJWlJ90JVW4PTJMTwnYwL0kYy7ABFtQPQf05QKUHpA5SmS-9cZ2nCCRnBq9mqlPagw0XJG8V0LQRuRddkRznSQ-CH3SPiyvFy0T5Y2mbM%7Enqm300ddfd%7EyowHH4nYgP5ryUoJ31Ucpl6kSXsSqikA__&Key-Pair-Id=K6UGZS9ZTDSZM
30853670b1858ff06b849385e6aa09f4
PDF Text
Text
Increasing Breast Cancer Screening Rates: same-day mammogram and PCP visit
The
Problem
The Results/Progress to Date
Screening mammograms increase early detection of breast cancer when they
are more treatable and reduces mortality.
Based on the 2010 National Health Interview Survey results, breast cancer
screening rate for women 50-74 in the United States was 72.4%.¹
2012 Screening rates women 50-69 at Healthcare Associates (HCA), a large
academic primary care practice at BIDMC, is 72%. While consistent with national
averages, there are opportunities for improvement.
Aim/Goal
Increase % of female patients (ages 50-69) who have mammogram every 2
years. Improve patient access and satisfaction.
Enhance patient-centered practice and provide same-day mammogram access
along with a PCP visit.
The Team
HCA
Jennifer L. Beach, MD
Kim Ariyabuddhiphongs MD
Cathy Hoffman
Louise Mackisack, MA
Brigitte Bowen-Benitich
Medicine QI
Scot B. Sternberg, MS
Radiology
Olga Augustus
Peter Cousins
Patient story:
“I probably would have delayed for another year on the mammogram if
you hadn’t made it easy for me to get it today.”
The Context and Interventions
BIDMC’s HealthCare Associates (HCA), a large hospital based adult primary
care practice (42,000 patients), initiated its transformation into a patient-centered
medical home in 2012 and currently has achieved Level II NCQA PCMH
certification.
In our continuing efforts to enhance patient-centered care, HCA collaborated with
the Radiology to offer same-day mammograms after the PCP visit.
Medical assistants, primary care providers and clinical administrative assistants
(CAAs) teamed up to identify female patients (50-69) who had not had a
mammogram in the past 2 years.
Providers discussed breast cancer screening and offered same-day option.
At check-out, patients were referred to radiology for a mammogram.
At Radiology, patients could either get breast imaging done at that time (goal <30
minute wait time) or schedule for a future date.
Radiology tracked the number of patients who received same-day mammogram
and time to wait and provided HCA with monthly data.
Same day mammogram was initially rolled out in one suite in November 2012
and was rolled out to the entire practice in July 2013.
Lessons Learned
Patients valued having same-day access which made it more convenient and
easier to follow-up on screening referral.
A medical neighborhood approach, collaboration between primary care and
radiology, can be effective model to increase screening rates and improve patient
experience.
Next Steps
Developed team-based reporting and pre-visit huddle worksheet to support
patient care teams.
Pilot team-based interventions to continue to improve breast cancer screening.
Continue collaboration with radiology for same day mammogram access
Explore ways to track patients referred at visit who did not follow-up.
¹ Klabunde CN, Brown M, Ballard-Barbash R,White MC, Thompson T, Plescia M. Cancer
Screening — United States, 2010. Morbidity and Mortality Weekly Report (MMWR).January 27,
2012 / 61(03);41-45. Accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6103a1.htm,
February 10, 2014.
For more information, contact:
Jennifer L. Beach, MD/ jlbeach@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.
Jennifer Beach(<a title="jlbeach@bidmc.harvard.edu" href="mailto:jlbeach@bidmc.harvard.edu">jlbeach@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Jennifer L. Beach<br />Scot B. Sternberg<br />Kim Ariyabuddhiphongs <br />Cathy Hoffman<br />Louise Mackisack<br />Olga Augustus <br />Brigitte Bowen-Benitich <br />Peter Cousins
Dublin Core
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Title
A name given to the resource
Increasing Breast Cancer Screening Rates: Same-Day Mammogram and PCP Visit
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/c8bfe4a10bdd1677c52e7c62acc2a338.pdf?Expires=1712793600&Signature=DfLWp3xj64Lj8TSQp405hyO3zvXBDAw2ZMIGPsJm7enWP%7EuOTEWCs4xtOGCdZEr8IAxX8hCulM4QAonNYR-xUAobP%7Er7h4F%7Eoys3IjU4K-0mbkVKPBIlqEOnbjo4WPP57Z98gcM4nHxsBz2PyM4GoW%7EAXUghpWid0cX2n08yRxH7u3cfvvVzxxONb4BDu-eSIGwNfmbhmSO4zyopKZdHDWtNQg8zQ57I62dv-dJv0NPFTJAM9oFeshlh5ZA01URR3M3%7EDcLDq0AH6R8df4bXQU4YTyB9lE9-NDYsM%7ErheaUartqU1rOLvvoqb3VWS3Hdpmi7npbmAApbwWfthR00tw__&Key-Pair-Id=K6UGZS9ZTDSZM
7d20ddbe855a4a6c1fd6a8a4065d0e9b
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Text
Inpatient-BMT Electronic Ordering
The Problem
Inpatient Bone Marrow Transplant (BMT) orders do not use the computerized order entry
systems (OMS and POE) for electronic provider order entry.
The lack of electronic ordering in this scenario does not comply with best practice standards
and was recently cited as a finding by FACT (Foundation for the Accreditation of Cellular
Therapy). The inconsistency in care leads to a gap in the overall safety systems provided to all
other patients receiving standard chemotherapy as well as non‐chemotherapy order entry
for routine inpatients. If our manual processes being used in the paper world fail, the
institution may be at risk from a patient safety, regulatory, patient satisfaction and financial
standpoint.
Comparison Table
Aim/Goal
Convert all BMT orders to computerized formats including OMS and POE by the end of
February 2014.
The Team
Under the direction of the OMS Steering Committee who sponsored and prioritized the
project (Aug 2013), The BMT Workgroup was developed. Members include: Roz Coss RN,
BMT Coordinator; Patty DiGiacomo‐MacDonald RN, OMS Coordinator; John Gersh IS
Programmer/Developer; Jean Hurley, IS Manager; Robin Joyce MD, Physician leader for
OMS; David Mangan PharmD., Manager of Pharmacy Operations; Stephan Maynard RPH,
Pharmacy IT; Loi Nguyen RPH, OMS Coordinator; Margie Reilly PharmD., OMS Project
Manager; Tatiana Vicente RN, Nursing BMT Educator; Zaven Norigian PharmD, Pharmacy,
Hem‐Onc Clinical Coordinator and Ad hoc member: Sean Corbett RPH, Pharmacy.
The Interventions
Standardization of non‐chemotherapy order sets for POE
BMT order sets created and tested in OMS and POE
Design/Build/Testing of new functionality in OMS to allow for clinical needs of BMT
order‐sets
Lessons Learned
Assessing and addressing critical resource needs must be done early to avoid
disruptions to the anticipated time line.
Standardization of orders with agreement from clinical staff is essential to allow for
efficient entry of regimen templates and sign off of orders.
Next Steps/What Should Happen Next
A problem log will be managed during the go live of the order‐sets in BMT with follow
up on resolutions.
The Results/Progress to Date
OMS team to continue to provide support and training on BMT ordering.
All BMT order templates are now electronic. See OMS Regimen Dictionary picture
The new electronic order‐set templates are now available for BMT in OMS and POE.
New OMS functions have been built, tested and implemented.
Go live BMT 2/24/14.
Workgroup to reassess priority of “nice to have “functionality changes.
Communication/Training of changes to all staff members involved in the workflow of
inpatient BMT orders
Workgroup will continue to meet until outstanding issues are resolved, then less
frequently.
QA process of order‐set review will continue with current sign‐off practices for
electronic orders.
For more information, contact:
Margie Reilly PharmD, OMS Project Manager
mdreilly@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
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Margaret Reilly (<a title="mdreilly@bidmc.harvard.edu" href="mailto:mdreilly@bidmc.harvard.edu">mdreilly@bidmc.harvard.edu</a>)
Department
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Cancer Center
Information Systems
Medicine
Nursing
Pharmacy
BIDMC Location
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BIDMC
Project Team
Roz Coss <br />Patty DiGiacomo‐MacDonald <br />John Gersh <br />Jean Hurley<br />Robin Joyce <br />David Mangan<br /> Stephan Maynard<br />Loi Nguyen <br />Margie Reilly <br /> Tatiana Vicente<br />Zaven Norigian <br />Sean Corbett
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Title
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Inpatient-BMT Electronic Ordering
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
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Safety
Timeliness
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29edb2d03a579d3ca42f776df10bb9af
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Text
Are We Ready?? “Inside Eyes”
The Problem
Internal and external audits showed that Ambulatory & ED Services were not
meeting the goal of everyday readiness
The SVP, Jayne Sheehan recognized the gap in education for a subset of
the population, mainly frontline staff
The Results/Progress to Date
The graph below shows data gained by asking the participants the following
question:
How knowledgeable did you feel about these 40 pieces of information
before and after the training?
The lack of knowledge and/or understanding of basic readiness
requirements could hinder safe patient care
Aim/Goal
To train frontline staff with face to face or direct care responsibilities on 40
key readiness elements
See a marked increase in level of comfort speaking about roles and
responsibilities as they pertain to everyday readiness
See a marked increase in the scores of a written assessment given at the
first and final sessions
The Team
Kerry Falvey, Ops Manager; Kevin Hart, Ops Manager;
Janet Lewis, Clinical Nursing Director; Kelly Orlando, Executive
Director; and Sheree Galpert, Service Excellence Trainer
Jayne Sheehan, SVP (sponsor)
Ambulatory and ED managers and frontline staff
The Interventions
Assembled a focus group of frontline staff to ascertain level of knowledge
and comfort in speaking to compliance practices
Assembled focus group of ambulatory managers to gather/ review existing
deficiency data collected via internal & external audits to identify program
curriculum.
Developed 4, two hour trainings over 8 weeks focusing on the following
chapter standards: Infection Control, Safety, Medication Management and
Emergency Response
Identified diversified methods of delivering information through experiential
training and drills, lecture, tactile assessments, demonstrations and
observation of best practices
Lessons Learned
Grouping staff who shared similar responsibilities created a network of peers
and provided the opportunity to share best practices in a structured
environment
The Inside Eyes program helped tie the individual’s work to the larger
organizational goal of providing exemplary care
Rewards and recognition for competitions should be awarded to all
participants as opposed to only the winning team(s)
Inside Eyes supported the goal of achieving Joint Commission Accreditation,
with only two findings within Ambulatory and Emergency Services out of all
Ambulatory sites visited
Next Steps/What Should Happen Next
Enhance Leadership to include two, new Ambulatory/ED managers
Change target audience to include newly hired, frontline employees
Sustain engagement of prior Inside Eyes participants by: inviting them to
Leadership education forums (CORE); participation in internal, quality audits
(Outside Eyes); hosting members from this year’s class during an internal
quality audit and to participate in the actual trainings!
For more information, contact:
Kevin Hart, BS, khart1@bidmc.harvard.edu
Kerry Falvey, BA, kafalvey@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.
Kerry Falvey (<a href="mailto:kafalvey@bidmc.harvard.edu">kafalvey@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Ambulatory
Emergency Department
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kerry Falvey<br />Kevin Hart<br />Jayne Sheehan<br />Janet Lewis<br />Kelly Orlando<br /> Sheree Galpert
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Are We Ready?? "Inside Eyes"
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
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-
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4c0d858279801a40c8e1876fab54624b
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Text
Beth Israel Deaconess Hospital-Milton
Laboratory: Decreasing Emergency Department Troponin Result Times
The Results/Progress to Date
The Problem
During 2012, the Lab did not achieve its goal for 1 hour resulted time for ED
Troponin testing (Mean: 61.1%).
G
O
L
Troponin testing is critical in the determination of Acute Myocardial Infarction
in patients presenting to the Emergency Department.
Aim/Goal
Increase % of ED Troponin tests that are resulted within 1 hour of collection
time from 61.1% in 2012, to 82.5% by the end of 2013.
The Team
Phlebotomists
Laboratory Technicians
Emergency Department Nursing Staff
Transport Services
Volunteer Services
Medical Staff
Although goal was not met, there has been significant improvement in ED Troponin
tests that are resulted within 1 hour of collection
Once samples have been received in the Laboratory, 95.6% are resulted within one
hour of receipt in the lab, with an average time of 38 minutes
The Interventions (Select Actions Taken)
Laboratory staff educated as to importance of timely processing and testing
Auto-verification of tests allows for more rapid release of results that are
within “normal limits”
New instrumentation allows Troponin testing to be run on multiple platforms
Shortened centrifugation time to five minutes to speed up testing
Close monitoring of “specimen received” to “specimen verified” time
New Troponin assay introduced in December 2013
Lessons Learned
Major opportunities for further reduction in the analytical time for Troponin
testing exhausted
Mean time from collecting the ED sample to receiving it in the lab is currently
16 minutes (down from 26 minutes)
Phlebotomist draws multiple patients in the ED, thus increasing ‘transport time’
and ‘result time’
Specimen transport time by volunteers is slower than by other modalities
Demand-capacity matching of Phlebotomy staffing implemented in November 2013
Next Steps/What Should Happen Next
Examine other transport options (pneumatic tube system, robot )
Work with ED to reduce the ‘order to collect time’ to less than 10 minutes
For More Information Please Contact: Alex Campbell, MSN, RN, NE-BC, CPHQ, Director HCQ & PS
alex_campbell@miltonhospital.org
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Alex Campbell (<a href="mailto:alex_campbell@miltonhospital.org">alex_campbell@miltonhospital.org</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Laboratory
Nursing
Medical Staff
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BID-Milton
Project Team
Phlebotomists
Laboratory Technicians
Emergency Department
Nursing Staff
Transport Services
Volunteer Services
Medical Staff
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Title
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Laboratory: Decreasing Emergency Department Troponin Result Times
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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The file format, physical medium, or dimensions of the resource
pdf
Safety
Timeliness
-
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dbba8bc9c5d323af2f483bf83e7f557f
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Text
Medication Prior-Authorization Requests Psychiatry
The Results/Progress to Date
The Problem
Health plans often require a Prior Authorization (PA) before a psychiatrist can
prescribe certain medications. Submitting PAs currently requires the
psychiatrist to perform several time-consuming administrative steps,
including:
Identify the correct pharmacy contact line associated with the patient’s
health plan
Call the pharmacy contact line to request the PA form, which often
entails multiple automated phone prompts, long hold times, and delays
when selecting the incorrect prompts
Complete the demographic portion of the PA, including items that the
psychiatrist may not know (i.e., patient health insurance ID number)
Fax the completed PA
Track whether it has been approved or denied
Aim/Goal
To minimize time spent by physicians on administrative tasks, allowing
them more time to focus on clinical issues
To eliminate the need to search for pharmacy contact information
To eliminate delays in health plan responses to PAs due to the
submission of incorrect demographic information
Lessons Learned
The Team
The Interventions
Sandi Leitao, CAO
Sherene Blake, Practice Administrator
Jounathan Paulsaint, Referral Specialist
Pam Peck, PsyD., Clinic Director
The Referral Specialist (RS) receives requests for PAs from psychiatrists
by e-mail or in RS’s mailbox. Patient and pharmacy requests for PAs are
transferred from the front desk staff or psychiatrist to RS.
An Excel Spreadsheet is used to enter data about each PA, including the
psychiatrist requesting PA, patient name and MRN, medication name
and dosage, health plan, pharmacy vendor, pharmacy contact line, and
weblinks to PA forms.
The Referral Specialist uses the spreadsheet to track the number of
requests by health plan, medication, and psychiatrist.
An insurance company may have multiple health plans, each with a
different vendor, making it more difficult to identify the correct
pharmacy contact line when requesting and submitting PAs
When a patient’s pharmacy requests a PA to fill a medication they
often do not provide the correct number to the psychiatrist or RS to
obtain the PA form
The psychiatrists appreciate the administrative support that allows
them to focus on their clinical tasks
Next Steps/What Should Happen Next
Create a Microsoft Access database to collect data on PA requests
and submissions, including information to track approval periods,
denials and reasons for denials, and appeals; and to identify
proactively when PAs need to be re-submitted
Identify more effective and efficient ways to track and update the
requesting psychiatrist on PA submission, approval, denial and
appeals
Maintain a database of direct pharmacy contact lines, which often
result in faster authorization, especially for urgent patient requests
For more information, contact:
Jounathan Paulsaint, Referral Specialist
jpaulsai@bidmc.harvard.edu
�
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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.
Jounathan Paulsaint (<a href="mailto:jpaulsai@bidmc.harvard.edu">jpaulsai@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Sandi Leitao<br />Sherene Blake<br />Jounathan Paulsaint<br />Pam Peck
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Medication Prior-Authorization Requests Psychiatry
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
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pdf
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Timeliness
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f7309984a5a44cb645686e192d161781
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Text
Monitoring Missing and Unsigned Notes in Ambulatory Psychiatry
The Problem
The Results/Progress to Date
Timely and complete documentation facilitates patient care and strengthens
decision- making. In June 2013, BIDMC updated its ambulatory
documentation policy requiring all notes be completed and signed within 7
calendar days after the outpatient visit. Although the Psychiatry Department
currently runs regular reports to identify unsigned and missing notes, these
reports are run separately making it difficult to track whether notes are
completed and signed in a timely fashion.
Aim/Goal
Our goals for this project were to
Create a system to integrate both missing and unsigned ambulatory visit
notes
Automate that report
Decrease the number of ambulatory notes designated missing or
unsigned more than 7 calendar days after the date of service.
The Team
Denise Doucette, Finance Manager
Rohn Friedman, MD, Vice Chair
Stephenie Loux, MS, Quality Improvement Data Analyst
Pamela Peck, PsyD, Clinical Director
Lessons Learned
While the majority of providers have few notes >7 days, a small number
of providers have high numbers of incomplete notes. The Clinical
Director is working to identify the causes to help staff eliminate the
backlog of missing and unsigned notes.
Notes awaiting co-signature do not show up in the current reports
The Interventions
Run weekly CCC OMRVN report for Psychiatry’s HMFP and Training
Clinics
Create automated summary and individual provider reports with
missing/unsigned notes categorized as <7, 7 to 13, and 14 or more days
after visit
Distribute individual reports to clinicians and summary report to Clinical
Director
Provide clinicians with assistance in resolving errors in missing notes
report
Monthly data summary for Departmental Management Report
Contact those with missing/unsigned notes > 14 days past due and
schedule an appointment with Chief of Psychiatry as per BIDMC policy
Next Steps/What Should Happen Next
Develop individual plans with providers who have high numbers of
missing and unsigned notes > 7 calendar days past the date of service.
Examine the feasibility of adding notes awaiting attending cosignature
For more information, contact:
Pamela Peck, PsyD, Clinical Director
ppeck@bidmc.harvard.edu
�
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.
Pamela Peck ( <a href="mailto:ppeck@bidmc.harvard.edu">ppeck@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Psychiatry
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Denise Doucette<br />Rohn Friedman<br />Stephenie Loux<br />Pamela Peck
Dublin Core
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Title
A name given to the resource
Monitoring Missing and Unsigned Notes in Ambulatory Psychiatry
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness