BWHers from many services gathered in the command center to respond to last week’s Code Amber, Internal.

It was an “all hands on deck” approach to respond to a Code Amber Phase 2, Internal, that was called the morning of April 6 as a result of an extremely high patient census in nearly every unit, including Intensive Care Units, the PACU, Operating Rooms (ORs) and the Emergency Department (ED). With steady communication and intricate teamwork among many departments and services, the code was cleared just about six hours later—a remarkable feat, said Executive Vice President and Chief Operating Officer Ron M. Walls, MD.

“To be able to accomplish what we did in just a few hours was nothing short of extraordinary,” said Walls. “I was so proud of the teamwork and leadership demonstrated by hundreds of staff, who remained focused on quality and patient safety while working to create capacity for those in need of care.”

In the 10 days that preceded the code, leaders from BWH and BWFH met frequently to identify potential patient flow concerns in preparation for the Partners eCare go-live at Mass. General Hospital and Newton-Wellesley Hospital. During go-live, both hospitals were accepting fewer patient transfers, and BWHC anticipated additional transfers.

At regular intervals throughout the day on April 6, representatives from many services came together in the hospital command center to provide updates, report on barriers to discharge and work together to solve them.

“There was unity of effort and remarkable teamwork,” said Eric Goralnick, MD, MS, medical director of Emergency Preparedness, who served as incident commander. “The lessons learned from this event will help guide our future capacity management efforts.”

Care teams on the units identified various issues that were delaying patient discharges, from logistical issues like waiting for transportation to go home or to other facilities, to requiring prescriptions, labs, tests and physical therapy. With expertise from so many areas in the command center, leaders from each area were able to quickly respond. Radiology and Phlebotomy expedited tests and labs, respectively, as Pharmacy and Rehabilitation Services addressed prescription needs and physical therapy. 

Care Coordination identified various means of transportation available to patients and worked with rehabilitation facilities to expedite the transfer of patients going to these locations. The Center for Patients and Families was on hand to explain the situation to patients and family members, providing them with information and resources as they waited.

Environmental Services and Central Transport doubled up on staff to clean rooms and turn them over as quickly as possible and to ensure transport within the hospital was available immediately. Admitting staff remained in constant communication with all services, monitoring available beds and quickly assigning them to waiting patients. Housestaff, fellows, attending physicians, nurses, unit coordinators and all team members on inpatient units, the ED, PACU and ORs worked together to ensure that every patient’s care needs were met during an especially challenging situation. Many other services and staff, including Food Services, were at the ready, ensuring minimal disruption for patients and families.

“Through excellent teamwork and collaboration, our triads of nurses, physicians and administrators were able to address barriers and free up capacity to safely manage the increase in volume and acuity of our patients,” said Lisa Morrissey, DNP, MBA, RN, associate chief nurse for Perioperative Nursing and Procedure Areas. “This would not have been possible without the hard work of everyone on the units and in many services who worked closely to prioritize, coordinate and provide patient care.”

BWHC President Betsy Nabel, MD, rounded throughout the hospital during the day, talking with patients, families and staff. “Patients and families were quite understanding of the situation and knew that we were focused on taking care of the needs of every patient,” she said. “For me, this urgent situation brought out the best of the Brigham. We can all be proud of the care we delivered during a challenging time.”