Betsy Nabel addresses BWHers during Town Meeting.

Overcoming challenges through collaboration, innovation and expansion was a theme echoed throughout Town Meeting, held in Bornstein Amphitheater on Dec. 1.

Among these challenges is the unusually high patient census BWH has experienced in recent months. While high volume is a testament to the quality of care at the Brigham, it can cause undue pressure on patient flow, requiring the use of Code Help and sometimes Code Amber to reduce the number of boarders in areas such as the Emergency Department (ED) and the Post-Anesthesia Care Unit (PACU), said Brigham Health President Betsy Nabel, MD.

“We’ve been very busy this fall, and that is a real sign of confidence that patients have in the care we deliver,” Nabel said. “But that also presents a challenge for us: We must continue to deliver safe, exceptional care every day, including when we have high occupancy rates.”

While there are long-term plans to build a new inpatient tower at 45 Francis St. to accommodate a greater number of patients, that is still several years away, Nabel explained. A more immediate solution is needed to optimize our existing resources, she added.

Charles Morris, MD, MPH, associate chief medical officer, and Eric Goralnick, MD, MS, medical director of Emergency Preparedness and the Brigham Health Access Center, announced a new initiative launching in January to address these challenges. Every weekday at 9 a.m., clinical staff and members of the senior leadership team will gather for a daily safety huddle. These focused meetings will provide an opportunity to proactively identify obstacles to managing patient care in a safe, timely manner.

“It’s a chance to increase the situational awareness of where we are each day at an institutional level,” Morris said. “At the same time, we’ll be able to do near real-time problem-solving so that we can get patients the care they need.”

At the heart of these efforts is greater communication at all levels, said Ron M. Walls, MD, executive vice president and chief operating officer.

“We need to learn from providers on the front lines – and not just people at the bedside but also those registering or transporting patients. We need all of your ideas about what things we can fix, and we’re very committed to fixing them,” Walls said.

Identifying Efficiencies

In addition, a project is underway in the ED to double its size – adding 30 patient rooms, larger trauma bays, a second CT scanner and areas dedicated to oncology and behavioral health patients.

During the question-and-answer portion of Town Meeting, one BWHer asked how the ED expansion will affect wait times and boarder volume without a concurrent expansion of inpatient beds in the short term. Walls explained that a redesign of BWH’s care continuum management program – a blend of care coordination and utilization management – is underway to better support both the ED and inpatient areas as well as imaging, transport, procedural areas, operating rooms and more.

“We know that we don’t have space to accommodate additional patients in the beds that we have, nor can we ask people to work any harder because it is plain to see how hard everyone works here,” Walls said. “Our goal is to provide teams with the support they need to be more effective, efficient and empowered to identify solutions.”

Community hospitals will also play an important role in streamlining patient flow.

Goralnick explained that the Access Center, launched earlier this year, provides a centralized system to facilitate timely, safe patient transfers across Brigham Health. Part of its goal is to identify which transfer requests from referring hospitals can be safely directed to community hospitals like BWFH or Newton-Wellesley Hospital. This improves access to care for more tertiary and quaternary patients at BWH.

“The idea is to find the right bed for each patient to support the best care,” Goralnick said.