Posts from the ‘Brigham Values’ category

Q&A: Creating Pathways for the Next Generation of Diverse PAs

Audrey Fritzinger, MMSc, PA-C, joined the Brigham three years ago as a physician assistant (PA) in Interventional Radiology and now cares for patients in both Cross-Sectional Interventional Radiology as well as the Division of Angiography and Interventional Radiology. In addition to her clinical work, she leads several diversity, equity and inclusion (DE&I) activities for PA Services.

Fritzinger recently spoke with Brigham Bulletin about her work as a PA and her commitment to expand opportunities for more PAs of color.

What’s your career path been like so far?

Audrey Fritzinger

AF: I was introduced to the PA profession through federally qualified health centers (FQHCs) in Philadelphia. I always knew I wanted a career with an intersection of medicine and public health, seeing the PAs in practice helped me solidify the decision to pursue a career as a PA. As a student at Yale, I did a rotation in the ICU at Yale New Haven Hospital, learning to practice critical care medicine in an urban environment. This helped guide me toward a position in the ICU after graduation, I loved practicing critical care medicine and performing procedures, and I really enjoyed utilizing ultrasound as a means to perform bedside procedures and evaluate progression of critical illness. When my time in the ICU came to an end and family brought me to Boston, I found my calling in interventional radiology, a specialty which is the perfect intersection of critical care, procedural and outpatient medicine.

Let’s talk more about your involvement in DE&I. What inspired you to become engaged in this work?

AF: My involvement DE&I work started when I was in high school. I attended predominately white high school and college and was involved in many extracurricular activities in this realm. This continued as I transitioned to PA school at Yale.

Yale is a predominantly white institution, and the PA profession is occupied predominantly by white females. So, early on, I saw there weren’t a lot of providers, preceptors or faculty who resembled me. I had to look outside of the program for mentors.

I was lucky enough to work with Dr. Marcella Nunez-Smith and a group of medical students and nursing students to create an elective course called U.S. Health Justice. We felt that there were a lot of gaps in the curriculum in terms of things that were happening in New Haven and more broadly — things that we never discussed but saw in our rotations.

For example, we partnered with community organizations — including, but not limited to, the Needle Exchange Program and the Community Health Care Van — and we delved deep into other social determinants of health that we were not really discussing in medical lectures. The course is still ongoing, and it’s now been integrated into the curriculum.

It excited me to be involved in this great work, but in my post-graduate period of starting a new job in the ICU, other Yale students continued this work while my focus shifted for a brief period. I didn’t really do anything extracurricular just because of the crazy hours, so when I came to the Brigham, I realized that was something that I needed fulfilled.

What kinds of initiatives are you working on now?

AF: I read about a PA student at Morehouse College, Calbeth Alaribe, who participated in the MIT Healthcare Hackathon and whose group won an award. After an exciting conversation with her, bells went off that there might be an opportunity for the Brigham to partner with a historically black college and university (HBCU) and potentially positively influence the community here.

Stronger Together Brigham Values LogoI find it a privilege to be around Black people and to have that celebrated. Boston is not a historically diverse city. In a lot of spaces where I occupy, it’s not celebrated. I’m also not frequently around a lot of Black people, especially here at the Brigham. I wanted to see if we could diversify the PA workforce here at the Brigham.

Jess Logsdon [senior director of PA Services] and Rosann Ippolito [manager of PA Education] were very excited about this collaboration and how we can foster a relationship with an HBCU — potentially opening the doors for more PA students who might want to work here at Brigham.

The plan is to start with a cohort of students this spring to offer clinical didactics and mentorship, including one-to-one mentors of color aside from their preceptors.

Other training programs in medicine have a visiting period, whether it’s residency or fellowship, or they get paid opportunities to visit a program. As PAs, we don’t have that, so when you’re considering whether to take a job somewhere, you don’t get to have an extended visit at the institution beforehand. I think what we’re doing with this rotation is unique and will allow students to experience the culture firsthand and see how we practice medicine here at the Brigham.

What do you find most rewarding about this work?

AF: I’m not the only PA doing it. There are so many other PAs who are active in DE&I work at the Brigham. I had an idea, I asked for help and people came running to support it.

I get excited when others are just as enthusiastic about this work as I am — that this is as close to their heart as it is to mine. That makes me feel like I’m at the right institution and in the right community. It also makes me want to invite others to join, which is why I’m so excited and confident about opening the Brigham up to more PA students of color, because it’s a great place to be. I want them to be here and learn alongside us.

Physician Assistant Week is held annually Oct. 6–12 to honor physician assistants’ substantial role in improving health. In celebration of Brigham PAs and their involvement in nearly every facet of the care across the institution, Brigham Bulletin has highlighted one of the many exceptional physician assistants to cap off PA Week this year.

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A Mother’s Day to Remember: After Heartbreaking Losses, a Couple Treasures Their Sweetest Gift — Family

Family of four

Alex and Tim Lieto with their children, Luca and Faith, outside their New Hampshire home

It’s hard to imagine a mom who cherishes Mother’s Day more than Alex Lieto, 34, of Portsmouth, N.H.

She still gets choked up remembering what it was like to hold her firstborn, Faith, now 2 and a half. After more than two years of fertility treatments, six pregnancy losses and unfathomable heartbreak, arriving at that moment with her husband, Tim, 34, felt like a dream — one they almost couldn’t believe had come true.

“There are no words,” Alex said through tears, recalling their experience in Labor & Delivery at the Brigham. “The second she came out, I was like, ‘She did it. We did it. I can’t believe we did it. Is this really happening? Thank God.’”

This Mother’s Day is even sweeter for the Lieto family, who recently celebrated the birth of their second baby — a boy, Luca, now 5 months old.

“There’s a heck of a lot more laughter in this house with them here. Even when things are really crazy with the kids, we never complain. Just being with them — and being a family — is something we never take for granted,” Tim said. “Al is a fantastic mom, and seeing her have the chance to be one is all we could ask for.”

Reflecting on the profound losses they have experienced over the years, Alex acknowledged that Mother’s Day also remains a somewhat bittersweet holiday.

“Before I had my kids, there was a handful of really hard days — Christmas, New Year’s, birthdays. Mother’s Day was the hardest of all,” she said. “The fact that they’re here is frankly surreal, and while I feel so blessed to be able to celebrate this day with them, my heart breaks for the women who are struggling because I know their pain.”

Two smiling children

“There’s a heck of a lot more laughter in this house,” says Tim Lieto of his children, Luca and Faith

Guiding and supporting the Lietos on their path to parenthood over the past six years was Antonio Gargiulo, MD, a reproductive endocrinologist and surgeon at the Brigham’s Center for Infertility and Reproductive Surgery.

Gargiulo, whose team performed several rounds of in vitro fertilization (IVF) for the couple at a Mass General Brigham-affiliated satellite in Exeter, N.H., said this was one of the most challenging, and ultimately heartwarming, cases he has worked on his 25 years in the field.

“This was a particularly hard-fought battle,” he said. “The humbling and inspiring part of this for me, as a provider, is seeing how these two people never lost hope. We’ve had many very difficult discussions and a lot of tears through the years, but the reality is our team knew they were going to be successful because of their attitude, dedication and the fact that they made this their No. 1 goal.”

More than just providers, Gargiulo and his multidisciplinary colleagues truly became part of their team, the Lietos said. “He’s part of our family, and he treated us like family,” Alex said.

‘A Whole Other Level of Loss’

Originally high school sweethearts, Alex and Tim married at 25 and knew that they would soon want to start a family. After struggling to conceive naturally due to male-factor infertility, they began pursuing IVF.

Initially, the procedure seemed promising. Egg retrieval and fertilization went smoothly, and Alex got pregnant right away. Within a few short weeks, however, she suffered a miscarriage. They waited and tried again — and saw the same outcome, over and over.

“When you have a miscarriage, it’s a pain you can’t even describe. Within a second, your world comes crashing down,” Alex said. “I remember very vividly talking to friends and family after my first miscarriage, and they would say, ‘So many women have a miscarriage, but the odds are you won’t go through that again.’ So, we tried again but had another miscarriage — and another and another and another.”

On their fifth round of IVF, they pursued additional screening to ensure a genetically healthy embryo was implanted. After they passed the first trimester, the couple allowed themselves to exhale. They excitedly began picking out names for a boy or girl.

But at 19 weeks gestation, they experienced their most tragic loss of all — a baby boy they named George. The grief was incomparable to anything they had gone through previously.

We care. Period. logo“It was a whole other level of loss,” Alex said. “We assumed we were just the unluckiest people ever.”

Alex and Tim delivered George at the Brigham in 2016, and the extraordinary compassion their Maternal Fetal Medicine care team demonstrated touched them deeply.

“The care we received during that delivery was amazing,” Alex said. “The nurse who delivered George impacted our life forever. After we went through that process, I realized there was no other place I’d rather deliver a baby and no other hands I wanted to be in. We always knew we had the best care in the world.”

Staff prepared a memory box for the family, including photos and other keepsakes, to honor baby George.

“It’s the worst day of your life. And then, all of sudden, you have this staff who are treating it not as the worst day but rather as an important day,” Tim said. “They said how beautiful he was and made us feel like it was going to be OK.”

Hope and Faith

Over the years, Alex and Tim said they explored countless explanations for their fertility challenges. They underwent medical and genetic tests and tried dietary changes, exercise regimens and more. They leaned on family, friends and their religious faith for strength. After experiencing yet another loss after George, they started considering options such as adoption and surrogacy.

Mom and child on the beach

Alex shares a special moment with her daughter, Faith, on the beach.

Gargiulo told them he had one more idea. He reached out to a colleague in New York — and former Brigham resident — who specialized in recurrent pregnancy loss. After extensive testing, they discussed two peculiarities in Alex’s biology that otherwise weren’t affecting her health but might explain their hardships: She had a form of insulin resistance that caused blood sugar spikes, although not severe enough to make her diabetic, and an inability in her body to break down blood clots.

Alex began taking medications to address both issues, and they tried another round of IVF. From the beginning, the odds did not seem to be in their favor. Of the 12 eggs retrieved, only two fertilized. Just one tested as genetically healthy.

The Lietos braced themselves for another heartbreak. But as the weeks went by, Alex’s pregnancy was closely monitored by her Maternal Fetal Medicine care team and continued to progress without major complications. Nine months later, they welcomed baby Faith into their arms.

Despite all they had to overcome, the couple say they never lost faith in their dream — the very sentiment that inspired their daughter’s name.

“We always kept hope,” Tim said. “We knew, one way or another, we were going to have a family.”

It’s a message the Lietos hope will resonate with other families experiencing similar challenges.

“I always had to dig a little bit deeper and find the strength I never knew I had. You can too. Don’t give up,” Alex said. “We always say to each other the only way out is through. All the losses we had were so that we could get to Faith and Luca. Do I want to do it again? No. But would I to get them? Every day for the rest of my life.”

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New COVID Recovery Center Seeks to Support ‘Long-Hauler’ Patients with Lingering Symptoms

Physician and medical assistants look at computer

From left: Judy De Leon, medical assistant, Ann-Marcia Tukpah, clinical fellow in Pulmonology, and Fotine Liakopoulos, medical assistant, converse outside a patient room in the COVID Recovery Center, located in the Lung Center.

There were so many things Monique Vaughan, 31, used to do without a second thought.

She worked full-time, sometimes up to 60 hours per week, at a busy mental health facility. To clear her head after work, she took her dog on a leisurely walk through her neighborhood for 30 to 45 minutes. In college, she had taken courses to sharpen her IT skills, making it a breeze for her to troubleshoot technology issues at home.

All of that changed after Vaughan tested positive for COVID-19 over one year ago. Long after recovering from the initial infection — which made her sick enough to require hospitalization for several days — she continues to live with a variety of lingering symptoms that have significantly affected her quality of life. Over the past year, she has been coping with extreme fatigue, intense migraines, severe muscle pain and ongoing cognitive struggles (or “brain fog”) and memory loss.

As a result, Vaughan says she had to scale back her hours at work to part-time. Walking more than a block feels like running a marathon. Focusing on a seemingly basic task can feel impossible at times.

“I was recently having trouble with my router at home. I’m a millennial, so internet stuff has never been hard for me to figure out. It was an issue I had fixed many times before, but this time I couldn’t remember how to do it,” she said. “I got so frustrated that I just sat in front of the router and cried.”

Among the many concerning aspects of COVID-19 has been its long-term effects on the body and mind — a mystery that scientists and health care experts are still just beginning to understand.

We pursue excellence logo

Seeking to address the complex medical and psychosocial needs of “long-hauler” patients like Vaughan, the Brigham recently launched the COVID Recovery Center, a new clinical and research center that brings together experts from a diverse range of disciplines. Each patient is assigned a patient navigator to help coordinate their care and facilitate follow-up appointments, referrals and testing.

While located in the Brigham’s Lung Center, pulmonology is just one of the many specialties the center offers. Depending on what a patient’s individual needs are, they can also be connected with cardiologists, hematologists, infectious disease specialists, nephrologists, neurologists, psychiatrists, dietitians, social workers or other health care providers.

“A new illness mandates a new approach,” said Bruce Levy, MD, chief of the Division of Pulmonary and Critical Care Medicine. “A lot of the symptoms these patients are experiencing are rather non-specific, so primary care providers are often challenged to figure out who is best suited to help their post-COVID patient when help is needed. For patients who may be going to multiple specialty clinics, finding those locations and navigating that system is not easy either. In the COVID Recovery Center, our goal is to ensure COVID ‘long-hauler’ patients get the best, most efficient care possible.”

Centered on Collaboration and Equity

Collaboration is at the heart of the center’s strategy. A multidisciplinary team conducts weekly case reviews to ensure all aspects of a patient’s care plan are thoroughly evaluated. Similar centers recently established at Massachusetts General Hospital and the Spaulding Rehabilitation Hospital for recovering COVID-19 patients offer additional systemwide collaboration opportunities.

The COVID Recovery Center team also works closely with primary care providers for referrals, serving as a centralized resource to patients and providers who are struggling with the management of long-term symptoms, also known as post-acute sequelae. In addition, the center plans to launch peer support groups to allow patients to connect with each other and share their experiences in a safe space.

An estimated 10 to 20 percent of people who had COVID-19 experience persistent symptoms long after their infection has resolved, Levy said. In addition to the symptoms that patients like Vaughan encounter, COVID-19 can also cause the immune system to have a long-term inflammatory response that may lead to serious consequences for the heart, lungs, kidneys and other organs.

“We’ve always known that surviving a critical illness isn’t the same as recovering,” said Daniela Lamas, MD, co-director of the COVID Recovery Center. “Our hope is that this isn’t a chronic condition but rather a lingering condition that improves over time. We are trying to not only respond to it but also find ways to help people improve.”

As part of a broader commitment to health equity, the COVID Recovery Center hopes to partner with community organizations to remove barriers that may prevent patients from disadvantaged communities from seeking care.

“The shared vision we all had was to ensure we were serving the patients who were acutely affected by this pandemic,” said Ann-Marcia Tukpah, MD, MPH, a clinical fellow in Pulmonology who was involved in drafting the proposal for the center last year. “We want to make sure that every element of how care is provided in the center confronts these inequities. It’s not enough to just have the center — we have to think about improving awareness, engaging patients in a thoughtful way, considering transportation costs, the prospect of multiple visits and so on. We have to first identify these barriers, then develop processes to eliminate them.”

In addition to providing clinical services, the center will also include a robust research component to advance our understanding of the long-term impact of COVID-19 from pulmonary, vascular, immunologic, neuropsychiatric, psychological and social perspectives. Patients will be invited to enroll in clinical trials and a clinical research registry.

“There’s a lot we don’t know about this disease,” said Elizabeth Gay, MD, director of the COVID Recovery Center. “Being able to see patients in a setting where other clinicians and providers are thinking about a similar set of issues can allow us to identify patterns and understand needs. And from a research perspective, that offers the ability to develop a cohort you can follow to try to answer some of these questions.”

For patients like Vaughan — who began receiving care at the Brigham prior to the center’s establishment — the prospect of getting answers, and hopefully relief from her symptoms, might be that much closer.

“My body is not the same as it was before,” she said. “It feels like I don’t know myself anymore. It is unsettling to have the body you’ve been in for 31 years feel like a complete stranger. And I don’t know if I’ll go back to normal or this is just the new normal — but I hope not.”

NICU Staff Organize Precious ‘Prom Night’ Party for Babies and Families

Collage of infants in formalwear

From left: Baby Maddie, Baby Alex and Baby Della, with her parents, get all dolled up for “prom night” in the NICU.

Before the pomp and circumstance of graduation come the festivities of prom night — and with it an opportunity to celebrate an important milestone in style. On the eve of their graduation from the Brigham’s Neonatal Intensive Care Unit (NICU), three infants and their families did just that in the most adorable fashion.

Babies Alex, Della and Maddie — whose families met and bonded while the three infants were receiving care in the NICU’s Growth and Development Unit — got glammed up for their own version of prom night on March 9, thanks to a team of creative and compassionate NICU staff.

The idea was the brainchild of NICU nurses Kerri Duggan, RN, SarahKatherine Mascoli, BSN, RN, and Mary Sawyer, RN, who were part of Baby Maddie’s care team.

When Maddie had enjoyed a successful feeding session after some previous difficulties, Duggan joked that Baby Alex could take her to prom as a show of support for her upcoming graduation from the NICU. As the families had also formed close ties with Baby Della’s family in the Growth and Development Unit — where each baby is assigned a bed space in different areas of a shared room — it was only fitting that Della also join the festivities.

We care. Period. logo“The moms found the concept comical, but also it ignited an idea — why couldn’t they have a NICU prom?” said Sawyer. “Our parents and their babies don’t often have ‘typical’ birth stories. We in the NICU celebrate every moment and milestone, as we recognize it’s important for parents to know that their infants are making progress. ‘NICU prom’ just seemed like an ideal way to celebrate all of the infants’ and parents’ hard work before they ultimately graduate from the NICU.”

Mascoli purchased supplies and props to set up a makeshift photo booth, which she decorated with the help of NICU physical therapist Tricia Flynn, PT. The families brought formalwear for their little ones, and Sawyer’s sister, a student in floral design school and former Brigham nurse, fashioned miniature corsages and a boutonniere.

Maddie’s mother, Eliza, expressed her gratitude to the care teams for devising such a special and heartwarming way to celebrate the families’ next chapter.

“Our NICU team brought in decorations and accessories, had customized corsages and a boutonniere made, and were able to celebrate our incredible infants with us,” Eliza said. “Of course, all three babies fell asleep almost instantly, but they were still completely adorable in their dresses and tux! We will never forget the NICU prom as a very bright spot during an emotional journey. To say that our care team is amazing is an understatement. They are now friends for life.”

Sawyer said that staff were grateful to help create a magical moment for the families.

“For these parents, it was a night of laughter that followed many days of a stressful hospital admission and an experience they can carry with them throughout the days ahead,” she said. “Since COVID-19, we have had to change so much, including how families interact with each other. They no longer have a dedicated parent lounge where they can meet other parents and reflect on what each other is going through. These three sets of parents have forged a unique bond from behind curtains and masks where they cheer on each other’s infant and the milestones they accomplish.”

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In Push to Dismantle Inequitable Systems, Brigham COVID-19 Equity Response Team Becomes a Force for Change

zoom call

Members of the Equity Response Team virtually “join hands” during a meeting last year.

Last April, a multidisciplinary group of equity leaders at the Brigham came together to develop strategies for addressing emerging equity issues in the pandemic and, when needed, escalating key concerns through the institution’s COVID-19 Incident Command structure.

With the support and engagement of leaders across the Brigham, the Brigham Health COVID-19 Equity, Diversity and Community Health Response Team became a driving force behind a number of initiatives during the height of the pandemic, including helping to establish community-based testing sites, advocate for equity in the state’s Crisis Standards of Care and conduct more than 100 COVID-19 information sessions for vulnerable populations of employees. As a reinvigorated racial justice movement swept the nation last summer, the group’s twice-monthly meetings also provided a haven for employees to express their concerns and organize actions to help dismantle structural racism.
Stronger Together Brigham Values Logo

Nearly one year after its formation, the Equity Response Team continues to meet and mobilize to address health equity issues at the Brigham and beyond. Most recently, the group has focused its efforts on equitable vaccine distribution, virtual care access and the dramatic rise of food and housing insecurity.

“We had a big opportunity to connect in an integrated way that hasn’t been done before,” said Cheryl Clark, MD, ScD, a hospitalist in Division of General Internal  Medicine and Primary Care, health equity researcher in the Center for Community Health and Health Equity (CCHHE) and a leader of the Equity Response Team. “Clinical departments, community health, employee wellness, the diversity, equity and inclusion team — all of these different workstreams came together under one umbrella to work together on health equity.”

As the crisis evolves, the team remains energized and continues to advance its mission, Clark said.

“We have a very inclusive way of thinking about health equity, and, because of that, the community that continues this work is very cohesive,” she said. “We have a lot to accomplish in vaccine equity, and I think we also have the potential to provide support for burgeoning health equity efforts in the hospital, as well as the United Against Racism work that’s happening MGB-wide.”

‘Inequities Thrive in Silence’

Comprising approximately 90 members, the Equity Response Team formed in response to the recognition last year that local neighborhoods with large communities of color were experiencing significantly higher rates of infection, hospitalization and mortality from COVID-19. These communities also have experienced immense economic and social stress due to job loss, food insecurity and housing instability.

To address these issues, members have focused their work on five equity workstreams: community health, patient access, employee equity, health equity data, and proactive engagement and policy development on key community health issues.

“This group has been a voice and a force for the community — patients, staff and those outside of the hospital walls,” said Tracy Sylven, director of Community Health & Wellness at BWFH and a leader of the team’s community health workstream. “We helped to drive the equity agenda and need to the forefront of the institution during this time of crisis, including the pandemic and the racial inequality and protests we saw during the past year. The group, with the variety of workstreams and leads, has a voice across many aspects of the institution and helps to incorporate equity into the planning and process of work.”

RonAsia Rouse, MPH, project manager for the team, said the group’s diverse makeup sparks innovation and inspires progress.

“The Equity Response team offers a space for employees to collaborate and have their ideas and opinions heard in a way that is unlike any other meetings I’ve been a part of,” said Rouse, who also serves as program manager for Health Equity in the CCHHE. “Our members include clinicians, researchers and administrators, and having the ability to get everyone’s direct feedback and input on equity-focused topics has propelled projects and strategies that otherwise may not have been thought of or initiated.”

Michelle Keenan, senior director for Health Equity and Social Innovation in the CCHHE, agreed.

“What I have valued the most is that it is a multiracial, multidisciplinary group with a deep commitment to be the change we want to see in the world,” Keenan said. “As we have built our equity response to COVID, we have also built trust and understanding among staff. Inequities thrive in silence, and what has been most important is breaking this silence and taking collective action.”

‘We Know the Goal’

In the realm of community health, the group worked closely the Ambulatory Services team, led by Kelly Fanning, MBA, vice president of Ambulatory Services, and leaders from Brookside Community Health Center and Southern Jamaica Plain Health Center to support testing sites in four Boston neighborhoods. At these sites, staff conducted approximately 19,000 COVID-19 tests, distributed over 12,000 food boxes and 18,700-plus hot meals, handed out more than 20,000 care kits and performed about 15,000 social-determinants-of-health screenings.

In the area of patient access, members created a virtual care equity committee and advocated along with Interpreter Services leaders for increasing access to iPads to better support patients who communicate in languages other than English. In an effort led by Bernie Jones, EdM, vice president of Public Policy, and Wanda McClain, MPA, vice president of Community Health and Health Equity, and supported by Equity Response Team members, the group reached out to state lawmakers to advocate for an eviction moratorium and developed resources to support patients facing eviction.

“We know the goal — breaking down unequal systems, not people,” Jacqueline Rodriguez-Louis, MPH, M.Ed., a member of the Equity Response Team and programs leader for Community Outreach at the Partners Asthma Center in the Division of Pulmonary and Critical Care Medicine. “That’s what this group endeavors to do. Together, we are making a real and measurable difference in the organization and in the community we serve. This work is not only rewarding, but it is also soul-healing for me as a person of color during this incredibly difficult time.”

The team has also worked in close coordination with colleagues across Mass General Brigham (MGB). More broadly, MGB has led a systemwide commitment to incorporate an equity lens into every aspect of pandemic response and other initiatives, including the United Against Racism campaign.

“I’m just so excited by the work everyone has done,” said Clark, who also serves as director of Health Equity Research and Intervention in the CCHHE and a multi-principal investigator for the All of Us Research Program. “Those of us who are engaged in health equity work, including health equity research, understand this is a multidisciplinary proposition. It has been really rewarding to be able to operationalize our workstreams and build partnerships to create an infrastructure where that kind of multidisciplinary, systemwide work can happen.”

Finding Community amid ‘the Crisis of Our Time’

Contributing to these efforts has been an empowering experience, especially during such an uncertain time, say the team’s members and leaders.

“When this crisis hit and research paused, I thought it was important to ‘redeploy’ myself and raise my hand to guide these efforts,” Clark said. “It really is the crisis of our time.”

Rodriguez-Louis said the team’s regular meetings were an essential source of support after the killings of Ahmaud Arbery, Breonna Taylor and George Floyd.

“This group has been a lifeline,” she said. “Our meetings have allowed us to put our feelings someplace safe. We cry together, scream when we need to and put our hands to work.”

Christin Price, MD, program director of Medicaid ACO for Brigham Care Strategies & Innovation, who led several of the team’s community health-related initiatives, said being part of the group has been both professionally and personally rewarding.

“For me, the greatest part of this experience was the opportunity to participate in work that I otherwise would perhaps not have the opportunity to be involved in, such as being site lead at the new testing site or being a part of the vaccine trial group,” Price said. “The other part has been being able to work closely with colleagues across Brigham that I had not known or not worked closely with before. I have made very close connections with new colleagues.”

The Brigham Health COVID-19 Equity, Diversity and Community Health Response Team meets virtually twice a month, Thursdays, 5–6:15 p.m. All members of the Brigham Health community and MGB system are welcome to attend. To learn more or become a member, contact covid19equity@bwh.harvard.edu.

‘The Best Feeling in the World’: Staff Reflect on Launching COVID-19 Vaccination Clinics for Patients

Collage of photos from COVID-19 vaccine clinics

As of March 1, the Brigham has completed about 8,600 patient COVID-19 vaccination appointments, including both first and second doses, at the Hale and Pembroke clinics.

Editor’s note: This is the second in a two-part series recognizing the extraordinary efforts of staff who made the Brigham’s employee and patient COVID-19 vaccination programs possible. Click here to read part one, which highlighted members of the employee vaccination team.

As the first patients age 75 and older began receiving the COVID-19 vaccine at Brigham and Women’s Health Care Center, Pembroke, on Feb. 3, an unexpected sound caught the attention of Julie Owens, BSN, RN, one of the site’s clinical leads.

What she heard was cheers and applause.

“I soon realized that the patients were celebrating this moment and the joy of being able to get a vaccine,” said Owens, who normally serves as professional development manager for Brigham and Women’s Harbor Medical Associates in South Weymouth.

The emotions in the room — happiness, relief and excitement — were contagious, Owens recalled.

“Several patients commented on how grateful and happy they were to be one step closer to hugging their children and grandchildren again,” she said. “This touched me personally, as a daughter and mother of two young children who long to hug their grandparents again.”

That celebratory evening kicked off the Brigham’s patient vaccination program, which in its first week delivered approximately 1,700 vaccinations in total at the Pembroke site and the Hale Building for Transformative Medicine on the main campus. As of March 1, the Brigham has completed about 8,600 patient vaccination appointments, a measure that includes both first and second doses. Brookside Community Health Center will also begin providing vaccines for local residents starting March 4.

Stronger Together Brigham Values LogoThe program’s successful launch was made possible by the efforts of a large multidisciplinary team who worked tirelessly behind the scenes — and in close collaboration with colleagues across Mass General Brigham (MGB) — to provide a seamless, safe experience for patients and clinic staff alike.

“I am always looking for the silver lining to this challenging COVID experience. When I think about a silver lining now, I am grateful for the wonderful people across Brigham Health Ambulatory,” said Kelly Fanning, MBA, vice president for Ambulatory Services and Patient Experience. “Consistently, clinical and non-clinical leaders have stepped up to the plate to go above and beyond and deliver for our patients. What it has meant for patient vaccination efforts is that we have been able to run clinics daily, nightly and weekends to care for our patients and serve the broader public health need.”

Kali Kearns, senior project manager for Ambulatory Services, said she cherished the opportunity to contribute to such a historic and important moment.

“When we first started planning, I don’t want to say it seemed impossible, but we’ve never really done this and didn’t know what to expect,” Kearns said. “But once all was said and done, our first night in Pembroke was full of joy and relief. I was a little bit tearful myself because my grandpa just got the vaccine, and our patients coming in reminded me of him. It was so touching. They were so vocally thankful and said things like, ‘This is the best day,’ ‘This is going to change my life’ and ‘You’re helping me see my family again.’”

Pam Cormier, MSN, RN, AHN-BC, who led strategic planning efforts for the Brigham’s patient vaccination program and collaborated with leaders at the system level, described being part of this team as “a highlight of [her] career.”

“It’s been a lot of work, but when you can get this vaccine into people, it’s the best feeling in the world,” said Cormier, professional development manager in Primary Care. “Everybody has been willing to step up and do whatever it takes to help. I’ve yet to encounter anyone who’s said, ‘No, I’m not interested’ or ‘I don’t have time for this.’ The minute we reach out, people drop what they’re doing and ask, ‘How can I help?’ It’s the Brigham way.”

Complex Challenges, Creative Solutions

In planning a strategy for setting up and running patient vaccination sites, the team drew from their experiences with the patient flu shot clinics held last fall.

Nurse Cassandra Kelly unpacks vials of the COVID-19 vaccine in preparation for the first patient clinic at Pembroke.

“We knew the model of standing up in existing clinic spaces — using the exam rooms, physical structures and staff who could work an extra shift — worked really well for the flu,” Cormier said. “We did have to pace it differently with the COVID vaccines, as we had to factor in the 15-minute observation period, but the bones of the model were pretty much the same.”

The employee COVID-19 vaccination clinics were also an important learning opportunity for understanding how a patient clinic would work.

“Starting with employees gave us a big window into some of the challenges we were going to face when we moved to patients,” Cormier said.

But the patient vaccination also presented new challenges — including different scheduling needs, additional staffing and location demands, alternative communication and outreach strategies — in addition to the ongoing uncertainties around vaccine supply.

Because demand for the vaccine greatly outweighed supply, the Brigham and other MGB institutions were unable to allow patients to self-schedule their appointments. Instead, the team began the meticulous process of proactively identifying eligible patients through Epic, formulating a strategy for inviting patients in waves and developing an efficient cadence in the clinic.

“It’s really about knowing how many patients we can vaccinate per hour and making sure that we build schedules that reflect that,” said Bill Guptill, director of Ambulatory Capacity Management, whose team developed the complex scheduling templates for the vaccine clinics.

On-site teams also worked around the clock to ready the clinics in Pembroke and Hale. In addition to setting up the sites’ various technology needs — from wireless networking to electrical engineering to software applications — a dedicated team of Information Systems (IS) staff provided at-the-elbow support for clinic staff before and after the vaccine clinics launched, said Michael Sweet, MBA, executive director of Clinical Systems in Brigham Health IS and Digital Innovation.

“Trying to see and touch base with everybody is a little more challenging in some of the ambulatory locations,” Sweet said. “By comparison, Hale is one big room, so we can see the vaccinators and check-in and check-out staff. But in Pembroke, staff operate on two floors and are more cordoned off, so it’s a little more difficult for them to see us, and for us to see them, when they need help. It was a collaborative effort to figure out how we could best support them in that space.”

Exceptional Teamwork

Those who contributed to the patient clinics in February said they were grateful to make a difference and be part of this dedicated team.

“This was truly an endeavor where we operated as one system,” Cormier said. “For me, it was a very tangible way to show and leverage the power of an entire health care system. If you normally get your care at the Brigham but live closer to Newton-Wellesley, then you could go to the Needham site — no questions asked. That’s really powerful for patients. They see and know they’re part of a larger system that takes care of them.”

The amount of planning that occurred behind the scenes was a sight to behold, Owens said.

“Operationalizing these vaccine clinics has taken the work of so many people. Through countless hours and attention to every detail, our staff have made the process as smooth and streamlined as possible while maintaining our Safe Care Commitment,” she said. “I am especially thankful to our staff for their dedication to our patients.”

In Administering Thousands of COVID-19 Vaccine Doses to Colleagues, Hale Clinic Staff Witness ‘a Glimpse of Hope’

Staff in clinical and non-clinical roles have volunteered their time or taken on new assignments to keep the employee COVID-19 vaccination clinic in the Hale building running smoothly and safely. Top row, from left: Megan O’Connor; Gyorgy Frendl vaccinating Zara Cooper; Brieanna Gacek. Bottom row, from left: Brendan Cormier, Rachel Fearing and Sarah Micucci

Editor’s note: This is the first in a two-part series recognizing the extraordinary efforts of staff who made the Brigham’s employee and patient COVID-19 vaccination programs possible. Click here to read part two, which features the patient vaccination teams.

In December, the second-floor atrium of the Hale Building for Transformative Medicine transformed from a quiet lunch spot to the bustling hub of activity for employee COVID-19 vaccination at the Brigham. In the weeks and months since, Brigham staff have continued to work tirelessly behind the scenes to administer the vaccine to their colleagues and provide a seamless experience for all who entered the clinic — all while becoming a part of history in the making.

To ensure the clinic was operational as soon as vaccines were available, the Brigham drew from its existing workforce to staff clinical and non-clinical roles. That included dozens of employees — medical assistants, nurses, physicians, physician assistants, practice managers, research assistants and more — who volunteered or were temporarily reassigned to support the clinic’s day-to-day operations and collectively administer thousands of vaccinations every week.

Stronger Together Brigham Values Logo“I have been so impressed by our Brigham staff who have stepped up to administer vaccines and support the clinic in Hale,” said Karl Laskowski, MD, MBA, associate chief medical officer for Ambulatory Services, who co-lead the employee vaccination program with Paula Kackley, MBA, executive director of Clinical Services, and Sarah Kirchofer, MSN, RN, NP-C, NE-BC, interim director of Occupational Health Services.

“Their enthusiasm and dedication have provided hope during what would otherwise be a very hard winter,” Laskowski added. “They have worked extra hours, sometimes in addition to their regular roles. They have braved snowstorms. They have come in early and left late. And they have administered tens of thousands of vaccines. None of this would be possible without their hard work.”

‘The Best Job I’ve Ever Had’

Among the vaccinators is physician assistant Megan O’Connor, PA-C, who volunteered to work 12-hour shifts at the Hale clinic once a week and said she gives about 70 to 80 doses of the vaccine per shift.

“It’s been such a rough year that it’s so nice to have a little bit of a bright side,” O’Connor said. “It’s exciting. I haven’t been involved in anything like this before.”

Every shift, O’Connor converses with colleagues she hasn’t seen in months, as well as many new faces, as she gives them a dose of the groundbreaking vaccine. Despite the long hours, O’Connor said the work is extremely rewarding.

“It seems like a simple task to give shots in arms all day, but the reaction from people is really overwhelming. Everyone’s so excited, emotional and a little bit anxious,” O’Connor said.

Image of quote from articleNurse Brieanna Gacek, RN, BSN, PCCN, helped open the first Special Pathogens Unit and Special Pathogens-Intensive Care Unit (ICU) during the first surge in spring 2020. Nearly one year later, she received a new assignment — to administer some of the first doses of the vaccine in the Hale clinic.

“We were all really grateful for the opportunity. I felt like it was a glimpse of hope after what we all had gone through in the last year,” Gacek said. “To be able to give the vaccine to my colleagues has been an honor and I am so grateful to help keep them safe from the virus.”

Gacek said it has been inspiring to see so many people come together, including colleagues from many different departments and retired staff who returned to support the clinic, all with the shared goal of overcoming the pandemic.

“The vaccine clinic is very busy. There are a lot of questions that come up and it can be hectic at times, but it’s been so rewarding to be there making a difference and seeing people who are so gracious and genuinely happy to be there,” Gacek said. “A lot of the vaccinators have said, ‘This is the best job I’ve ever had.’ Everyone feels they’re getting this sense of fulfillment from being able to help protect people from the virus and return to a sense of normalcy.”

Anesthesiologist Gyorgy Frendl, MD, PhD, who also serves as director of Anesthesia Critical Care Research, spent his vacation days volunteering as a vaccinator at the employee clinic in Hale.

“At some point, there were a lot of doctors, surgeons and anesthesiologists coming in to get vaccinated, and they were all surprised that I was sitting there. But I think it was very reassuring for them to hear that I already got the vaccine,” Frendl said. “So, I not only vaccinated them, but I also told them that when I got it, I was OK.”

‘Even Better Than I Could Have Hoped’

Non-clinical staff have also played an essential role in employee vaccination efforts — including checking in colleagues for their appointments, scheduling their next dose and countless unseen contributions that keep the clinic running smoothly.

Sarah Micucci, a medical assistant in the Division of Rheumatology, works as an operations lead at the Hale clinic, where she helps with check in and check out, greeting new arrivals, distributing the vaccine to vaccinators and assisting with Epic troubleshooting. She said the vaccine clinic’s greatest strength is that it draws on the diverse experience and expertise of employees from across the Brigham, resulting in a team with an expansive skill set.

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“I’m extremely grateful to be working and learning alongside people who genuinely want to help in any way that they can,” Micucci said. “This has made the clinic run even better than I could have hoped.”

Brendan Cormier, a Safe Care Commitment assistant and nursing student, said being an operations lead at the clinic has been his favorite job to date. Playing a crucial part in helping colleagues receive the vaccine, and working in the clinic’s inviting atmosphere, keeps him motivated during long shifts.

“Arriving to work and seeing the schedule full of people to be vaccinated can be a bit daunting at times, but then I remember that every person who comes into the clinic is one more person who is on their way to being protected,” Cormier said.

Patient care associate and graduate student Rachel Fearing said she checks in about 700 to 800 people during her shifts as an operations lead. When the employee vaccine clinic began transitioning to appointments for patients 75 and older, Fearing remembered one woman tearing up when she arrived for her first dose.

“No matter how hectic the day is, or how long the hours are, experiences like that one — with someone who was just so overwhelmed and so overjoyed with our little clinic in the Hale building — make it all worth it,” Fearing said.

Laskowski reflected on the tremendous difference that clinic staff have had on the Brigham community.

“With very little lead time and a seemingly non-stop schedule since then, staff in Hale clinic have done an outstanding job in helping our employees get vaccinated these past three months,” he said. “Leaders from some of the mass vaccination sites visited Hale prior to their launch to learn how they might model a successful high-throughput clinic. We could not have achieved nearly a fraction of what we did without the remarkable contributions of our vaccinators and clinic staff.”

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Rejecting Fear, Embracing Life: After Second Face Transplant, Brigham Patient Welcomes ‘New Life, New Adventures’

Collage of two photos. Left photo, Carmen Blandin Tarleton seven months after her second face transplant. Right photo: Bohdan Pomahac examines Tarleton during a recent follow-up appointment.

Left photo: Carmen Blandin Tarleton, seven months after her second face transplant; Right photo: Bohdan Pomahac examines Tarleton during a recent follow-up appointment.

An unusual pain on her face caught Carmen Blandin Tarleton by surprise one day in August 2019.

It had been six years since Tarleton underwent a face transplant at the Brigham following a brutal attack by her estranged husband, who doused her with chemicals that caused severe burns on over 80 percent of her body and rendering her legally blind.

A former nurse, Tarleton knew the symptoms might be her body signaling that her transplant was failing. Her doctors had warned her of the possibility over the years. Fiercely optimistic by nature, however, she tried to push the thought out of her mind. The pain could be anything, she told herself.

Within two days, it became clear something was wrong. Her discomfort worsened, and now it was accompanied by swelling. Tarleton contacted her Brigham care team and scheduled an appointment for the following week. But by the time the weekend arrived, the swelling turned into intensely painful blisters. She came to the Brigham, where her care team confirmed her worst fear: Her body was rejecting the transplant.

“I was in shock,” Tarleton recalled.

Nearly one year later, life would surprise her again — this time for the better.

Last July, at age 52, Tarleton became the first person in the U.S. and second in the world to receive a second face transplant. The 20-hour surgery, involving a multidisciplinary team of over 45 clinicians, was the 10th face transplant performed at the Brigham since 2011 and the 16th nationwide.

Photo of Tarleton being transported to the Operating Room

Tarleton is transported to the Operating Room for the first of two procedures for her second face transplant in July 2020.

“I said, ‘I want one more shot, and if it doesn’t work, then so be it,’” Tarleton said, recounting a conversation with her care team about pursuing a second face transplant. “If I was a candidate, I wanted the best possibility. But I just let it go after that. I didn’t worry about it, and that’s sort of how I roll because you can’t get caught up in the drama, worry and concern of that and still feel good.”

Now, seven months after her second face transplant, Tarleton says she feels better than she has in years and is deeply grateful for not only her donor’s gift but also the compassionate, dedicated Brigham team who has stood behind her every step of the way.

“When life brings you negative experiences, it’s only to allow you to evolve as a human being, and I feel like that’s what happened to me,” she said. “Do things get easier, and then I get happier? No. I get happier, and things get easier. And that’s what I’m realizing.”

Tarleton had the opportunity to speak with the family of the donor recently and came away inspired after the emotional meeting.

“I have such great appreciation for my donor and donor family for this life-changing gift,” she said. “Their ability to make such a decision in the most difficult of times is a true offering of love to their family member and me, a stranger they did not know. I was so happy for the opportunity to let them know how much they impacted my life for the better.”

Writing Her Next Chapter

Compared to her first face transplant, the donor tissue used in Tarleton’s recent surgery is far more compatible — greatly reducing the risk of another rejection — and it more closely resembles how Tarleton looked before her injury, in terms of skin tone, hair color and face size. Her recovery has also been smoother this time, thanks to several changes her surgeons made to the transplant procedure (see related sidebar for more details).

Bohdan Pomahac, MD, director of Plastic Surgery Transplantation, who led the surgical team for both of Tarleton’s transplants, said he has been delighted with how well Tarleton is progressing and recovering.

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“One can hope for a transplant to last a patient’s lifetime, but realistically speaking, every type of transplant has a finite lifespan. Carmen’s second transplant was a carefully planned and executed operation that provides hope to all patients whose transplant is failing,” Pomahac said. “Carmen is one of the most resilient patients that I have had the opportunity to care for. We call this procedure life-giving, and we are thrilled to offer her the opportunity to return to the type of life that she so richly deserves.”

Since her injury, Tarleton’s life has been full of rewarding experiences. She became a published author and inspirational speaker, sharing her story of courage and forgiveness with audiences worldwide. She also celebrated more personal milestones, including learning to play piano and becoming a grandmother.

“My first face transplant served me very well. I accomplished many things that I really needed to stay in this life, and one of them was comfort,” Tarleton said.

With her next chapter waiting to be written, Tarleton sees only greater possibilities on the horizon.

“I am looking for a new life, new adventures,” she said. “I can’t put it into words yet, but it’s going to be a lot of fun. I’m just going to have a really good time, and I know it.”

A Different Transplant Experience

Photo of surgeons in Operating Room

Members of the Otolaryngology-Head and Neck Surgery team work in collaboration with members of the Plastic Surgery team to prepare Tarleton’s face for transplant.

Carmen Blandin Tarleton’s first transplant experience was challenging because the lifesaving blood products and tissue grafts she needed as a result of her original injury placed her at a higher risk to reject the transplant, a complication known as sensitization. Over the years, she experienced repeated episodes of rejection, which injured the blood vessels supporting her first transplant.

“Once a patient is highly sensitized, they remain at higher risk of rejection,” said Anil K. Chandraker, MD, director of Renal Transplant Medicine and a member of the transplant team. “Going into her second face transplant, Carmen was not highly sensitized, not at high risk of rejection, as she had lost nearly all of the HLA antibodies in her blood that had made her previously highly sensitized — likely due to the immunosuppression she had received during the first transplant.”

In addition to the rarity of a second face transplant, the surgery was unique on several other fronts. First, it was marked by an unusually close tissue match from Tarleton’s donor, which lowers her future risk of rejection. Additionally, the surgery progressed differently than the previous ones the Brigham team had performed.

“This will likely serve as a prototype going forward,” said Bohdan Pomahac, MD, director of Plastic Surgery Transplantation. “The surgical team paused the transplant approximately 15 hours into the surgery, allowing us to better manage the blood loss, which can interfere with blood clotting during the operation. We completed the surgery the following day, which decreased the time Carmen had to spend in the operating room overall.”

Tarleton said the acceleration of her recovery was remarkable. “I stayed in the hospital for half as long than I did the first time, and I did not need as many medications. I almost lost my first face transplant post-operatively, and this time it wasn’t like that at all,” she said. “I did so much better. My recovery has gone extremely well.”

New Clinic Supports Employees with COVID-19 Vaccine Allergy Concerns

From left: Jeremy Dias, Jeanette Cote, Kenisha Lewis and Paige Wickner helped lead the team behind a new clinic supporting employees with allergy concerns related to the COVID-19 vaccine.

The arrival of COVID-19 vaccines inspired hope and relief around the world, but it also raised another emotion — uncertainty — for those with a history of allergic reactions to certain vaccines. A new clinic at the Brigham is helping employees across the system assess and alleviate allergy concerns by helping them better understand their risk and, in many cases, develop a plan to safely receive the vaccine.

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Launched in late December, the service is part of the Division of Allergy and Clinical Immunology. It is one of two specialized clinics to offer skin and allergy testing for employees across Mass General Brigham (MGB) who are at risk of an allergic reaction to the COVID-19 vaccine. The second clinic is located at Massachusetts General Hospital (MGH).

“When we were developing our plan for vaccination for employees across MGB and saw the emerging reports about allergic reactions to the COVID-19 vaccine, we knew we had to work across our system to develop a framework so that our employees felt safe, comfortable and supported,” said Paige Wickner, MD, MPH, an allergist and immunologist who developed the framework for the Brigham clinic.

Providing these services and support to colleagues who might otherwise decline the vaccine has been tremendously gratifying, said Jeanette Cote, MSN, RN, charge nurse for the Allergy and Clinical Immunology Clinic, who led the implementation of the new clinic’s skin testing protocol.

“There’s a lot of anxiety about vaccination, especially for people with allergies, so it’s nice to offer some peace of mind,” Cote said. “This is why nurses go into our profession — it’s rewarding to know that you’re helping somebody.”

Although it’s been a fast-moving project and the additional visits have added to the Allergy and Clinical Immunology team’s usual caseload, providers and staff are committed to supporting their colleagues across the system, said Jeremy Dias, DNP, RN, NEA-BC, nursing director for Allergy and Clinical Immunology.

“Despite the challenges, it’s gone really smoothly, which speaks to everybody’s willingness to step up and go above and beyond to make this happen,” Dias said. “What was most important to us was making sure this vaccine could be available to as many people as possible, as fast as possible, so that our community is protected.”

Creating a Safe Plan for Vaccination

The team has worked closely with colleagues in Ambulatory, IS and Occupational Health Services to proactively identify employees who might be at risk for an allergic reaction to the vaccine.

Before employees can schedule a vaccine appointment in COVID Pass, they must complete a brief questionnaire to assess their allergy risk. Those whose indicate they have a history of allergies to ingredients in the vaccine or a history of anaphylaxis — a rare but severe allergic reaction throughout the body — are referred to the clinic for a consult with an allergist.

The team aims to schedule virtual consults within three days of receiving an employee’s responses to the questionnaire. In the five weeks the clinic has been operational, the team has conducted hundreds of virtual consults.

“We are aware that many employees are very anxious to get their vaccination, so it’s important that we get them in for a consult in a timely manner, especially if they’re concerned about a possible reaction,” said Kenisha Lewis, practice manager for the Allergy and Clinical Immunology Clinic, who led efforts to develop the scheduling strategy for the vaccine allergy and skin testing clinic.

If an allergist determines the employee would benefit from skin testing, a follow-up appointment is scheduled. During a skin test, small amounts of three vaccine ingredients that are known allergens are injected into the skin. In this controlled setting, a reaction would be far milder than if an allergic person received the full amount present in the vaccine.

The team also maintains a pager for an on-call allergist to assist with allergy questions that arise at the employee vaccination clinic. In addition, the small subset of employees who had an unanticipated reaction to their first dose can arrange for an allergist to be present for their second-dose appointment.

In many areas of the country, those with vaccine allergies are simply advised not to receive the vaccine or to forego their second dose if they have a reaction to the first. Leaders at the Brigham, MGH and MGB saw an opportunity to support their workforce by leveraging the system’s expansive allergy expertise, Wickner said.

“A lot of systems in the U.S. don’t have anything like this in place,” she added. “Our goal was to be risk-averse and develop a framework to help our employees safely get vaccinated. We’ve also learned a lot from this process, and this collaboration will inform what we’ll be able to offer patients.”

‘Passionate About the Power of Immunization’

Launched just 10 days after the Brigham vaccinated its first employees, the clinic rapidly came together thanks to interdisciplinary collaboration.

“It needed to be multidisciplinary because everybody’s expertise was needed,” Dias said.

Designing the framework and protocols from scratch in such a short timeframe was an intense process with a rapid cycle of process improvement.

“When we started, it was two to three meetings per day, every day. If we saw something wasn’t working, we were like, ‘Let’s jump on a call to figure this out,’ and within a week it was running very smoothly,” Lewis said. “It was challenging because we’re working with the same amount of staff and still running the regular allergy clinic as well, but we put in the time and made it a priority because we know how important this is.”

Collaboration also extended beyond the core team at the clinic. For example, nurses worked closely with Pharmacy Services at 850 Boylston St. to make the process seamless for providers who conduct skin testing. Cote recognized the efforts of Tamara Roldán Sevilla, PhD, BPharm, senior pharmacist, who sought to support her nurse colleagues by preparing convenient, individualized packets of medications for the skin-testing orders.

“Tamara went the extra mile to make sure we had what we needed and delivered it to us in a way that eliminated any guesswork,” Cote said. “We didn’t have to go hunting for anything. She made it very easy for us.”

The entire team’s dedication has been nothing short of remarkable, Wickner said.

“This has been a very heavy lift for everyone. Like everything from the past year, this clinic has been an ‘add on,’ not an ‘instead of,’ and it’s a real testament to all our staff who have worked tirelessly on this effort,” Wickner said. “We all feel so passionate about the power of immunization and helping those who have a history of allergies get vaccinated safely.”

‘This Family’s Story Sat in Our Hearts’: Care Teams Go Above and Beyond to Support Patients

Amanda, Patrick and Noah Beauregard

Amanda and Patrick Beauregard bond with their newborn son, Noah

Amanda Beauregard, 31, did her best to ignore the mounting discomfort in her belly while resting in her husband Patrick’s room in Medical Oncology on Connors Center 7.

Amanda, then 38 weeks pregnant, tried to reassure herself the pain was probably just pent up stress after the crazy day they’d had. The Lowell couple originally planned to come into the Brigham that morning for an MRI scan to determine if some worrying symptoms Patrick, 32, was experiencing meant the colon cancer he’s lived with for three years had spread to his brain.

But that morning, Patrick’s symptoms were so severe that they instead took an ambulance to a nearby community hospital, and he was soon transferred to the Brigham. After an MRI confirmed a cluster of tumors were pressing on Patrick’s brain, the couple met with his care team to discuss their options, ultimately opting for surgery and radiation therapy.

After they were settled on Connors Center 7, Amanda sent a message to her obstetrician’s office about potentially transferring her care from Massachusetts General Hospital, where she had planned to deliver, to the Brigham. Just in case.

Baby Noah unexpectedly arrived a few hours later. Patrick went into the Operating Room the following day.

Behind the scenes of the family’s emotional whirlwind of events, their Brigham care teams — comprising countless staff across multiple areas — rallied together in extraordinary ways to support them at every turn.

We care. Period. logoThroughout the family’s stay, staff from several areas coordinated visits between floors so that Patrick and Amanda could be by each other’s side and bond with Baby Noah together. Anesthesiology, Neurosurgery and Operating Room (OR) staff seamlessly accommodated a last-minute schedule change to move Patrick’s surgery from Saturday to Sunday to give the couple extra time to celebrate the joyous addition to their family.

And while navigating the compounding challenges of a high census and the COVID-19 pandemic, several teams collaborated to ensure Amanda and Baby Noah could stay a few extra days so that all three could go home together when Patrick was ready for discharge.

“We were treated with such care, compassion and thoughtfulness,” Amanda said. “It took a lot of people working together to make sure we got the best care — not just physically but also emotionally — and could stay together as a family, understanding how important that was to us.”

Katherine Gregory, PhD, RN, associate chief nursing officer for Women and Newborns, described the event as a shining example of the compassionate, patient- and family-centered care that staff deliver every day.

“The pandemic has changed many things about how we care for patients and families, but it has not changed our commitment to meeting our patient’s complex health needs with expertise and empathy,” Gregory said. “Caring for Patrick, Amanda and Noah as a family required the expertise of many teams from across the Brigham.”

‘Let’s Do This for This Family’

When Amanda went into labor in Patrick’s room, Medical Oncology nurses accompanied her to Obstetrical Admitting. Baby Noah arrived about two hours later — before Patrick could even make it to Labor and Delivery, where staff ensured Amanda received additional support amid such a rapidly evolving event.

“It is not often in adult Oncology that we have a crossover to Labor and Delivery, but I think this event truly exemplifies the level of compassion and dedication that exists among our staff,” said Emily Hagens, MSN, RN, nurse director for Connors Center 7. “Everyone on the unit recognized what a unique and incredibly stressful situation it was for Patrick and Amanda.”

Obstetrics and Gynecology resident Samantha Truong, MD, who was among the many members of Amanda’s multidisciplinary care team, agreed: “In so many ways, our care expands beyond just making sure a patient is meeting their postpartum milestones. We wanted to make sure their family could be together during such an important time, from the birth of their son to Pat’s surgery. As a care team, this family’s story sat in our hearts.”

Neurosurgeon Nirav Patel, MD, who was part of the multidisciplinary team that performed Patrick’s surgery, recalled how the family’s touching story inspired the whole team.

“After we decided to postpone the surgery, I explained the situation to the OR team. To be honest, I wasn’t sure how people would react. It was already a busy weekend, and the OR was stretched a little thin due to COVID,” he said. “But, of course, everyone jumped in to help. The day of the surgery, Evan Blaney, the anesthesiologist, turned to me and said, ‘Let’s do this for this family.’ Our patients’ bravery makes any challenges we face look like nothing.”

Supporting Patients and Families

During such an unpredictable time in their lives, it was reassuring to have so many people in their corner, Amanda said.

Beauregard family

Amanda and Patrick Beauregard, with Baby Noah, during their stay at the Brigham

“I cannot imagine having to go home without Pat. It just meant so much to be able to stay there and know that we were in such good hands. If I was trying to speak with one of Pat’s providers on the phone and Noah started to have a fit, my nurses would say, ‘It’s OK. I’ve got him. I’ll take him to the nursery for you,’” Amanda said. “Then they’d be on the phone with Pat’s nurses coordinating so that Pat could come down or, if Noah was in the nursery, that I could go up and see Pat.”

The dedication demonstrated by staff in the Neurosciences Intensive Care and intermediate units, where Patrick recovered after surgery, came as no surprise to Karen Reilly, DNP, RN, MBA, NEA-BC, associate chief nursing officer for Critical Care, Cardiovascular and Surgical Services.

“We have extraordinary staff who not only provide outstanding clinical care but also go above and beyond to meet the physical and emotional needs of both the patient and family,” Reilly said. “This is vital to the healing process.”

After experiencing so many ups and down with Patrick’s illness over the years, Amanda said they take each day together as a gift — one that has now become even more precious.

“Any time we get bad news, it’s obviously very shocking and so upsetting. But I think we’ve always tried to stay positive, stay hopeful and keep moving forward,” she said. “We don’t want to fill any day with negativity. We just don’t see a point in it, and that’s especially true now with Noah. We try to soak up every day together as much as we can.”

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Digital Technology Becomes Essential Part of Patient Care

Peter Chai demonstrates "Spot," a robot

Peter Chai demonstrates “Spot,” a robot used in the Emergency Department to remotely triage COVID-19 patients. Photo credit: Susan Symonds/Mainframe Photographics

Physical distancing remains one of the most important and effective measures for preventing the spread of COVID-19, but it initially presented clinicians with a dilemma: How do you safely deliver care when face-to-face interactions suddenly pose so many challenges?

One compelling solution: digital technology.

The meteoric rise of virtual care and rapid adoption of new technologies across Brigham Health helped keep staff, patients and families healthy, safe and connected throughout the pandemic. From the booming expansion of existing programs to the swift implementation of new ones, multidisciplinary teams used mobile devices, video conferencing and even robots to continue delivering expert care with compassion.

“Before COVID, there was almost no virtual care happening in our acute care settings, and less than 1 percent of ambulatory visits were done virtually,” said Adam Licurse, MD, MHS, executive director of Virtual Care for Brigham Health. “That changed nearly overnight.”

 ‘A Game-Changer’

When the spread of COVID-19 prompted the Brigham to shutter most ambulatory clinics in mid-March, the Virtual Care team and Information Services (IS) staff came together to support hundreds of providers who were caring for patients remotely for the first time.

In February, prior to COVID-19’s widespread presence in the Northeast, Brigham outpatient providers collectively conducted 200 virtual visits. In May, they completed 80,000.

“Very quickly, we had to train nearly all outpatient providers on how to do visits over the phone and by video,” Licurse said. “It was a huge mobilization of resources and communication, including guidance around regulatory issues and reimbursement, in addition to procuring and distributing a lot of new equipment like webcams.”

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Primary care physician Lilian Mahrokhian, MD, completed approximately 500 virtual visits between March and May, mostly from her home via video. In May alone, her appointment volume exceeded that of a typical October, historically the busiest month for primary care.

“It’s been a game-changer. Patients have loved the opportunity to see and talk with us, and it has been invaluable to check in with them while keeping all of us safe,” said Mahrokhian, who practices at the Fish Center for Women’s Heath. “I keep thinking, what if this pandemic had hit at a time when this technology wasn’t in place? We would not be able to deliver this type of care as effectively.”

Mahrokhian, an enthusiastic proponent of telehealth prior to the pandemic, said that while not every condition can be treated remotely, many aspects of primary care are well-suited to the model.

“There’s a lot of counseling we can do in primary care that translates well to virtual care,” she said. “An in-person exam is not as relevant for evaluating a patient’s response to an antidepressant or helping them manage weight loss.”

Mahrokhian said she was exceptionally grateful to Virtual Care and IS teams who worked behind the scenes to continually monitor the system, respond to providers’ needs and quickly implement improvements.

“As a provider, I felt really supported,” she said. “It seemed like they were working tirelessly to get this up and running for us, and there was always someone available to help if I ran into any issues.”

Keeping Everyone Safe

Inside the hospital, where care teams needed to maintain in-person contact with patients, the use of technology flourished in creative ways as staff sought to minimize exposure to COVID-19, conserve personal protective equipment (PPE) and help patients and families remain connected while most visitors were prohibited.

A video intercom system enabled hospitalized patients with COVID-19 and their providers to interact via secure video conferencing. Through a bedside iPad in the patient’s room, clinicians could initiate a video chat using a computer or mobile device — relieving providers from needing to enter patient rooms for every routine question or conversation.

Thanks to the innovative work of a multidisciplinary team — led by Cheng Zhang of Virtual Care, Greg Kane of Analytics, Planning, Strategy and Improvement, and Laura Carroll and Steve Penney of Brigham Health IS — the group deployed nearly 400 iPads in only a few weeks.

To help nurses wearing full PPE in patient rooms communicate more easily with colleagues on the other side of the door, Brigham Health IS staff also expanded the hospital’s use of Vocera, a system of lightweight, wearable badges that staff can clip to scrubs or a gown for hands-free, real-time voice communication.

person holding tablet

Staff communicate through a video intercom system. Photo credit: Max Esposito

“A silver lining of the COVID-19 pandemic has been the rapid adoption of new technology. We have achieved years of digital transformation in just a few months,” said Adam Landman, MD, vice president and chief information and digital innovation officer at Brigham Health. I’m especially proud of the BH Information Systems, Virtual Care and Digital Innovation Hub (iHub) team members, who worked tirelessly to rapidly deploy these new tools to front-line clinicians.

Additionally, the pandemic transformed daily rounds, as several inpatient units used iPads to conduct virtual rounds to limit the number of providers who needed to enter a patient’s room.

Hospitalist Karen Jiang, MD, medical director for BWFH’s 7 North, normally conducts rounds on her own, but during the pandemic she found that conducting virtual rounds with a trainee was helpful in juggling the many tasks at hand.

“Even though we didn’t have as many patients, I spent much more time and energy planning each interaction,” Jiang said. “I had to think a lot about hand-washing, wiping things down, gowning and de-gowning each time, so to have another person helping with other needs, such as taking notes, allowed me to stay more focused on everything I needed to do in the room.”

In the Emergency Department (ED), a research team piloted the use of Boston Dynamics’ four-legged robot, known as “Spot,” which was equipped with a video conferencing-enabled tablet. By sending Spot to interact with patients in a triage tent outside the ED, providers could evaluate patients while conserving PPE.

Other uses of digital technology were more internally facing, such as the COVID Pass app, a mobile app and web-based portal staff used to attest to their wellness each day before reporting to work. The multidisciplinary project, which was deployed across the entire Mass General Brigham system, was led by Landman and Mark Zhang, DO, MMSc, medical director of the Brigham Digital Innovation Hub, with app development completed by the MGB IS Application Development team.

Staying Connected

Technology also became an essential means of maintaining human connection, such as when staff on Connors Center 7 donned party hats and used the video intercom system to sing “Happy Birthday” to their patient.

To support patients who didn’t have access to personal devices, a device loaner program enabled any hospitalized patient to borrow mobile devices and laptops to stay in touch with loved ones through apps like Zoom and FaceTime.

Additionally, a virtual family visit program also provided an opportunity for patients and their loved ones to connect through staff-facilitated video sessions at the bedside. Ngoc Vu, a medical assistant in the Neurosciences Center who was redeployed to support the program, coordinated and conducted eight to 10 video sessions each day throughout the pandemic.

While holding an iPad so that a patient and their loved one could see each other and speak, Vu often used her free hand to offer a comforting touch, such as holding the patient’s hand, during the session.

“Sometimes the conversations were very sad, but other times they were happy — the patient was doing well and getting extubated, and the family members were excited to see them,” she said. “It gave me a new appreciation for how precious life is and how important these connections are.”

Staff Adapt to Unexpected Needs with Flexibility in New Roles

Two staff members at an attestation table

From left: Victoria Glassman and Marlee Anne Jean Philippe staff an attestation table at the 15 Francis St. entrance.

When Courtney Callahan, a medical assistant at Brigham and Women’s Harbor Medical Associates in Scituate, learned that a new COVID-19 testing site at Brigham and Women’s Health Care Center in Pembroke needed staff support, she didn’t hesitate to volunteer.

“I wanted to do something — I wanted to help,” said Callahan, who was among the thousands of staff members who accepted temporary reassignments during the pandemic.

As hospital operations shifted to address the rapidly evolving demands of COVID-19, entirely new categories of staffing needs emerged. In response, the Brigham community heeded the call to serve wherever help was needed. At the same time, maintaining a flexible workforce enabled staff whose normal duties were temporarily suspended to remain employed during the pandemic.

After valet service was halted in March, valets helped distribute face masks to employees, patients and visitors at hospital entrances. Nurses from clinical areas whose services were scaled back, such as procedural and perioperative areas, went to inpatient floors to care for COVID-19 patients in specialized units. Administrators, physical therapists, practice assistants and others helped run attestation sites at employee entrances, where staff were required to report their wellness upon entering the building.

A Rewarding Experience

For Callahan, supporting the team in Pembroke, where she helped prepare and swab patients for COVID-19 testing, was more rewarding than she ever anticipated.

Courtney Callahan

Courtney Callahan

“I remember my first day. I was very nervous, but the nurses there were so helpful and supportive, and they always made sure we were safe,” she said. “I’m going to attend nursing school in the fall, and I’m so glad I experienced this because it has shown me I’m on the right path.”

Robb Ponder, RMA, practice operations lead for Neurosurgery in South Weymouth, learned that the attestation team needed supervisor coverage for overnight shifts. Despite the personal sacrifices it entailed, he eagerly offered to help.

“I had just returned in February from parental leave, so I hadn’t even been back in the swing of things for long before the pandemic hit. I also hadn’t worked an overnight shift in 20 years, and personally it was challenging to adjust to that schedule and sacrifice the time with my daughter during the first months of her life,” he said. “That said, it was very inspiring to see so many people from across the organization come together for this important job. We all understood the value of what we were doing and did it with purpose.”

The experience also gave Ponder a new appreciation for the many, and sometimes unseen, contributions of departments across the Brigham.

“You can work your whole career in a place and not know half of what goes on in areas you aren’t directly working with,” he said. “Through this role, I got to know many new colleagues from other areas of the organization, and it gave me an appreciation for their work and all the elements that make a hospital function.”

Supporting At-Risk Patients

Other members of the Brigham community shifted the focus of their work to support the unprecedented needs around caring for COVID-19 patients.

Prior to the pandemic, Lynne O’Mara, PA-C, a physician assistant in the Center for Geriatric Surgery, spent much of her time providing consults for geriatric surgical patients. But that work paused in March when the hospital canceled all elective surgeries in preparation for a surge of COVID-19 patients.

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O’Mara began working from home full-time — often balancing a toddler in her lap — and collaborating with on-site colleagues Rachelle Bernacki, MD, a palliative care specialist and geriatrician, and Shoshana Streiter, MD, a geriatrician, to establish a program for identifying older, at-risk patients with COVID-19 in the Emergency Department (ED).

Because older adults are at higher risk for the most severe symptoms of COVID-19, and the disease often progresses rapidly, there was an urgent need to establish a proactive model and remove the burden of arranging consults from their ED colleagues, the team said.

Each day, O’Mara would pore over the ED track board — a digital database of patients in Epic — and search for patients age 70 and up who had signs of frailty, a complex syndrome characterized by physical decline and increased vulnerability to stressors.

“Once Lynne identified a patient, she would call me, and I’d run down to the ED quickly to see them,” Bernacki said. “Because of this, we were able to have important conversations with patients and their families early in their care. Intubating a 90-year-old patient or sending a really frail patient to the ICU is different from a younger, healthy patient, and it’s vital that everyone understands what it means.”

Although the work in some ways familiar, O’Mara said much of it was new territory for her. Even so, it was immensely gratifying.

“I’m used to seeing patients in person, so I was adjusting to a new virtual world, and the number of patients was overwhelming at times,” she said. “But I always had Shoshana and Rachelle as backup, and I never met a patient or family member who wasn’t deeply thankful for every single person caring for them. I don’t think I’ll ever forget how many times people said thank you.”

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Confronting and Combating Health Inequities During the Pandemic

Victoria Addonizio and Krista Atherton prepare a COVID-19 testing booth

From left: Victoria Addonizio and Krista Atherton prepare a COVID-19 testing booth at a community site in Dorchester.

One of the pandemic’s greatest tragedies was COVID-19’s disproportionate impact on underserved communities, particularly among people of color — a grim trend caused by structural inequities throughout the nation, local communities and the health care system at large.

During the pandemic, state data revealed several “hotspots” — areas with disproportionately high rates of infection – in predominantly Black and Latinx communities, including Dorchester, East Boston, Hyde Park and Roxbury.

By late April, Black residents of Boston accounted for 41 percent of known COVID-19 cases and 34 percent of deaths, yet Black people comprise only 22 percent of Boston’s population. Similar disparities were reflected in the Brigham’s own patient census during the pandemic.

“Prior to COVID-19, many of us were painfully aware of the inequities faced by patients in our surrounding communities as a result of racism and poverty,” said Christin Price, MD, program director for Medicaid ACO/E-Care Optimization in Brigham Care Strategies & Innovation. “When COVID-19 disproportionately hit such neighborhoods, these inequities were brought to light for all to witness.”

In mid-March, a large team at the Brigham came together in anticipation of this crisis and to plan a comprehensive response. Meeting daily, the multidisciplinary team worked to identify, escalate and address equity concerns within the Brigham and the communities it serves.

“One of my biggest lessons from the COVID-19 equity response is how necessary it is to have teams that are multidisciplinary, diverse and community-engaged if we hope to be effective at addressing inequities,” said Cheryl Clark, MD, ScD, a hospitalist and health equity researcher, who led Incident Command’s Equity, Diversity and Community Health Response team.

Offering a Helping Hand

One notable aspect of the Brigham’s equity response was the establishment of several temporary sites in Dorchester, Hyde Park, Jamaica Plain and Roxbury where staff provided COVID-19 testing, educational resources and care kits containing cloth masks and hand sanitizer. In addition, eligible residents received boxes of fresh fruits and vegetables. At Brookside Community Health Center, staff also distributed diapers and assisted residents with voter registration.

“Social determinants of health (SDOH) — such as food, housing and financial stability — greatly impact one’s health and access to quality treatment,” Price said. “The Brigham Health response, therefore, involved an approach that served the needs of the whole person.”

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Tracy Sylven, CHHC, MCHES, director of Community Health & Wellness at BWFH, worked closely with a team from across Brigham Health, which included Price and Kelly Fanning, MBA, executive director for Ambulatory Services, to stand up the sites, facilitate testing and manage the logistics to support the teams performing SDOH screenings.

“Just as a blood sample can tell us so much about your health, the same rings true about your address,” Sylven said. “We’re committed to reaching those who have been underserved. Our calling is to allow every voice to be heard and to make a positive impact in each community we serve, but the stark reality is that not only do people need our help today more than ever but they’re also going to need our help going forward, too.”

Patricia Gonzalez, a community health worker at the Phyllis Jen Center for Primary Care who supported the community testing sites, said it was “a true blessing” to help local families.

“Through working at these community sites, I have seen firsthand the struggles that families are facing right in our neighborhood,” Gonzalez said. “This experience has given me an even greater sense of responsibility to make sure I am taking care of each of my patients to the best of my ability every time.”

Read more reflections from staff who supported community testing sites.

Wanda McClain, MPH, vice president of Community Health and Health Equity, praised the team’s response and noted that it creates a strong foundation for future equity work.

Group photo

Staff supporting the Hyde Park-based mobile testing site gather for a team photo.

“This multi-departmental and Brigham Health-wide team broke down silos, came together quickly and got to work,” McClain said. “I could not be prouder of this group and look forward to carrying the lessons learned during the pandemic into our reimagined future.”

Brigham clinicians and staff also helped support Boston Hope, a 1,000-bed medical center built at the Boston Convention and Exhibition Center for COVID-19 patients who could safely recover outside of an acute care facility. Giles Boland, MD, chair of the Department of Radiology, served as its co-medical and operations director.

Bernie Jones, EdM, vice president of Public Policy, expressed his admiration for the many ways the Brigham community supported its neighbors in their hour of need. He applauded the teams led by Fanning, Price and Sylven for stepping up to assist with the sites during the pandemic.

“Their collective work clearly represented our value ‘We’re stronger together’ and embodied teamwork, partnership and community, in every sense of those words,” Jones said. “People came together from across the institution in a way that was nothing short of inspirational, propelled by a common desire to serve communities disproportionately impacted by the virus.”

Supporting the Brigham’s Workforce

In addition to community-based efforts, staff from several areas — including the Center for Diversity & Inclusion, the Center for Community Health and Health Equity, the Office of Diversity, Equity and Inclusion, Patient Safety, Quality and Safety and the COVID-19 Equity, Diversity and Community Health Response team — collaborated to support the Brigham’s workforce on issues related to equity.

They organized several virtual forums on a range of topics, including raising awareness about health equity issues, prejudice against Asian-American communities during the pandemic and the combined trauma of racism and COVID-19.

Recognizing that many members of the Brigham’s workforce live in communities that were disproportionately affected by COVID-19, they also organized a series of educational forums for groups of employees.

“We will continue to be persistent with our anti-racism work, our commitment to health equity, diversity and inclusion as our institutional priorities,” said Tina Gelsomino, MSW, LCSW, RCC, director of the Center for Diversity & Inclusion. “Compassion for ourselves and each other is also an essential tool as we continue to work through this.”

Meeting Multilingual Needs

Interpreter Services staff worked tirelessly throughout the pandemic to ensure multilingual access to resources and information. The team not only provided medical interpreter services in clinical settings, but also completed more than 140 urgent translation projects for materials distributed to staff, patients and families.

Interpreter Services staff

Interpreter Services staff, from left: Veronica Larouche, Yilu Ma and James Wiggins

“Timely translations are essential to reach underserved populations,” said Yilu Ma, MA, MS, CMI, director of Interpreter Services.

During the pandemic, Interpreter Services and others also helped launch a new program, Bilingual Clinician Volunteers for Interpreter Services Emergency Response Planning, to ensure that patients and families with language barriers wouldn’t experience challenges accessing interpreting services, even during a worst-case pandemic scenario.

Led by Marta Solis, Spanish-language interpreter and training coordinator, the program assessed more than 20 medical professionals at the Brigham who could potentially be called upon to interpret if all other interpreter resources were exhausted.

“Being able to experience firsthand the candidates’ outpouring of love and willingness to help was my silver lining during this pandemic,” Solis said.

Wave of Innovation Occurs in the Fight Against COVID-19

Two researchers in PPE working in lab

From left: Vannessa Davis and Samuel Bates support the MGB Center for COVID Innovation’s Diagnostic Accelerator.

With expertise that spans basic, translational and clinical research, Brigham clinicians and investigators have been working tirelessly to address the most urgent needs related to the COVID-19 pandemic.

To help reduce the spread of COVID-19, the Brigham shut down most of its physical research labs from March through the beginning of June. But even during the shutdown, many labs continued their work remotely and new efforts began to better understand the virus that causes COVID-19 (SARS-CoV-2), and the nature of the pandemic itself, in order to develop treatment strategies against them.

“In mid-March, hundreds of Brigham investigators and laboratory staff quickly pivoted to contribute to COVID-19 research and addressing COVID-related problems,” said Jacqueline Slavik, PhD, MSc, executive director of the Brigham Research Institute (BRI). “Within days, Brigham investigators were launching clinical trials, developing safer testing procedures and solving problems around personal protective equipment (PPE) shortages.”

Throughout the pandemic, Brigham investigators continued to pursue and receive funding for COVID-19 research — including clinical studies for a variety of potential therapies — through government and industry grants.

“Thanks to incredible ingenuity, a strong foundation and a breadth of core resources, our research community remains remarkably successful at putting forward award-winning research proposals and conducting first-class research,” said Paul Anderson, MD, PhD, chief academic officer and senior vice president of Research and Education. “As our research enterprise ramps up, these awards will become more important than ever, not only for individual research labs but also for the larger world as we continue to combat this pandemic.”

A Wave of New Solutions for COVID-19

Anesthesiologist Greg Crosby wears a 3D-printed face shield. Photo credit: Jim Rathmell, MD

Clinicians and researchers from the Brigham have come together with colleagues from around the world to produce a wave of innovative solutions faster than ever before.

Some of the Brigham’s advances in the fight against COVID-19 include:

  • Developing an innovative testing strategy to conserve PPE: A Brigham team developed the Brigham Protective Equipment for Clinical Test Environment and Diagnostics (B-PROTECTED) booth to preserve PPE and protect clinicians from COVID-19.
  • Creating in-house COVID-19 testing with results available within 24 hours: Brigham investigators implemented a rapid in-house test for COVID-19 patients who’ve been admitted to the Brigham but don’t yet have a definitive diagnosis.
  • Designing new face shields to protect health care workers from infection: A team of clinicians at the Brigham worked with academic and industry partners to design and develop a new 3D-printed face shield that offers a number of advantages over traditional shields.
  • Developing new protective materials: The lab of Jeff Karp, PhD,is working on an extended-duration sanitizer and a nasal spray to form a shield that protects against inhaled pathogens and viruses.
  • Investigating a safer way to split ventilators: Pulmonary physicians and biomedical engineers have been working together to develop a system that can be built from off-the-shelf components to allow for patient-specific volume and pressure control when using a single ventilator for more than one patient.
  • Using sewage to map an outbreak: Physician-investigators Peter Chai, MD, and Tim Erickson, MD, both of the Division of Medical Toxicology, are working with collaborators to develop technology and a plan for sampling sewage in North Carolina and Boston. These samples may provide important clues about the presence or absence of SARS-CoV-2 over time.
  • Investigating connections during social distancing: The lab of Amar Dhand, MD, DPhil, of the Department of Neurology, is researching the connections between individuals and their social networks. The team is learning firsthand how to stay connected during the time of social distancing.
  • Developing a universal coronavirus vaccine: The lab of Thomas Kupper, MD, chair of the Department of Dermatology, is investigating a vaccine that may protect against COVID-19 along with past, current and future strains of coronavirus.
Shriya Srinivasan and colleagues are working on a safer way to split ventilators

Shriya Srinivasan and colleagues are working on a safer way to split ventilators

“It’s inspiring to see how highly collaborative the Brigham research community has been during this crisis,” said Slavik. “Our research efforts have involved countless individuals from many academic institutions, the technology sector, industry and private companies — all of whom are working towards the common goal of mitigating COVID-19.”

Clinical Studies to Understand, Treat and Prevent COVID-19

To better understand COVID-19 and the virus that causes it, investigators are working on a range of studies and trials. These include:

  • Remdesivir clinical trials: The Brigham is a clinical trial site for evaluating the antiviral medication remdesivir in patients with COVID-19.
  • Learning from patients who’ve recovered from COVID-19: The lab of Duane Wesemann, MD, PhD, of the Division of Immunology and Allergy, is testing blood samples from people who’ve recovered from infection. These samples will help the team learn more about rates of exposure, the types of antibodies an infection elicits and the degree of immunity recovered patients have against re-infection.

“The Brigham has also created a COVID-19 biorepository to collect an array of biospecimens from patients who are or have been COVID-positive,” said Allison Moriarty, MPH, vice president of Research Administration and Compliance. “We believe this biorepository will be a key tool in helping us learn how to detect, treat and prevent COVID-19 in the future.”

A New Center for COVID Innovation

To rapidly develop new innovations and protect frontline staff across the Mass General Brigham (MGB) community and beyond, colleagues at Massachusetts General Hospital (MGH) and the Brigham research community launched the Mass General Brigham Center for COVID Innovation (MGBCCI) in March.

We create breakthroughs. It's in our DNA logo.“The mission of the MGB Center for COVID Innovation is to organize and consolidate the rapid investigation and clinical deployment of devices, diagnostics, data, analytics and the therapeutics that MGH and the Brigham is generating to combat the COVID-19 crisis,” center co-director said David Walt, PhD, a medical diagnostics researcher at the Brigham and Harvard University’s Wyss Institute for Biologically Inspired Engineering.

Investigators at the MGBCCI directly responded to, and continue to address, the most pressing needs that face health care workers — prototyping and testing new PPE, patient isolation hoods, alternative versions of respirators, face masks, face shields and nasal swabs.

Working groups within the MGBCCI have already identified and developed several new devices. They’re exploring other potential solutions for problems related to the pandemic. These efforts include:

  • Improving surgical mask design: The surgical masks group identified design inputs and criteria that are being applied to the design of an “ideal” surgical mask to improve upon the current design.
  • Reusing ventilators: The ventilators team is investigating the potential disinfection and reuse of HME/HEPA ventilator filters. They’re also working with software engineers to build a remote monitoring and alarm system for ventilators.
  • Replacing N95 respirators with novel devices: The N95 respirators team is exploring novel ideas for devices that could replace N95 respirators that aren’t dependent on the filtration media supply chain. They also developed a way to repair 50,000 defective N95 respirators with New Balance.

“We’re also working to identify a direct-to-consumer diagnostic test that could be used at home. When implemented, people can quarantine themselves if they are positive for COVID-19,” said Walt. “These tests could help stem flare-ups of COVID-19 cases that will invariably happen when people return to work and reintegrate into society.”

Study: Widowhood Accelerates Cognitive Decline Among Older Adults

Nancy Donovan

Nancy Donovan

The death of a spouse often means the loss of intimacy, companionship and everyday support for older adults. A new Brigham-led study finds that widowhood can have another profound effect: It may accelerate cognitive decline.

Investigators from the Brigham and Massachusetts General Hospital analyzed older, cognitively normal Americans enrolled in the Harvard Aging Brain Study whose marital status and brain β-amyloid levels — a marker of Alzheimer’s disease — were determined at the beginning of the study. The team found that individuals who were widowed experienced a sharper cognitive decline than their married counterparts, especially among those who had high β-amyloid levels.

The study suggests that widowhood may be an important and understudied risk factor for cognitive decline associated with Alzheimer’s disease and highlights the need for increased focus on this high-risk population. The team’s findings were published recently in JAMA Network Open.

“We know that social relationships can be an important buffer against cognitive decline,” said senior author Nancy Donovan, MD, of the Division of Geriatric Psychiatry. “Being married provides opportunity for more social engagement and emotional support from a spouse, it expands one’s social network and it provides more opportunity for cognitive stimulation. All of these benefits are lost in widowhood. Importantly, loss of a spouse is a highly stressful life event, which can have deleterious effects on the brain.”

Women are at increased risk for both widowhood and Alzheimer’s disease, both of which increase in frequency with age. The study, which included 260 cognitively unimpaired men and women ages 62 to 89, classified its subjects into three groups: married, widowed or unmarried (divorced, single, separated or never married).

We create breakthroughs. It's in our DNA logo.

Donovan and colleagues evaluated a participant’s cognitive performance each year for four years using a series of tests to analyze various dimensions of cognition. They found that cognitive performance declined in the widowed group, differing significantly from the married group. There was no difference between the married group and the unmarried group.

In addition, they found that among adults with the highest β-amyloid levels, widows had the sharpest decline in cognition compared to those who were married, declining at a rate three times faster. This finding was independent of many factors, including age, sex, socioeconomic status and a diagnosis of depression.

The authors noted this is the first study to show widowhood and β-amyloid have a combined effect on cognitive decline and will need to be replicated in other studies.
“Our division has become very interested in understanding the physiological effects of widowhood so that we can develop interventions to try to alter these trajectories,” said Donovan. “Our findings also suggest that researchers engaged in Alzheimer’s disease prevention trials may want to pay particular attention to widowed older adults to tailor interventions for this especially susceptible group of patients.”

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Brigham Hosts Open Forum on COVID-19 Preparedness

Dr. Morris stands in front of audience in lecture hall

Charles A. Morris, vice president and associate chief medical officer, responds to an audience question during the forum.

Editor’s note: Due to the rapidly evolving nature of the worldwide COVID-19 (Coronavirus Disease 2019) outbreak, faculty and staff are strongly encouraged to stay tuned to their work email for updates from Partners HealthCare and Brigham-specific guidance. Visit PikeNotes for additional resources and updates.

On March 3, clinical experts and hospital leaders on the front line of the Brigham’s COVID-19 (Coronavirus Disease 2019) response hosted an open forum to provide an update on preparation efforts and respond to questions from faculty and staff.

In a wide-ranging presentation before a full audience in Bornstein Amphitheater and more than 800 webcast viewers, speakers reviewed what is currently known about the disease, how caregivers should screen and care for potential COVID-19 patients, protocols for using personal protective equipment (PPE), other preventive measures and guidance around travel, furlough and sick time.

“You are all very important to us, to the organization and to the patients and families whom we serve and support. We want you to know, too, that we want to support all of you by making sure that you’re well-educated,” said Jean Jackson, SPHR, SHRM-SCP, RACR, vice president of Human Resources. “It’s really important to us that we keep the lines of communication open and continue to have opportunities to engage.”

Patient Screening

Worldwide, most COVID-19 patients have a mild form of the illness, with only 20 percent requiring hospitalization, explained Michael Klompas, MD, MPH, hospital epidemiologist. Of that 20 percent, one-quarter need to be treated in an intensive care unit (ICU). The U.S. Centers for Disease Control and Prevention (CDC) report that the disease has a 2 percent mortality rate as of March 5.

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During the open forum, Brigham clinical leaders emphasized the importance of following the Identify, Isolate and Inform protocol (see related box below) for screening patients in inpatient settings, ambulatory areas and the Emergency Department (ED).

In the ED, patients are being screened at registration for fever, cough or respiratory symptoms and recent travel outside the U.S. In the ambulatory setting, teams are screening all patients proactively before their appointment and upon arrival at the clinic.

“What I would ask of everyone is to take a philosophy much like hand-washing,” said Karl Laskowski, MD, MBA, associate chief medical officer for Ambulatory Services. “We need to hold ourselves accountable. If you go into a clinic and see people aren’t asking these questions, politely remind each other we should be asking these patients about fever, cough and travel history.”

Preparations Continue

Since Jan. 29, a multidisciplinary team has met regularly to develop, update, drill and refine the Brigham’s preparation and response plan in coordination with colleagues across Partners HealthCare and its member institutions. This includes readying the hospital and distributed campus for a variety of potential scenarios, including patient surges, to ensure the Brigham has the supplies, staffing and protocols in place to safely deliver care no matter the circumstances.

For example, ED staff have been conducting ongoing drills in close coordination with the Medical ICU (MICU), where initial patients with a suspected or confirmed case of COVID-19 would receive care, said Janet Gorman, BSN, MHA, associate chief nursing officer for the ED.

An important part of the strategy for managing a potential patient surge will be helping clinicians determine which patients need acute care, which can be monitored at home and which require an intermediate approach, said Eric Goralnick, MD, MS, medical director of Emergency Preparedness.

Michael Klompas standing behind podium

Michael Klompas presents during the forum.

As drills continue and the first test cases emerge, Goralnick encouraged staff to share their feedback about opportunities for process improvement.

“We need your help to get this right — to ensure that we communicate with all of our teammates, understand where our gaps are and learn from every one of these engagements,” he said.

Jon Boyer, ScD, CIH, director of Environmental Affairs and hospital safety officer, reviewed when and how PPE — including N95 respirators and powered-air purifying respirators (PAPRs) — should be used. To protect critical supplies, N95 masks are being provided at high-risk locations, and PAPRs are available 24/7 from Central Transport.

Boyer also clarified the process for N95 fit-testing. Nearly 6,700 staff have been fit-tested, including those who would most likely assist or care for a COVID-19 patient, such as clinicians, Environmental Services staff and Brigham Police and Security personnel.

Protecting Each Other

To minimize the risk of infection, speakers at the forum advised employees to practice what they normally would do during flu season: frequent hand-washing, staying home if sick and avoiding touching one’s mouth, nose and eyes.

Responding to an audience question about the effectiveness of hand sanitizer versus hand-washing, Meghan Baker, MD, associate hospital epidemiologist, said that alcohol-based hand sanitizer effectively kills coronavirus. She noted that someone who has soiled hands, including direct exposure to blood or other bodily fluids, should wash them with soap and water for at least 20 seconds.

Speakers reiterated that all personnel should stay home if they are sick. Jackson noted that the Human Resources team is working with Partners to review sick-time and remote-work policies.

Staff who stay home because they do not feel well and who cannot perform their job duties remotely will be paid under the guidelines of their paid time-off policy. If an employee does not have enough paid time off available, Partners will advance them up to two weeks of their scheduled hours, as needed. Staff who do not accrue paid time off may use time off available to them per Massachusetts’ Earned Sick Time law. (Learn more.)

Brigham personnel who travel to areas with widespread local transmission of COVID-19 must complete Occupational Health Services’ Returning Traveler Activity Survey, and OHS will communicate when they are allowed to return to work. Employees who have traveled to these areas — regardless of whether or not they have symptoms — will be furloughed from work upon their return date for 14 days. Partners’ TravelSafe website contains the most up-to-date information about what qualifies as an area with widespread local transmission.

For more information, including FAQs and a webcast recording of the March 3 forum, visit BWHPikeNotes.org.

Patient Screening for COVID-19: Identify, Isolate and Inform

Identify: Ask patients if they have a fever, cough or respiratory symptoms and if they have traveled outside the U.S. in the past 30 days.

Isolate: If the patient has a fever or respiratory symptoms and either (1) recent travel to an area with widespread COVID-19 or (2) contact with someone who has a known or suspected case of COVID-19, implement precautions immediately. If the patient is already on site, this includes giving the patient a surgical mask and directing them to a private room, preferably one with negative pressure if available, and closing the door.

Inform: Page the Biothreats Attending (pager #30331). For nonurgent questions, page Infection Control (pager #11482).

For more details about screening protocols, visit BWHPikeNotes.org.

Take the DO IT Challenge and Help End Operational Inefficiencies

project team members standing in front of table

DO IT Challenge project team members, from left: Santosh Mohan, Callie Patel, Caroline Coy and Reed Goldberg

Through a new challenge called DO IT — Decreasing Operational Inefficiencies Together — the Brigham Digital Innovation Hub (iHub) is inviting faculty, staff and trainees to help uncover the most inefficient, cumbersome or redundant work-related tasks and technologies that they wrestle with daily.

But that’s just the beginning. The iHub team also wants to solve these day-to-day headaches and administrative burdens using digital technology.

“It’s the little things that amount to mountains — stacks of paperwork, confusing technology, long hours spent on bureaucratic tasks like documentation and billing, resulting in less and less time to deliver care,” said Santosh Mohan, MMCi, CPHIMS, FHIMSS, managing director of iHub. “These everyday inefficiencies clutter our workflows and lead to frustration among staff and patients.”

Now through March 18, the DO IT Challenge welcomes all Brigham employees, regardless of department or role, to participate by visiting bwhihub.org/doit. Using an online submission form, staff can describe an existing problem and share a digital solution, including ways to improve Partners eCare (Epic). Staff can vote and comment on their favorite ideas to give them a better chance at being selected.

The iHub team will begin evaluating the crowdsourced ideas and proposed solutions in late March. One or two submissions will be chosen and matched with resources and support from the iHub and other internal funding to bring them to life. The winning projects will be announced this summer.

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“Maybe someone has an idea about moving an inefficient paper process into the digital age, or perhaps they’re interested in how to make any number of arduous and repetitive technology-based tasks in their workflow more efficient,” Mohan said. “Whatever their ‘Eureka!’ moment is, DO IT is all about enabling simple and nimble digital solutions to creatively solve cumbersome problems.”

Channeling a Community of ‘Doers’

In developing the program, the iHub team partnered with Healthbox, the innovation arm of the Healthcare Information and Management Systems Society (HIMSS), and drew inspiration from an unconventional source: Marie Kondo, the Japanese author and self-described tidying expert who became a global sensation for her philosophy of discarding possessions that fail to “spark joy.”

“We are on a quest for digital solutions that can help us get rid of things that don’t ‘spark joy’ for our staff and patients,” Mohan said.

Another large source of inspiration was a similar initiative at Hawaii Pacific Health, a health care system in Honolulu, whose “Getting Rid of Stupid Stuff” program aimed to reduce documentation burdens for clinicians using its electronic health record (EHR) system.

“The initiative struck a chord with us,” Mohan said. “We decided to leverage the crowdsourcing approach, expand the scope of our program to cover more than the EHR, and collect not just problems, but also solutions and votes from staff.”

DO IT’s grassroots approach is essential to ensuring that whatever solutions are implemented address true pain points and resonate with staff, Mohan said.

“Our team believes that those best suited to voice these frustrations and help solve them are the employees who deal with them firsthand,” he said. “We’re bringing together a community of creative, insightful thinkers and ‘doers’ who want to improve the Brigham Experience for all of us.”

To participate in the DO IT Challenge, visit bwhihub.org/doit. The submission deadline is Wednesday, March 18. For questions or assistance, email ihub@partners.org.

Behind the Scenes at the Brigham: Supply Support

Hazel Carleton unpacks carton of gloves

Hazel Carleton, a member of the Supply Support team, unpacks a carton of nitrile gloves.

When Mustapha Khiyaty joined the Brigham’s Supply Support team 10 years ago, the importance of his contributions as a supply supervisor for Labor and Delivery and the Neonatal Intensive Care Unit became apparent to him almost immediately.

“It makes you feel like you’re making a difference when you see a new mom with a smile on her face,” said Khiyaty, now an inventory controller on the 42-person Supply Support team.

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Part of Materials Management, Supply Support oversees the procurement, stocking and distribution of clinical supplies — such as bandages, gloves and syringes — throughout the hospital. At an institution as large and busy as the Brigham, this is no small feat. The team maintains 90 supply areas, and at any given time manages a total inventory of about 1,300 items.

To accomplish this, members of the team work closely with staff and distributors to ensure clinical areas have the supplies they need to deliver safe, high-quality care.

A tight-knit unit with a shared passion for helping others — and each other — the team emphasizes that their close bond is key to their success.

“On our team, it’s easy to care about the people you’re working with,” said Dave Shelton, a Supply Support manager.

Always on the Lookout

On a typical day, the first shift arrives and evaluates the status of current supplies, places orders as needed and responds to supply requests or concerns. When the team’s second-shift staff arrive, they unload any newly delivered supplies, put together orders for different areas of the hospital and make deliveries. Staff on the third shift assist with any remaining supply deliveries for the day.

Even getting a single box of disposable gloves to an individual hospital room takes a great deal of care and coordination, team members say, and everyone works together to ensure nothing gets left behind or lost in the process.

“No task is too small for anyone on our team, no matter your role,” Khiyaty said.

Mustapha Khiyaty examining shelves with supplies

Mustapha Khiyaty examines the stock of clinical supplies in one of the team’s main inventory areas.

Supply Support staff work to anticipate future needs. They track and analyze previous records and data to plan and account for a variety of situations so that they can anticipate supply needs for whatever may come their way. They maintain a robust backup inventory in case an unexpected event — including everything from snowstorms to supply shortages — interrupts regular deliveries.

If an unavoidable supply disruption does occur, they pivot quickly to identify and procure alternatives.

“We have to look at the news and be proactive,” Khiyaty said.

Like a Family

Supply Support staff say one special component about the team is its retention rate, with many members being part of the Brigham for 10 to 20 years.

“We get to see the people we started with getting married and having kids,” Shelton said.

In addition to creating a family feel, the prevalence of long tenures on the team has resulted in a wealth of institutional knowledge and given staff the opportunity to support their colleagues’ growth and development.

“Brigham has always been nice to me. I’ve been here for almost half my life. I care about the people who work for me and whom I work with,” said Benjamin Wallace, operations team manager.

“Behind the Scenes at the Brigham” is a monthly series in Brigham Bulletin that provides a glimpse of the people whose everyday contributions help make the Brigham a world-class institution. Is there a team you’d like to see featured? Send your ideas to bulletin@bwh.harvard.edu.

‘A Game-Changer’: Cardiac Procedure Heals Patient’s Heart

George Araneo walking in woods

George Araneo enjoys a hike in Maudslay State Park in Newburyport about a month after his procedure.

George Araneo’s life changed forever last October. Walking home from dinner on Halloween night, Araneo, 66, suddenly became unconscious and fell to the ground. Having no idea what just happened or why, his next memory is waking up on the sidewalk. Today, the avid cyclist, runner and hiker is on the road to recovery, thanks to the lifesaving care he received at the Brigham. He’s back to exploring his favorite walking trails and working out at the gym. He’s even entertaining a future cross-country bike trip — an activity he worried might not be possible when he got sick.

Two years ago, Araneo, who lives in Newburyport, was at a general check-up when his physician heard a strong heart murmur — an unusual sound heard between heartbeats. He was sent for an echocardiogram and was diagnosed with aortic stenosis, a common but serious disorder in which blood is unable to flow freely from one of the heart’s valves to the body’s main artery, the aorta.

Experiencing no symptoms prior to this diagnosis, Araneo was shocked when he received this news. He continued to live as much of a normal life as possible following that appointment, but in 2019 he noticed cardio exercise was becoming more difficult and subsequently scaled back his workout routine.

It was not until that evening last fall when Araneo knew his heart problems were more serious than he realized.

An Alternative to Surgery

After seeing his cardiologist in Brookline, Araneo was referred to the Brigham, where his care team began preparing to replace his heart valve. Upon being evaluated at the Brigham’s Structural Heart Clinic, Araneo learned that he was a candidate for transcatheter aortic valve replacement (TAVR), a minimally invasive alternative to open-heart surgery performed in the Cardiac Catheterization Lab.

Traditionally reserved for sicker, older patients in their late 70s and 80s who have other health complications — and for whom surgery carries higher risks — TAVR uses advanced imaging to help specialists guide a catheter into the heart through a small incision in the groin and insert a replacement aortic valve. Last year, the U.S. Food and Drug Administration approved the clinical use of TAVR for low-risk patients like Araneo.

Interventional cardiologist Pinak Shah, MD, medical director of the Brigham’s TAVR program, said Araneo was a good candidate for TAVR because he was in great physical shape and had the ideal valve anatomy for obtaining a positive result from the procedure.

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“He is definitely one of the more active and fit patients whom we have treated with TAVR,” Shah said. “He is in excellent physical condition, and our team wanted to avoid surgery in order to help him get back to his activities sooner.”

When Araneo heard the news that he would not need open-heart surgery, he relaxed instantly.

“As soon as I walked into the Brigham, I felt safe and secure,” he said. “I always knew I was in good hands and that my comfort was top priority for my care team.”

An ‘Incredible’ Experience

Araneo underwent a TAVR in January, and the procedure was a resounding success. Immediately afterward, he was transported to the Cardiovascular Recovery Room and was speaking with friends 30 minutes later, said cardiac surgeon Tsuyoshi Kaneko, MD.

“TAVR is a game-changer in the management of aortic stenosis,” Kaneko said. “Traditional open-heart surgery would have required George to stay in the hospital for four to five days, and he would have had at least six weeks of recovery time. Instead, he was discharged the next day and almost fully recovered within a week.”

Araneo is grateful for the care he received at the Brigham and was elated to return to his normal routine just days after the procedure.

“I had the surgery on Thursday, and I was walking out of the hospital at 2 p.m. that Friday,” Araneo said. “The procedure was just unbelievable. I got in a cab from the Brigham to North Station and was on the train heading home before I knew it.”

Now, he’s back at the gym, getting outside as much as possible and researching upcoming cycling events.

“My entire experience at the Brigham was incredible,” Araneo said. “I met great people who took such great care of me.”

Kaneko said the Brigham Heart Team hopes more people will be able to benefit from this minimally invasive procedure now that it’s been approved for a larger patient population.

“It is a great joy for us to see our patients recovering so quickly following the TAVR procedure,” Kaneko said. “Our dream is to treat more patients like George.”

To learn more about TAVR at the Brigham, contact the Structural Heart Program at 617-732-7678.

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Study: Skin Cancer Risk Varies Among Sexual Minorities

Arash Mostaghimi

Arash Mostaghimi

In the largest study to date of skin cancer rates among gay, lesbian or bisexual individuals, a team of Brigham investigators found important differences in skin cancer prevalence among sexual minorities in the United States. Rates of self-reported skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women. The team’s results were published in JAMA Dermatology.

Arash Mostaghimi, MD, MPA, MPH, director of the Brigham’s Dermatology Inpatient Service, and colleagues analyzed data from the U.S. Centers for Disease Control and Prevention’s annual Behavioral Risk Factor Surveillance System (BRFSS) surveys from 2014 to 2018. The BRFSS interviews approximately 450,000 adults for the survey each year, and only began asking about sexual orientation and gender identity in 2014.

“This is the first time we’ve been able to look nationally at data about skin cancer rates among sexual minorities,” said Mostaghimi.

After analyzing data from 37 states, Mostaghimi and colleagues found that 8.1 percent of gay men and 8.4 percent of bisexual men had a history of skin cancer, compared to 6.7 percent of heterosexual men — a statistically significant difference. Women fared somewhat differently. Lesbian and heterosexual women had a similar rate of skin cancer (5.9 percent and 6.6 percent, respectively), while bisexual women had a considerably lower risk at 4.7 percent.

The survey did not collect information about risk factors for skin cancer. However, smaller studies have reported higher use of indoor tanning beds, a known risk factor for skin cancer, among gay and bisexual men.

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The study has important implications for patient education and community-outreach initiatives for reducing skin cancer risk.

“This helps inform the nation about how to allocate health resources and how to train future physicians,” Mostaghimi said. “As a next step, we want to connect with sexual-minority communities to help identify the cause of these differences in skin cancer rates.”

The findings also reinforce the value of asking questions about sexual orientation and gender identity in national health surveys, he added.

“We have uncovered a clinically meaningful health variation,” Mostaghimi said. “If the BRFSS survey had never asked questions about sexual orientation and gender identity, we would never have known that these differences exist.”

Patient Shares Story of Resilience and Recovery

Seven panelists sitting in chairs

Panelists, from left: Nomi Levy-Carrick, Gail Levine, Cheryl Clark, Lindsey Wu, Kerry Quealy Son, Bill Theisen and Joji Suzuki

The first time Dawn Shreve reached out for help, she was a scared and confused teenager struggling to cope with a series of disorienting changes at home, including her parents’ divorce and the death of her grandmother.

At age 12, she smoked marijuana for the first time. Soon, she was using it every day to dull her distress. It wasn’t long before Shreve, previously an honor roll student, began struggling academically and acting out at home. Her parents urged her to see a counselor, but it took time for her to warm up to the idea.

Eventually, she made an appointment. Despite feeling overwhelmed and vulnerable, she hoped it would start a healing process. Instead, Shreve said, she was shuffled between various therapists and psychiatrists who made her feel judged and powerless.

“They never listened, so I stopped talking,” she said.

That experience stayed with Shreve throughout her teens and 20s — discouraging her from trusting the health care system again even as her need for support only grew. She started misusing other substances, including prescription painkillers and alcohol, and experienced addiction, relapse, intimate partner violence, the death of two children and several other traumas.

Dawn Shreve

Dawn Shreve shares her story.

Today, she is nearly 11 months sober, backed by a robust support network and filled with hope. Shreve — who shared her powerful story of recovery and resilience as the keynote speaker of the Brigham’s fifth annual V-Day event on Feb. 6 — said she would not be where she was today without the compassionate, expert care she received at the Brigham’s Bridge Clinic, which provides rapid access to multidisciplinary care for patients with substance use disorders.

“Seeking their help was one of the best decisions of my life. They believed in me when I did not believe in myself,” she said. “My providers don’t judge me for who I was but rather look towards the future. They focus on what and who I can be, not who I used to be.”

The event, “Caring for Survivors of Interpersonal Violence with Complex Medical Needs: Fostering Resilience,” was among the hundreds held worldwide this month to honor V-Day, a movement aimed at raising awareness about violence against women and girls.

A New Approach

Following Shreve’s remarks, a panel of multidisciplinary experts reflected on what providers can learn from her story and how they can best deliver trauma-informed care more broadly.

Joji Suzuki, MD, director of the Division of Addiction Medicine in the Department of Psychiatry, said Shreve’s early experiences underscored the need for providers to become well-versed in motivational interviewing, a clinical technique for accomplishing behavior change in patients by evoking their own desire to and reasons for change that align closely with principles of trauma-informed care.

“Earlier on, clinicians did care but they didn’t know how to express that care other than being punitive and coercive because that was the definition of ‘helping,’” Suzuki said. “We’ve evolved to a place where we acknowledge that coercive strategies can be useful in certain situations, such as emergent and acute situations. But for the most part, it has to be about empowering patients to make the choices they would like to make and giving the choice back to them.”

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Lindsey Wu, MD, a hospitalist and director of the Integrated Teaching Unit, agreed that all patients, and especially those with a trauma history, need to have “a voice and a choice” in their care plan.

Bill Theisen, RN, nurse case manager for the Integrated Care Management Program in Care Continuum Management, also emphasized that providers need to exercise patience and flexibility when caring for patients with complex needs and backgrounds. “It takes a long time sometimes for people to feel safe enough to tell you some of the things that are really underlying all the challenges,” he said.

Jeffrey Katz, MD, MSc, a member of the V-Day Planning Committee and director of the Orthopaedic and Arthritis Center for Outcomes Research in the Department of Orthopaedic Surgery, offered the event’s closing remarks and invited attendees to reflect on the discussion’s themes of patient empowerment.

“As employees in a health care institution, it’s our privilege to nurture and bear witness to the resilience of survivors of interpersonal violence, and it’s also our responsibility to take care of these survivors with compassion,” he said.

View a webcast recording of the event.

‘We Are a Community’: Brigham Comes Together After Shooting

On Feb. 7, the Brigham community came together to offer support to one another in the aftermath of a shooting that took place outside of the hospital that morning and injured a member of the Valet team. His condition has improved, and he was listed in good condition as of Feb. 13.

Within hours of the incident, hospital leaders organized a forum in Bornstein Amphitheater and via webcast, during which they encouraged attendees to both care for one another and practice self-care. Faculty, staff and trainees were also invited to access support and resources at the Kessler Library in the Bretholtz Center for Patients and Families, where counselors, chaplains and social workers were available 24/7 for several days.

“There’s no extra credit for feeling brave through this,” said Ron M. Walls, MD, executive vice president and chief operating officer. “It’s normal to feel frightened and vulnerable, and it’s natural to wonder what might happen next. But please know that we are a community. We need to bring our arms out around one another — our whole community — including our valets, our Police and Security team, our patients and their families, and our co-workers.”

Sejal Shah, MD, director of the Division of Medical Psychiatry, amplified the message of self-care and offered additional insight into common reactions after a traumatic event. She explained it’s normal to experience a range of emotions, some of which may be new or unexpected.

“We all react in different ways — accept that in yourself. Make sure you are looking out for yourself,” Shah said. “The most important thing you can do is try to return to a routine that seems normal and recognizable to you.”Stronger Together Brigham Values Logo

Shah noted that if someone is not able to return to a normal routine, and is scared to leave his or her house or return to work, those are signs that additional support, such as talking to a counselor or therapist, would be beneficial.

She added that, for some, it can also be helpful to take a break from social media and other news sources after an incident like the Feb. 7 shooting, explaining that rewatching and rereading coverage of the event often increases distress without offering any benefit.

“I’ll end by saying this: We are a community. We are a family,” Shah said. “I think of this place as my second family. Reach out to each other. Give each other a hug. Check in with each other.”

In addition to the Feb. 7 forum, the Emergency Preparedness team hosted two more on Feb. 13 for the Brigham community to share feedback about how the hospital responded to and communicated about the incident. Staff were also invited to share their feedback via an online form.

In a message to staff on Feb. 7, Brigham Health President Betsy Nabel, MD, and Walls expressed their appreciation for the “utmost care, professionalism and compassion” demonstrated by all, despite the trying circumstances.

Among the many groups that rapidly responded were the Employee Assistance Program, Psychiatry, Spiritual Care Services and the Center for Community Health and Health Equity’s Violence Intervention and Prevention programs, whose clinicians and advocates provided in-person counseling in the Kessler Library.

“Like many of you, we experienced a range of emotions in response to today’s terrible events: disbelief, sadness, worry and uncertainty,” Nabel and Walls wrote. “Upon witnessing how quickly and skillfully our Brigham family came together during and after this emergency, another feeling soon surfaced: immense pride in the extraordinarily expert and supportive way you comforted and cared for our patients, their loved ones and each other.”

Resources for Support

Employee Assistance Program (EAP)

Free, voluntary and confidential support, available 24/7
866-724-4327

Spiritual Care Services

Chaplains are available to counsel individuals and teams.
617-732-7480 or pager #11724

Psychiatry

For emergencies, call 911 or go to the Emergency Department. For non-emergency acute distress, contact EAP at 866-724-4327 or Psychiatry Triage at 617-732-6753. Staff should identify themselves as an employee and indicate they would like to speak with someone in relation to the Feb. 7 events.

Learn more at BWHPikeNotes.org.

Study Shows High Rate of Antibiotics Prescribed Without Office Visit

Michael Fischer

Michael Fischer

A new nationwide study led by investigators at the Brigham found that more than a quarter of antibiotic prescriptions dispensed to Medicaid recipients were not associated with a clinician visit. The results, published in Health Affairs, raise questions about the effectiveness of efforts to curb inappropriate prescribing.

A wide range of clinical guidelines aim to reduce the prescribing of antibiotics for illnesses not caused by a bacterial infection. These efforts aim to help lower the rate of antibiotic prescribing in the U.S., which is about double that of many other countries. However, such efforts may miss antibiotics that providers prescribe outside of clinical visits.

After evaluating nearly 300 million antibiotic prescriptions filled by Medicaid recipients over a decade, investigators found 28 percent were not associated with a clinician visit in the preceding seven days. In addition, 17 percent were prescribed after visits where no infection-related diagnosis had been documented.

“If we’re thinking about how to improve antibiotic prescribing, we need to understand the context in which it occurs,” said the study’s lead author, Michael Fischer, MD, MS, of the Division of Pharmacoepidemiology and Pharmacoeconomics. “If prescribing is taking place outside of an office visit, most of the approaches we are taking to combat antibiotics overuse will miss those completely.”

To capture these blind spots, Fischer and colleagues examined national Medicaid claims data from 2004 to 2013. They identified 298 million antibiotic prescriptions filled during this time for 53 million patients. The researchers used this data to determine whether patients had made a clinic visit in the seven days prior to filling the prescription. When there was a visit, they checked whether billing claims data specified an infection as the cause for the visit.

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The authors acknowledge that a critical question remains: What occurred clinically in the many cases when antibiotic prescriptions were dispensed without a visit?

Since researchers’ analyses were based on claims data, they did not have access to medical records to determine what types of interactions took place between patients and prescribing clinicians. The authors said they assume most of these prescriptions were associated with a phone interaction, although some communication may have occurred over email, via web portals or during informal, uncaptured visits. Most encounters would be blind spots for existing interventions designed to improve appropriate antibiotic use, they noted.

Fischer said it will be important for future research to use clinical data to examine outcomes for patients who are prescribed antibiotics outside of office visits, adding that future interventions should be designed with the study’s findings in mind so that this large proportion of prescriptions is not missed.

A ‘Novel’ Approach: Traveling Book Cart Lifts Spirits with Literature

Suzanne Erwin standing with book cart

Suzanne Erwin delivers books and magazines to patients with warmth and compassion.

Even in the era of Kindles, iPads and countless other digital distractions, technology is no replacement for the simple joy of curling up with a book or thumbing through a magazine for some people. One person who is keenly aware of this is Brigham volunteer Suzanne Erwin, the shepherd of the hospital’s traveling book cart.

For more than 20 years, the Brigham’s book cart program has invited hospitalized patients to enjoy donated reading materials delivered by friendly volunteers, including Erwin. The cart, which visits most inpatient units once per week, is filled with books and magazines spanning a variety of genres — mystery novels, historical nonfiction, celebrity gossip magazines and crossword-puzzle books, just to name a few.

It would be inaccurate to call the program a lending library; it offers the books and magazines with no expectation of return. For that reason, the need for a steady donation of reading materials is ongoing.

“There’s just something special about reading an actual book that brings comfort to a lot of people,” said Kelsey Craig, volunteer program and training coordinator in the Office for Sponsored Staff and Volunteer Services, which oversees the program. “It’s not just about the books, either. It’s also the conversation and human connection. Some people don’t want to take anything but appreciate having someone to talk to.”

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Erwin, who began volunteering at the Brigham last September, agreed that the books and magazines are only part of what the program contributes to the patient experience. Patients who have been in their hospital room for several days may want to chat about the weather. Others swap book recommendations with Erwin. On Mondays during football season, Erwin noticed that many patients were eager to chat about the previous night’s game, so she often brushes up on sports news before making her rounds.

Some simply thank her for coming in.

“Even if they don’t take a book or magazine, people are really happy to have that face-to-face interaction and have a conversation about something other than their illness,” Erwin added. “Some patients may not be up for a visit when I come by with the cart, and that’s OK, too. They’ve got a lot on their plate. But if they’re receptive to a visit, I’m delighted to help make their stay here a little more comfortable.”

The Write Stuff

To protect the health and safety of all patients and families, the book cart is unable to visit certain units — such as those caring for patients with a compromised immune system — or rooms where precautions for infection control are in effect.

For those patients who are able to participate, many will opt for a standard novel or nonfiction book. But most gravitate toward shorter paperbacks and, most popular of all, magazines. Perhaps unsurprisingly, thick tomes like War and Peace aren’t in high demand.

“Especially for someone who isn’t feeling well, or who may be in the hospital for only a day or two, flipping through something like People magazine or National Geographic can be a relaxing and welcome distraction from their illness,” Craig explained.

Erwin, who previously worked in health care, said it has been immensely gratifying to combine her love of reading with the opportunity to give back.

“At this moment in my life, I have time to give, and seeing the impact of that contribution is super rewarding,” she said.

If you would like to donate books or magazines to the book cart, contact Kelsey Craig at kcraig5@bwh.harvard.edu or 617-732-6584. Materials should be new or gently used. For magazines, recent editions are preferred, but all donations are welcome.

‘We Are Family’: Brigham Community Stands with Puerto Rico

Four staff members singing

From left: Patty Lee, Monique Cerundolo, Holly White and Stephen Nicholson perform a song during the service.

Uplifted by solidarity and song, the Brigham community came together to show its support for the people of Puerto Rico during a service on Jan. 29. Since December, the island has been devastated by hundreds of earthquakes and aftershocks, leaving many regions and cities there in disarray.

Organizers of the event, hosted by Spiritual Care Services and held in Bornstein Amphitheater, said they sought to not only acknowledge the recent natural disasters but also celebrate and honor Puerto Rico and its culture. The bilingual service featured scripture readings, a candle-lighting ceremony, a photo slideshow depicting scenes from the island, live and recorded performances of Puerto Rican music and remarks from staff who shared stories about what Puerto Rico means to them.

“The ceremony was very beautiful. I feel very grateful for the thoughtfulness towards our people. It was a beautiful gesture,” said Nelly Pardo, an Environmental Services employee and native of Puerto Rico, who contributed to the event planning and music selection.

Patty Lee, a chaplain in Spiritual Care Services, expressed her gratitude for all who came to collectively celebrate Puerto Rico and mourn its many losses.

“It was an honor to be part of such a moving prayer service and to feel the warmth and love that is present at the Brigham in our community of strength and solidarity,” she said. “We join together in prayer and hope as Puerto Rico continues to rebuild its beautiful island together.”

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George Player, CPE, FMA, vice president of Facilities and Operations, was among those who saw a need to bring the Brigham community together and helped organize the service to support colleagues affected by the earthquakes.

“I want our employees to know that we are family at the Brigham, and we are here to support each other — always,” Player said. “There are events that happen every day all over the world, and it can be difficult to have family living in an area affected by a natural disaster, deal with the unknown and wonder if everyone is safe.”

For Monique Cerundolo, MA, BCC, a staff chaplain in Spiritual Care Services, it was vital that the event centered on the themes of family and hope. As a member of the Hispanic community herself, Cerundolo, who is Uruguayan, also felt a personal and special connection to the service.

“We want people to know that they aren’t alone,” Cerundolo said. “In Puerto Rican culture, there is a tremendous sense of community. The concept of familia is very vivid. We hope those who attended found the event to be comforting and unifying.”

Small prayer cards were handed out during the event that included various prayers and blessings in Spanish. By the event’s conclusion, all 150 cards had been distributed. Many attendees told organizers they were going to hold on to the cards and share them with loved ones. For Kevin Long, MEd, operations project coordinator in Spiritual Care Services, it was a touching symbol of community.

A Message of Hope

Cerundolo said the event’s organizers — who also included Kathleen Gallivan, SNDdeN, PhD, director of Spiritual Care Services, Mikhala Heil, MDiv, chaplain, and John Kearns, MDiv, BCC, staff chaplain — wanted to ensure that music played a pivotal role in the ceremony. The event featured live performances of the Spanish-language songs “Color de Esperanza” and “Dios Milagroso Asi Eres Tú,” performed by Spiritual Care Services staff. Singers included Cerundolo, Lee and White, who were accompanied by chaplain Stephen Nicholson on acoustic guitar and members of the audience who sang along.

During one especially moving part of the program, organizers played a recording of “Almost Like Praying,” a song written by Hamilton creator Lin-Manuel Miranda, who is of Puerto Rican descent, and performed by him and more than 20 Latino musicians. Written in 2017 to support the victims of Hurricane Maria, the lyrics individually reference all 78 of Puerto Rico’s cities and towns.

“We wanted to make sure the music we played during the ceremony was something that our Puerto Rican employees could identify with,” Cerundolo said. “That song is very comforting, unifying and supportive for the Puerto Rican people.”

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