Posts from the ‘We Pursue Excellence’ category

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.

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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.”

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.”

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.

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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.”

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.

Improving Access to Community-based Speech Pathology Services

Beth Regan

There are five words that always make Beth Regan, MS, CCC-SLP, senior speech language pathologist in Rehabilitation Services, smile when she meets with patients at Brigham and Women’s/Mass General Health Care Center at Patriot Place in Foxborough: “I’m so relieved you’re here.”

That’s because, until recently, the Speech and Swallow Service at the Brigham had primarily functioned as an inpatient service. Upon recognizing the large and growing need for more comprehensive speech therapy services in an outpatient, community-based setting, the Rehabilitation Services team opened the ambulatory speech clinic in Foxborough last fall. The launch follows an expansion of outpatient services last summer on the main campus, where the team hosts a half-day clinic for patients with swallowing disorders.

The Foxborough clinic, which operates five days a week, cares for patients with a diverse range of needs around swallowing disorders, language disorders, speech difficulties and cognitive deficits. Patients may be referred to the service following a neurological event that affects their speech, such as a concussion or stroke, or if they experience difficulty swallowing food, liquids or medication.

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Laura Kasparian, MS, CCC-SLP, a coordinator in the Speech and Swallow Service, said the team saw an opportunity to improve continuity of care for existing patients who were looking to access physical therapy, occupational therapy and speech therapy in one place. They were also watching the diminishing availability of speech services in the region with growing concern as more local rehabilitation centers closed their doors.

“After an acute neurological event, such as a stroke, patients usually make the most progress in speech rehabilitation within the first six months to a year. If a patient has trouble accessing services during that time, that is a precious window in which they could be making gains,” Kasparian said. “We’re really excited to help meet that need for patients in a convenient setting.”

Regan, who serves as the Foxborough clinic’s sole speech pathologist, said many patients have expressed appreciation for having access to these specialized services in the local community.

“Going into the city can be daunting for a lot of patients who live outside of Boston and are recovering from a stroke or traumatic brain injury,” Regan said. “Being able to access these services closer to home is a true relief for many of our patients.”

The clinic’s integration into the Brigham’s Foxborough site has also enabled Regan to work closely with colleagues in neurology, physical therapy, occupational therapy and other referring providers — ultimately enhancing care for their patients.

“We talk and collaborate often, sharing what we’re seeing in terms of a patient’s rehabilitation and what could be helpful moving forward,” she said. “It’s very much a team effort.”

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Brigham Increases Tuition Reimbursement for Staff

Thinking about enrolling in a training class or educational course to enhance your professional skills? Thanks to a recent expansion in benefits, doing so is more affordable for eligible employees.

At the start of the new fiscal year in October, the Brigham increased its tuition-reimbursement benefit — now providing up to $3,000 for full-time, benefits-eligible, weekly paid employees and research fellows in good standing.

Paula Squires, MBA, SHRM-SCP, SPHR, senior vice president of Human Resources, said the Brigham encourages staff to take advantage of educational opportunities that help them build their skills and competencies and advance their careers.

“We care deeply about our staff, and we’re always working hard to ensure that we are able to support those who seek out educational opportunities,” Squires said. “We are pleased that we’ve been able to increase our tuition reimbursement amount and hope many colleagues take advantage of the program.”

About the Program

Employees and research fellows who have at least six months of continual employment at the Brigham upon submitting the tuition reimbursement application are eligible to apply.

To qualify for reimbursement, staff must receive at least a C grade in a for-credit course, a pass in a pass/fail course or earn a program certification. The course or program must take place outside of the employee’s regular working hours.

J.F. Goldstyn, MBA, director of Organization Development and Learning in Human Resources, said the beauty of the program is its flexibility around what types of courses are eligible for reimbursement. To qualify for reimbursement, the course must provide knowledge or skills that the employee can directly apply to a current position or would assist in transitioning to a new role within the Brigham.

We pursue excellence logoEmployees can receive reimbursement for tuition and fees, the latter of which includes laboratory, registration, exams, books, technology and application fees. The Brigham will reimburse employees who are successful in completing non-degree, degree courses and/or programs, continuing education and certification programs. All courses or programs must be completed either in person or online through an accredited school, college or university.

Courses and programs that are ineligible for reimbursement include doctoral degrees, audited courses, conferences and seminars. Nurses who are part of the Massachusetts Nurses Association bargaining agreement are not eligible for reimbursement through this program. These nurses are eligible for a separately administered tuition reimbursement and professional development program within the Department of Nursing.

Goldstyn said a key component of the program is the opportunity it provides for employees to discuss their career goals with their supervisor. All managers are involved in the approval process for tuition reimbursement.

“We view learning as a lifelong activity,” Goldstyn said. “Not only do we encourage you to take the time to learn, but we also want to help pay for your course expenses and make investments in your education.”

To learn more about the tuition reimbursement program, including how to apply via PeopleSoft, visit hospitalpolicies.ellucid.com and search for policy HR-507.

 

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Brigham Bioengineer Works to Build a Bright Future

Natalie Artzi and Jackie Slavik with award check

Natalie Artzi, left, receives the BRIght Futures Award from Jackie Slavik, of the Brigham Research Institute

Natalie Artzi, PhD, of the Division of Engineering in Medicine, and her team were hard at work on research related to delivering cancer treatment when tragedy struck close to home. Artzi found out that a family friend’s 13-year-old son had been diagnosed with brain cancer. As she began reading more about the disease, Artzi realized how little progress had been made in the last 20 years.

“Treatment hasn’t improved much for this deadly cancer. With all of the advancements in our understanding of immunology, we thought, maybe we can leverage what we’ve been working on to change this,” said Artzi.

Think Local Delivery

Artzi and her lab have been working on a new way to deliver effective cancer therapy where it is needed most. Their research on solid tumors, including breast cancer and colon cancer, has shown that local delivery — delivering a drug to the site of a tumor rather than infusing it into the bloodstream — is the best way to hit cancer hard while keeping side effects to a minimum.

“Less than 1 percent of the administered dose of drugs get to solid tumors. Now, imagine what’s happening when we have another biological barrier to cross, the blood-brain barrier, which is designed to keep molecules out,” said Artzi.We pursue excellence logo

Artzi’s team specializes in nanotechnology and is developing particles no larger than 1,000th the diameter of a human hair that can deliver cancer drugs. They envision that during surgery to remove a tumor, an adhesive material containing the nanoparticles can be sprayed onto the brain, creating a hydrogel patch.

Artzi’s team is especially excited about the power of immunotherapy — a therapeutic approach that retrains the immune system to detect and destroy cancer cells.

“We think that combining the power of local delivery and immunotherapy will have a big impact,” said Artzi.

Raising Excitement and Hope

To build public support and funding for this new approach, Artzi submitted an application for the BRIght Futures Prize.

“I felt both excitement and fear,” said Artzi. “I have a lot of experience presenting at scientific conferences. But I had little experience in talking to the public. But as a scientist, we’re trained to dive into new areas.”

Artzi and her lab worked tirelessly to engage with as many people as possible to raise awareness about their research, especially on social media.

“We did as much as we could, as fast as we could, and just when I thought we’d done everything possible to get the word out, we accelerated even more.” said Artzi.

Lab members from Mexico, Spain, Portugal, Brazil, England, Ireland, India, China and Israel began sharing news about the competition with people from their home countries and word spread rapidly. News stations became interested, and Artzi was soon interviewed by broadcasters in Israel. As the project began to go viral, messages of encouragement poured in.

“We got messages from families of brain cancer patients encouraging us to keep pursuing this project. Some said they knew it was too late for the work to help their loved ones, but they hoped it would save the lives of other children someday,” said Artzi. “There were so many times when I was in tears.”

The project also generated buzz closer to home — faculty members from the Neurosurgery Department have reached out to Artzi about future collaborations.

Artzi says the competition has given her team opportunities they could not have predicted.

“I didn’t anticipate that level of support and touching responses from people all around the world,” Artzi said. “The recognition, the excitement, and the hope it gave people — that’s what we came here to do. Saving lives is our dream, and this competition gave me a glimpse into how it could be.”

Description of BRIght Futures Prize Competition

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BWH Maps App Puts Indoor Navigation in the Palm of Your Hand

From left: Rintaro Sato, Mark Zhang and Aaron Pikcilingis display the BWH Maps app.

A new smartphone app called BWH Maps, released by the Brigham Digital Innovation Hub (iHub), makes finding your way around the hospital easier than ever with real-time indoor navigation to more than 300 destinations on the main campus.

With functionality similar to consumer apps like Google Maps, BWH Maps uses Apple and Android smartphones’ native capabilities — including Bluetooth and Wi-Fi — to pinpoint your exact location inside the hospital, track your movement on the map with a blue dot and deliver turn-by-turn walking directions to your chosen destination on the main campus. The mobile app is free and available for download by employees and the public.

“The Brigham is a big place, which can make it challenging to navigate. Whether you’re visiting a sick loved one in the hospital or you’re an employee trying to get to your next meeting in a hurry, the last thing you want to worry about is figuring out how to get there,” said Mark Zhang, DO, MMSc, iHub’s medical director. “Having an easy, reliable and fast tool in scenarios like these can be a godsend.”

With the release of BWH Maps, Brigham Health is the first organization in the Partners HealthCare system to support real-time indoor navigation on mobile devices. Earlier this year, iHub launched the BWFH Maps mobile app, which provides the same functionality for Brigham and Women’s Faulkner Hospital.

Aaron Pikcilingis, an innovation specialist at iHub and one of the project leads, said the value of the app was quickly proven whenever he and iHub colleague Rintaro Sato, an innovation and operations analyst, would walk around the main campus to test out and finetune the app.

“Pretty much every time Rin and I were out testing the app, we’d wind up using it to help five or six people who needed directions,” Pikcilingis said. “It’s amazing how the app makes it so easy to assist someone even if you don’t personally know where their destination is.”

A Game-Changer

Kelsey Craig, volunteer program and training coordinator in the Office for Sponsored Staff and Volunteer Services, sees tremendous potential for the app among her volunteer corps. For the past two years, all college volunteers enrolled in the Medical Career Exploration Program have been required to complete a rotation as wayfinders, a role in which they make themselves available in high-traffic areas of the main campus to proactively assist anyone who looks lost.

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Until now, volunteers would direct patients and visitors using a printed map containing some general information about key areas of the hospital — such as the locations of entrances, bathrooms, amenities, elevators and some larger clinics — but it can’t compare to BWH Maps’ robust database of destinations, which include all patient-facing areas, most conference rooms and more.

Craig has begun training volunteers to use the app when providing directions. Volunteers will also show patients and visitors how to download the app themselves so that they can take advantage of the location-tracking feature and turn-by-turn directions on their own smartphones.

“Being able to pull up directions on their phone will be a game-changer for our volunteers,” Craig said. “They will be able to provide an answer more quickly and efficiently, leading to a better experience for our patients and families. In addition, I think the fact that volunteers are using a device they’re already comfortable with, rather than rustling through a packet of papers, will allow them to feel more confident helping someone — which in turn leads to better customer service.”

Building on Success

Since beta testing the BWH Maps app this spring, the iHub team has added more destinations to its database, improved the reliability of the location-tracking function and added an “offline mode” feature that enables the app to continue providing directions even if the device loses its internet connection.

The smartphone app builds on the success of a browser-based predecessor, maps.brighamandwomens.org — an effort previously led by Josie Elias, MBA, MPH, former iHub program manager for Digital Health Innovation. The website, which allows users to plot out directions in advance, remains available and will continue being updated by the team.

The most popular destinations accessed in the browser-based version have been clinics that use Medumo, a digital health tool that sends patients text messages with appointment reminders and other important information — including directions to the clinic via maps.brighamandwomens.org — in advance of their visit. The iHub team hopes to build a similar functionality with the BWH Maps mobile app and is beginning to explore opportunities for future integration with other Brigham apps and operations.

In addition to internal collaborations with departments such as Facilities and Patient Access Services, the iHub team worked with wayfinding technology vendor LogicJunction on both projects.

“Everyone who works here wants to be helpful, but sometimes you just don’t know the answer when a patient or colleague asks you how to get somewhere,” Zhang said. “This app is a great way to empower all of us to provide the best experience.”

Find BWH Maps in the Apple App Store or Google Play Store, or visit maps.brighamandwomens.org.

 

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Brigham Performs Nation’s First Face Transplant for Black Patient

face transplant

Robert Chelsea, shown before and after undergoing a face transplant at the Brigham.

When Robert Chelsea noticed his car was overheating while driving on a California freeway six years ago, he never could have imagined the life-altering trauma that would occur just moments after he stopped his vehicle on the side of the road.

Chelsea, who had been on his way home from church, was sitting in his car when a drunk driver struck his disabled vehicle. It burst into flames — resulting in a fiery explosion that burned over 60 percent of Chelsea’s body and face. After being rescued by a bystander and rushed to a nearby hospital, Chelsea remained in a coma for six months and hospitalized for a year and a half. During that time, he underwent more than 30 surgeries. His injuries drastically altered his physical function and appearance. His lips, part of his nose and left ear were unable to be reconstructed, and his face was severely scarred.

We pursue excellence logoAfter learning about face transplantation, Chelsea and his family pursued the option, in the hope that he could qualify for and receive a face transplant. In July, Chelsea, at age 68, became the first black patient, and the oldest, in the U.S. to receive a full face transplant in a procedure performed at the Brigham.

The 16-hour surgery, involving a team of over 45 physicians, nurses, anesthesiologists, residents and research fellows led by Bohdan Pomahac, MD, was the ninth face transplant procedure at the Brigham and the 15th nationwide.

“Despite being the oldest face transplant patient at 68, Robert is progressing and recovering remarkably fast,” said Pomahac, the Roberta and Stephen R. Weiner Distinguished Chair in Surgery and director of Plastic Surgery Transplantation at Brigham Health. “We are looking forward to seeing a significant improvement in Robert’s quality of life.”

Making History

The Brigham performed the nation’s first full face transplant in 2011 and has long been recognized as one of the world’s leaders in transplantation. The institution’s other transplant milestones include the first successful human organ donor transplant, a kidney, in 1954; the first heart transplant in New England in 1984; the first heart-lung transplant in Massachusetts in 1992; and the first bilateral hand transplant in New England in 2011.

From left: Robert Chelsea speaks with Bohdan Pomahac during a recent follow-up appointment.

After evaluation by Pomahac, and an extensive screening process, Chelsea became eligible for a face transplant in March 2018. His wait for a donor was longer than that of previous Brigham face transplant recipients due to the effort to find a match that would work for Chelsea’s skin tone. This was complicated by the fact that the number of black organ and tissue donors is disproportionately smaller — and range of skin tones much larger — compared to white donors. The gap is caused by several issues, but numerous studies have shown that chief among them is a broad mistrust of the U.S. medical system by many black Americans due to the racism that African-American patients experienced throughout the nation’s history.

Chelsea is the first-known black patient to receive a full face transplant; another black patient in Paris received a partial face transplant in 2007. The care that Chelsea received at the Brigham reflects the institution’s commitment to reversing the health disparities that patients of color nationwide continue to face today.

“It is vitally important for individuals of all races and ethnicities to consider organ donation, including the donation of external grafts, such as face and hands,” said Alexandra Glazier, president and CEO of New England Donor Services. “Unlike internal organs, the skin tone of the donor may be important to finding a match.”

A follow-up study of face transplant recipient outcomes, recently published in The New England Journal of Medicine, found the Brigham’s first face transplant patients had a robust return of motor and sensory function of their face, as well as functionality, allowing them to socially reintegrate in a way that would not have been possible pre-transplant. These data indicate Chelsea is likely to achieve near normal sensation and about 60 percent restoration of facial motor function within a year, including the ability to eat, smile and speak normally.

“Our previous experience has demonstrated that face transplantation is a viable option for patients with severe disfigurement and limited function who have no alternatives,” said Pomahac. “As we continue to expand this treatment to more patients, we are exploring the ways in which we can quantify how much benefit our patients receive as well as identifying opportunities to limit the risks of this transplant through new immunosuppression protocols.”

 

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Surgical PA Combines Bedside Experience and Operational Expertise in New Role

Jennifer Beatty

Jennifer Beatty

Physician Assistant (PA) Week is held 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 is highlighting one of the many exceptional physician assistants to cap off PA Week this year.

Looking back on when she joined the Brigham a decade ago as a new physician assistant in the Department of Surgery, Jennifer Beatty, PA-C, still remembers how daunting it all felt at first. Having made a career jump from physical therapy to medicine, she was filled with excitement and anticipation for this next professional chapter.

“Starting off as a brand-new PA was overwhelming. Trying to figure out how to care for complex patients while learning the ins of outs of an academic medical center — it took me a good year to 18 months to feel comfortable rotating into difference services,” Beatty recalled.

Now as the department’s first director of Surgical PAs and Clinical Operations — leading more than 100 surgical PAs and championing multidisciplinary process-improvement efforts — she draws on her years of experience at the bedside and operational expertise.

Continuing to devote 30 percent of her time to clinical practice, Beatty emphasized that staying close to patient care is essential for obtaining an authentic perspective on challenges and opportunities for surgical PAs.

“It’s hard to really know what the problems are without seeing what is happening on the floor, so having someone who can be a link between more senior leaders and frontline clinicians is vital as we all come together to set objectives and improve care,” said Beatty, who has served as director since March.

We pursue excellence logoAmong several projects she’s working on is a multidisciplinary effort to streamline patient flow and discharge processes for the Extended Recovery Unit, which serves patients who require overnight observation after a procedure.

Joy Brettler, PA-C, chief physician assistant in the Department of Surgery, applauded Beatty as a tremendous advocate who excels at identifying operational barriers and implementing smart interventions.

“As a surgical PA with nearly a decade of experience as part of the inpatient teams that provide care in General Surgery and Burn/Trauma, Jen understands the logistical issues each department has with hiring, training and retaining PA staff,” Brettler said. “Having her represent our voice and opinions on how to properly integrate and maximally utilize our skills is a huge asset.”

Malcolm Robinson, MD, associate chair of Surgery for Clinical Operations for the Department of Surgery and director of the Nutrition Support Service for its Division of Gastrointestinal and General Surgery, agreed that Beatty was an ideal fit for this new role.

“Jen is an excellent clinician who has the respect of her colleagues. She is a great leader and problem-solver, and she is a hard worker who collaborates well with health care professionals at all levels of responsibility and authority,” said Robinson said. “We are fortunate to have her and look forward to working with her for years to come.”

Above all, Beatty noted she is proud to be part of such an extraordinary group of PAs at the Brigham and have the support of her colleagues as well as hospital leaders, the latter of which include not only Robinson but also Gerard Doherty, MD, chair of Surgery; Kevin Hart, MBA, senior director of Clinical Operations for Surgery; and Jessica Logsdon, MHS, MHA, PA-C, senior director of PA Services.

“PAs have been in the Department of Surgery for 30 years, and we historically haven’t had an administrative structure to support their growth. The hope is that other departments see what we’re doing and adopt a similar model,” Beatty said. “We’re trailblazing a new level of support that our PAs deserve.”

 

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In Journey to Improve Health, Brigham Staffer Aims to Run 5Ks in 50 States

Karen Bruynell before and after her weight-loss journey

Left: Karen Bruynell in 2016, before embarking on her weight-loss journey. Right: Bruynell in 2019, after completing a recent 5K.

When Karen Bruynell, administrative director of Brigham Education Institute (BEI), sets a goal, she doesn’t stop until it’s achieved. So, when she decided to compete in 5K races in all 50 states, she hit the ground running — literally.

The idea came to her as part of a two-year weight-loss journey. In March 2017, at age 53, Bruynell realized several health issues were hindering her day-to-day activities. She began to change her lifestyle and improve her health, including undergoing bariatric surgery that fall. In January 2018, Bruynell embarked on her personal challenge to run throughout the country.

Since starting her journey and losing a total of 140 pounds, Bruynell, now 55, has competed in Florida, New York, Tennessee, Texas, Virginia and every state in New England. She set a goal to run in at least 10 states each year to complete the map by age 60.

But maintaining a healthy weight is not the only thing that motivates Bruynell to keep going. With every step, she is reminded that each charity race she runs benefits people all over the country.

“It’s great to be indirectly connected to people through a cause. I like the idea of being able to help everyone through donations and raising awareness, even if I only play a small part,” said Bruynell.

Many of the causes have personal connections. Bruynell participated in a charity run for multiple sclerosis research in honor of a colleague living with the disease. She selected a 5K in Arlington, Va., that benefited the maintenance of Mount Vernon — a place Bruynell cherishes because of her love for history. She also completed a race benefiting people with brain injuries in honor of her stepmother, who recently experienced a stroke.

One of the most poignant and touching events was a race she didn’t select for herself.

This past May, Bruynell’s youngest son suggested she take part in “Tracy’s Run,” a race dedicated to supporting individuals with mental health issues, in Gilford, Conn. What he didn’t know then was that Bruynell had lost her best friend, who lived in Gilford, to suicide 14 years ago. She said completing that race was an experience she will always hold close to her heart.

Drawing Inspiration

We pursue excellence logoIn addition to competing in about four 5Ks a month around the U.S., Bruynell maintains her athletic prowess by remaining active in local running programs, including the Brigham’s, and has participated in the Boston Athletic Association (B.A.A.) 5K and 10K races while fundraising on behalf of the hospital.
“The Brigham Running Program is excellent. The leaders’ enthusiasm is so great and helpful. It makes me consider running a marathon,” said Bruynell.

Cheering her on from not only the sidelines but also, in some cases, alongside her are Bruynell’s BEI colleagues. Anna De Cristofaro, senior administrative coordinator at BEI, said Bruynell inspired her to get back into running after taking a hiatus due to a prior injury. De Cristofaro has completed three races with Bruynell by her side, including one in Florida.

“Karen has been a great encouragement for me to get out there and get active with running again, and she is the sole reason why I pushed myself to start competing in more 5Ks,” said De Cristofaro. “She’s excelled immensely and exudes confidence in every workout she does.”

Looking to the future, Bruynell strives to make additional progress each day. Since embarking on her unexpected running career, Bruynell has improved her per-mile pace by five minutes, and in a recent race placed first in her age category. She plans to push herself to compete in longer races, such as 10Ks and half-marathons, more frequently.

“I am constantly striving to become better, and running presents me with that challenge,” she said. “Since deciding to follow through with my running goal, I feel like my life has just started.”

 

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Putting Inefficiency to Bed: Team Finds Creative Approach to Linen Loss

Jonathan Santiago displays one of the disposable linen kits available to EMS personnel outside the Emergency Department.

Jonathan Santiago displays one of the disposable bedding kits available to EMS personnel outside the Emergency Department.

As director of Materials Management at the Brigham, Jonathan Santiago spends many days thinking about two kinds of sheets: bedsheets and spreadsheets. They have more in common than you might expect.

That’s because, like many hospitals across the country, the Brigham rents linens — which encompass bedsheets, hospital gowns, pillow cases, scrubs, towels and wash cloths — from an outside vendor, which delivers thousands of clean linens each day and sanitizes used linens off-site. Each item contains a microchip the vendor uses to identify unreturned items. When linens are not returned to the vendor within 60 days, the Brigham is charged for each missing item at a considerably higher rate.

In looking for opportunities to identify cost savings for the institution, Santiago and his team investigated the greatest sources of linen loss. They saw a disproportionately high volume occurred through the Emergency Department (ED), specifically via the ambulance bay. Through a collaboration between Materials Management, the ED, Boston Emergency Medical Services (EMS) and Fallon Ambulance, a multidisciplinary team developed a single-use, disposable bedding kit for EMS personnel that is on track to dramatically reduce lost linens and yield significant savings.

Cutting Costs, but Not Corners

When most patients come to the ED via ambulance, they arrive with the ambulance’s linens, which are ultimately cycled through the hospital’s standard housekeeping procedures. Many hospitals, including the Brigham, provide replacement linens to EMS personnel for their next patient. This informal system traditionally has operated on an expectation of “one-to-one” use.

Several Boston-area hospitals use the same medical linens service, Angelica Corp., so most of the replacement linens EMS personnel retrieve eventually find their way back to the rental company. The Brigham team learned these replacement linens had an elevated loss rate and identified a number of contributing factors, such as an ambulance transferring a patient to a nursing home or another facility that wasn’t contracted with Angelica.

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After crunching the numbers, the team determined that it would be more cost-effective to supply EMS personnel with prepackaged, disposable bedding kits — also known as ambulance kits — each containing a heavy-duty sheet and fleece blanket the hospital has purchased with no expectation of return. As of this summer, EMS personnel dropping off a patient at the Brigham’s ED now take a single kit on their way out.

“While some linen loss is always expected, we realized it made sense to move forward with a disposable kit so that we pay this one price and avoid a larger charge in loss fees,” Santiago said.

The kits rolled out sooner than anticipated due to an unexpected, hospital-wide linen shortage. Because their contents come from a separate supply, the kits allow Materials Management to keep more of the standard sheets and blankets within the hospital.

As part of the project, the team also learned EMS personnel usually did not require towels for clinical use and worked with ambulance providers to exclude towels from the kits, while leaving a smaller amount on a nearby cart. In addition to reducing the volume of towels, Materials Management educated ED staff on how to replenish the carts so that older clean towels would be rotated to the top of the pile, minimizing the chance of them missing the 60-day rental deadline. These changes alone netted an additional $9,500 in savings, Santiago said.

Andrew Sants, materials coordinator for the ED, applauded Santiago for his creative approach and for ensuring all stakeholders had an opportunity to contribute to the kits’ design.

“We’re trying to save money, but not cut corners. Everything revolves around providing the best care to our patients,” Sants said. “I really believe this can do a lot of good, and I think it’s a model that other hospitals should follow.”

Brian Luongo, EMT, an emergency medical technician and assistant manager of Partners Hospital Operations for Fallon Ambulance, said that while the kits are a notable change in process for him and his colleagues, they were an innovative, mutually beneficial means of meeting everyone’s needs.
“We were able to come up with a creative solution for both the hospital and EMS to address our linen needs within an easily accessible, self-contained packet,” Luongo said. “It has everything we need right there.”

Scott Goldberg, MD, the Brigham’s EMS director and an emergency physician, reiterated that quality and safety were priorities for everyone involved.

“We wanted to find a solution that EMS providers were comfortable using and that didn’t detract from the patient experience,” Goldberg said. “We’re trying to reduce waste and inefficiency, but it’s important that we provide a high-quality alternative that everyone is happy with.”

 

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Lifesaving Cardiac Procedure Restores Health and Joy for Grateful Patient

Sabina Barry, cardiac patient, cuddles with her recently adopted puppy, Poco.

Sabina Barry cuddles with her recently adopted puppy, Poco.

Earlier this year, Sabina Barry, 69, couldn’t imagine walking up the stairs without gasping for air. Today, she’s doing a lot more than that — including playing catch with her grandson and keeping up with a playful new puppy — thanks to the lifesaving care she received at the Brigham.

Since age 60, Barry had been advised by her doctor to undergo an annual echocardiogram to monitor her heart health. She soon learned she had 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. For years, her case was diagnosed as mild to moderate, but last August her primary care provider in New Hampshire informed her that the condition had progressed to moderate-to-severe status.

Barry was stunned. She had recently lost 60 pounds, and the fatigue and shortness of breath that would later become debilitating were mild enough then to seem like a normal part of aging.

“‘You’re looking at open-heart surgery in a year,’” Barry recalled her doctor saying. “I looked over one shoulder and then the other, and said to him, ‘Do you have the right chart?’”

By the fall, however, it was clear there was no mistake. Her symptoms worsened by the day.

“I knew open-heart surgery would have a difficult recovery. My husband had it at 85, and I saw firsthand what he went through over two to three months,” Barry said. “I was really hoping there would be an easier and faster solution.”

After seeking a second opinion at the Brigham, Barry learned she was a candidate for a clinical trial involving 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 leg, groin or chest and insert a replacement aortic valve.

TAVR can be done without general anesthesia and usually offers a quicker recovery than conventional surgery. The procedure takes about 90 minutes, with patients often discharged within a day or two.

‘Amazing, Amazing, Amazing’

Barry underwent a TAVR in March as a participant in the PARTNER 3 Continued Access Trial registry, a continuation of the landmark PARTNER 3 Trial, which reported this spring that TAVR was effective and safe for low-risk patients like her with severe aortic stenosis. The Brigham was one of two centers in New England contributing to the study.

“Amazing, amazing, amazing — that’s how I feel today. There aren’t words to explain the difference between before and after. I feel like I’m 50 again,” Barry said. “It’s incredible to have this procedure on a Thursday, go home Friday and be back at work the next week.”

This month, the U.S. Food and Drug Administration approved the clinical use of TAVR for low-risk patients. With this approval — backed by evidence confirming TAVR is as good as open-heart surgery in terms of valve function and long-term outcomes — the procedure is now the default treatment option for most patients with severe aortic stenosis, said interventional cardiologist Pinak Shah, MD, medical director of the Brigham’s TAVR program.

We pursue excellence logoBrigham cardiac surgeon Tsuyoshi Kaneko, MD, agreed: “We’re going to see a paradigm shift. Whenever we see patients with aortic stenosis, we will be thinking of TAVR as a first potential option rather than surgery.”

Noting that not all patients will be candidates for TAVR based on their anatomy, Shah and Kaneko said the Brigham Heart Team carefully evaluates each individual to determine the best treatment option.

“It is exciting and a privilege to be at the forefront of the implementation of this technology that will benefit so many patients,” Shah said. “It has been a remarkable journey watching TAVR being performed only in clinical trials to now being a standard procedure, and all of this has happened in a span of just over a decade. It is hard for me to think of another technology in medicine that has been so transformative.”

Not Missing a Beat

Barry, who has also twice overcome breast cancer, said the procedure has opened up her heart in more ways than one.

When she was at her sickest last year, she grieved the loss of her beloved dog of 14 years. Buoyed by her new energy, she recently adopted a precious Pomeranian, Poco, who fills her life with joy and even accompanies her to cardiac rehab.

“I could say Poco rescued me,” Barry said. “I truly believe you don’t realize how sick you are until you get better, and I really mean that from the bottom of my heart. It’s so hard to put into words how it feels to get your life back.”

 

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Brigham Recognized in U.S. News Best Hospital Rankings

US newsBrigham and Women’s Hospital rose to No. 13 on the 2019 U.S. News & World Report’s ranking of Best Hospitals, up from No. 20 in last year’s annual Honor Roll. The Honor Roll is a distinction awarded to 20 hospitals that deliver exceptional treatment across multiple areas of care.

In addition, many specialties improved significantly over last year and earned top spots, with five specialties at the Brigham landing in the top 10. The Brigham ranks fifth for cancer; fifth for gynecology; fifth for rheumatology; eighth for nephrology and ninth for cardiology and heart surgery.

In a message announcing the news to the Brigham community, Brigham Health President Betsy Nabel, MD, and Executive Vice President and Chief Operating Officer Ron M. Walls, MD, thanked faculty and staff for their tireless pursuit of excellence in clinical care, research, education and community outreach.

“Beyond this outstanding recognition, for which we are so grateful, what matters most is the hope and compassionate service we bring to others each day,” wrote Nabel and Walls. “Thank you for all that you do to help us advance our vision of creating a healthier world.”

The annual rankings are based on a point system derived from a comprehensive, nationwide evaluation of nearly 5,000 hospitals in 16 adult specialties. Points are awarded based on institutions meeting certain criteria, and then are ranked according to the number of points earned. The Brigham was bolstered this year by achieving Magnet designation in 2018 — an honor representing the gold standard of nursing excellence and recognizing the highest quality of care hospital-wide.

Across Partners HealthCare, the Brigham’s sister institutions were also recognized with top honors, including Massachusetts General Hospital, which ranked second on the Honor Roll.

Massachusetts Eye and Ear, McLean Hospital and Spaulding Rehabilitation Hospital were also recognized for national excellence. Mass. Eye and Ear ranked second for ear, nose and throat care and fourth for ophthalmology. McLean Hospital was ranked second in the nation for psychiatry, and Spaulding Rehabilitation was ranked third for rehabilitation. U.S. News also makes regional hospital rankings to complement its national rankings. Newton-Wellesley Hospital ranked No. 5 in the region and was recognized as high-performing in geriatrics and pulmonary, while North Shore Medical Center was recognized as high performing in heart failure chronic obstructive pulmonary disease.

The complete listing of America’s Best Hospitals can be found online and will be published in the magazine’s August issue as part of its 2019–2020 Best Hospitals Guide.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Brigham Co-Leads Citywide Hospital Response to Opioid Crisis

From left: Christin Price and Samata Sharma, who care for patients with substance use disorder, meet in the Bridge Clinic.

The Brigham is one of 12 local hospitals that have committed to training their care providers about addiction as well as supporting faculty and staff faced with challenges related to their own or a loved one’s substance use disorder (SUD).

For the past several months, Brigham Health President Betsy Nabel, MD; Kate Walsh, president and chief executive officer of Boston Medical Center Health System; and RIZE Massachusetts, a nonprofit working to end the opioid epidemic in Massachusetts, have collaborated to develop a collective strategy that builds on the work each respective institution is doing to address the opioid crisis.

We pursue excellence logoThe participating hospitals, which also include Brigham and Women’s Faulkner Hospital and Massachusetts General Hospital, have agreed to take on a set of priorities as the first step to reduce stigma and enhance the uptake of treatment for SUD. They’ve also committed to conducting mandatory training for all hospital-based physicians and residents in key departments and creating support initiatives for faculty and staff and their loved ones.

In addition, addiction care will be further mainstreamed into all primary care encounters, and residents will be better prepared to treat addiction, including with medication, as a foundational part of their practice.

Scott Weiner, MD, MPH, an emergency physician and director of the Brigham Comprehensive Opioid Response and Education (B-CORE) Program, said he’s proud of the work the Brigham has done to address the opioid crisis thus far and sees great potential in this latest, multi-institutional effort to save more lives.

“This new consortium allows us to share our approach across the city, which greatly increases the impact,” Weiner said. “It also allows us to learn from our colleagues. If we’re going to solve this issue and ultimately reduce overdose deaths, we all need to work together.”

Making the Pledge

As part of the strategy, all hospital-based emergency physicians, hospitalists, obstetricians, psychiatrists, pediatricians, infectious disease specialists, primary care providers and internal medicine residents will undergo a mandatory SUD training. The course — which at the Brigham standardizes, centralizes and expands on existing, smaller-scale programs — will cover the fundamentals of addiction; modern treatment of opioid use disorder, including utilization of buprenorphine (widely considered one of the most effective medications available to treat opioid use disorder); and addressing stigma.

The Brigham and other participating institutions have also committed to increasing the number of providers who obtain buprenorphine training by offering additional in-person training sessions. Clinicians must undergo a specialized, eight-hour training to prescribe buprenorphine to patients with opioid use disorder.

In addition to being health care providers for the public, Boston and Cambridge hospitals employ thousands of people, many of whom may need their own support with substance use. The committed hospitals have pledged to doing at least three activities from a list of 10 that are meant to encourage campus-wide discussion around substance use and uptake of relevant health care services. 

Some of the activities include providing free, on-site training and subsidized access to naloxone, a fast-acting treatment for opioid overdoses; developing a training program for all managers on how to identify and support employees with substance use disorder; and sending a SUD-specific benefits guide to all employees.

 

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Brigham Installs New ‘Stop the Bleed’ Kits

 Dan Scanlon (center) of Fallon Ambulance instructs Brigham staff on bleeding-control techniques during a recent training.

Dan Scanlon (center) of Fallon Ambulance instructs Brigham staff on bleeding-control techniques during a recent training.

The Emergency Preparedness team and The Gillian Reny Stepping Strong Center for Trauma Innovation are placing 25 bleeding-control kits across Brigham Health facilities to help lay bystanders and medical professionals alike respond to someone experiencing uncontrolled bleeding before a code team or other first responders arrive.

Mounted next to automated external defibrillators and at other high-traffic locations across the Brigham’s main campus, ambulatory sites and BWFH, these emergency kits contain trauma dressings, gloves and tourniquets, among other supplies.

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The kits also provide supplementary support for untrained individuals through the “Mobilize Rescue” mobile app (for iOS and Android devices), which can be downloaded in advance or on the scene to receive step-by-step audio and visual cues for using the supplies. Brigham Health is the first health care system in the nation to deploy this technology.

Once the rollout is complete, the kits will be installed at 14 locations on the main campus, five locations at BWFH and six ambulatory sites.

The initiative is an outgrowth of the Brigham’s contributions to Stop the Bleed, a national awareness campaign aimed at teaching members of the public how to stop life-threatening bleeding in emergency situations. The effort was started in the wake of the Sandy Hook shootings by the Hartford Consensus, a group of clinicians working to minimize preventable deaths after mass shootings and other mass-casualty events.

“Keeping our patients, visitors, faculty and staff safe and secure is our top priority,” said Eric Goralnick, MD, MS, medical director of Emergency Preparedness and the Access Center. “Now, you will always have access to lifesaving supplies while waiting for a medical code team or other first responders to arrive.”

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These boxes contain bleeding control kits.

The Stepping Strong Center has provided funding to Goralnick and clinician-investigators at the Center for Surgery and Public Health to study the implementation challenges for this global public health campaign and approaches for overcoming barriers, including solutions based on education, logistics, policy and epidemiology. In February, the center and the Uniformed University of the Health Sciences co-hosted the first National Stop the Bleed Research Consensus Conference at the Brigham, which gathered 45 subject-matter experts, professional society leaders and funding agency representatives to define the next decade’s research agenda for pre-hospital bleeding control.

In addition to increasing trauma survival rates, the goal of the Brigham’s implementation is to prepare bystanders to first call for the appropriate medical code or 911 and then grab a kit, open the app on their mobile device and follow the prompts to provide lifesaving interventions to anyone experiencing severe bleeding.

For those interested in further developing their emergency response skills, Brigham Health and the Stepping Strong Center will regularly host one-hour, in-person Stop the Bleed training sessions, during which participants learn how to properly apply a tourniquet and pack a wound, among other techniques.

The next Step the Bleed training sessions will be held Thursday, July 25, 4–5 p.m., in Carrie Hall, and Monday, July 29, 4–5 p.m., in the Mary Ann Tynan 1 Conference Room at BWFH. Registration is required. For questions or to register, email stopthebleed@bwh.harvard.edu. Faculty, staff, patients, family members and the public are all welcome to attend. You can also learn more by watching this brief video.

 

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Quality Rounds: ‘Intersectionality and Care: Identity Matters’

Tim Ewing

Tim Ewing delivers a presentation during Quality Rounds.

On May 10, Quality Rounds provided an opportunity for Brigham faculty and staff to discuss the critical intersection of identity and patient care as part of our overall Brigham Experience work, which comprises the patient and employee experiences.

Tim Ewing, PhD, vice president of employee diversity, inclusion and experience, kicked off the discussion by describing how his own sense of self cannot be fully gleaned from appearances alone.

“I’m 6-foot-6 and I’ve never played basketball. I’m also a learned extrovert; I get a great deal of energy by being alone and recharging, but because I have a sister who is a Broadway actress, I learned how to be an extrovert so that I could be heard,” he said.

We pursue excellence logoIn the context of patient care, understanding the role of identity is crucial to delivering high-quality care and cultivating an environment where people feel respected, Ewing added. For example, when caring for a transgender patient, asking their preferred pronoun is an important, meaningful gesture that builds trust and helps prevent a potentially trauma-inducing experience for the patient.

“There are coatings on our eyeglass lenses that shape how we view the world,” Ewing explained during a thought-provoking presentation.

Attendees were also invited to introduce themselves and use guided talking points, such as, “If you really knew me, you would know that…” to explore the concept of establishing high-quality connections in small groups.

To watch Quality Rounds, visit bwhedtech.partners.org/programs/quality.

 

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Environmental Services Training Enhances Care, Professional Growth

From left: Jean Honorat, Labina Shrestha and Tereza Teixeira Pereira

From left: Jean Honorat, Labina Shrestha and Tereza Teixeira Pereira

Tereza Teixeira Pereira considers her work in Environmental Services vital to the health and safety of everyone at the Brigham. An employee here for the last 12 years, Teixeira Pereira said when she recently had the chance to expand her skills and education, she jumped at the opportunity.

“I come to the Brigham every day and believe what I do is not only a job — it’s a career,” said Teixeira Pereira, who works primarily in the Mary Horrigan Connors Center for Women and Newborns. “I want to do everything I can to continue learning and improving because I want to ensure that I’m doing my very best to keep the Brigham safe and clean for our patients, their families and my colleagues.”

Teixeira is among the approximately 80 Environmental Services staff members who’ve completed one of two training and certification programs the department recently began offering to its employees. One is a specialized certification, the Certified Surgical Cleaning Technician program, created for staff responsible for cleaning and disinfecting operating rooms. The other, the Certified Healthcare Environmental Services Technician (CHEST) program, is designed for all department staff.

The Association for the Healthcare Environment sponsors both programs, which set a national standard and best practices for cleaning and disinfecting in a hospital environment. They consist of classroom training and a written exam hosted at the Brigham. Recertification takes place every three years. Over time, all Brigham Environmental Services employees will undergo the program best suited to their role.

The Brigham is the only Environmental Services department in Massachusetts to offer these certification programs to staff.

Consisting of 468 people, the Environmental Services team works nonstop to keep Brigham facilities across the main and distributed campuses sanitary, safe and attractive for patients, visitors, faculty and staff, in accordance with established policies, procedures and regulations. The department oversees institution-wide housekeeping, waste/recycling management, pest management, interior plants and grounds maintenance policies, and programs and services.

‘Knowledge Is Power’

Labina Shrestha, an education specialist in Environmental Services, was trained to teach both courses. In addition to supporting professional growth, she said the programs are a meaningful morale booster and remind staff of the important role they have on a care team.

We pursue excellence logo“Knowledge is power, and throughout these training programs the staff have come to realize even more so that their roles are essential to the healing process for our patients,” Shrestha said. “We are not only cleaning and disinfecting, but we are saving lives — and that is very powerful.”

Environmental Services staff member Jean Honorat, who recently completed the CHEST certification, said he’s grateful for the opportunity to strengthen his skills and is excited to share what he learned with his colleagues. Someone who is passionate about his work and caring for others, Honorat said participating in this program has helped him love his job even more.

“I’m so thankful,” said Honorat, who works in the Braunwald Tower. “It feels good to make a difference.”

For All the Lives We Touch: Q&A with ACMO Charles A. Morris, MD, MPH

Hand Hygiene Task Force members

Hand Hygiene Task Force members

In just six months, the Brigham increased its hand hygiene compliance rate from 67 to 90 percent, thanks to a clear mission, committed leadership, an efficient team structure, comprehensive communication and analytics, and the ongoing efforts of local leads, frontline staff and support services. That said, we still have work to do. Brigham Bulletin recently sat down with Charles A. Morris, MD, MPH, associate chief medical officer and Hand Hygiene Task Force member, to talk about what our “For All the Lives We Touch” campaign has accomplished to date and how it’s paving the way for lasting cultural change.

Q: What has it been like to work on the hand hygiene campaign this past year?

CM: It’s been a tremendous opportunity to co-lead a high-visibility project with Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Patient Care Services, and Julia Sinclair, MBA, senior vice president of Clinical Services. This project has great alignment with hospital priorities and, of course, watching the remarkable success of the campaign has been very fulfilling.

Q: How has the Brigham demonstrated leadership throughout this campaign?

CM: We would not be where we are without the tremendous investment and energy of countless others. Time and again, when Maddy, Julia and I and the other members of the Hand Hygiene Task Force have been wrestling with an obstacle, we’ve elected to turn it back over to local leaders to brainstorm, solve and implement a solution that works for them — and then we ask them to share with the entire group so we all benefit from that solution. The Department of Surgery, for example, figured out how to engage residents in observing hand hygiene while fulfilling Accreditation Council for Graduate Medical Education-required participation in a process improvement project. This may, in turn, become a template for other departments. Having such a strong presence of local leadership has been rewarding to watch and critical to the success of this work.

Q: What feedback have you received from faculty and staff over the past six months?

CM: We’ve been hearing great feedback that the messaging is connecting and resonating. We’ve also been challenged on our assumptions in provocative and productive ways. For example, Post-Anesthesia Care Unit staff told us that a major barrier to hand hygiene was the inaccessibly of sanitizer pumps, even though it looked like there were adequate numbers. Local leaders worked with our Facilities teams and helped to craft a workable solution with more dispensers affixed to tables. Other groups, including our Inpatient Services and Emergency Department staff, have struggled with our observation platform and have been instrumental in communicating those pain points to us. We’ve also gotten clear feedback that recognition matters — we’ve tried to routinely reward groups that are pushing performance and compliance, whether that’s with a team pizza party, staff recognition photos on PikeNotes or our upcoming hand hygiene celebration on May 2 (see box below).

Q: How will we sustain this work in the months ahead?

CM: It’s going to be an ongoing challenge. We must work together to keep it visible, whether that’s through digital signage, videos, celebrations or other internal messaging. Achieving a goal is one challenge; sustaining that performance as newer, competing priorities emerge poses a different opportunity. We simply need to make it everyone’s priority. As Maddy often asks, “How do we make hand hygiene muscle memory?”

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So far, we’ve engaged people across all groups, including primary clinical teams and ancillary supporting groups. Previously, we targeted clinical teams who have a direct role in patient care and contact, and we had focused less on groups that were only entering a room but did not otherwise have patient contact. We realized sustaining this work necessitated one standard for everyone, and that became the expectation for hand hygiene each time someone entered or exited a room, regardless of activity, role or intent. This has meant engaging with groups that have not been involved in clinical initiatives before, and they have responded in extraordinary ways. Food Services, for example, has transformed their approach to hand hygiene, and as a result has enviable performance from which we’re all learning.

Q: How does the hand hygiene campaign set the stage for similar strategic work?

CM: We plan to broaden our current efforts to include other hospital-acquired condition and quality goals this year. We’re applying our hand hygiene frameworks and lessons learned to our planning efforts for reducing catheter-associated urinary tract infections and central line-associated bloodstream infections, for example, which we’ll share more about in the coming months.

I think these initiatives are perfectly aligned with a few of our newly stated values. Above all, hand hygiene is about caring for our patients, which means doing right by and for them — simply put, we care. We achieve our goals through a collective effort and, as stated in another newly articulated value, we’re stronger together. There is no way to achieve this kind of success unless everyone in our community is committed and working in lock-step with one another. A critical component to this is feedback — how do we want to tell others they’ve missed an opportunity for hand hygiene, and how do we want to receive that feedback ourselves? I think transforming our culture by creating an environment where that kind of respectful, constructive feedback is freely shared and received will be foundational for many other initiatives going forward.

Hand Hygiene Celebration, May 2

In appreciation of the tremendous progress we have made with our hand hygiene compliance rates, all faculty and staff are invited to a celebration on Thursday, May 2, 6:30 a.m.–5 p.m., on the Tower 2 mezzanine (across from the Shop on the Pike). Present your Brigham ID badge for giveaways, including a “For All the Lives We Touch” mug and other campaign swag.

Brigham Emergency Response Team Simulates Ebola Outbreak

How would we respond if there was a patient infected with Ebola at the Brigham?

On April 1, a multidisciplinary team sought to answer that complex question by participating in a live, three-hour functional exercise coordinated by Brigham Health Emergency Preparedness with participants from several departments, including Admitting, Emergency Medicine, Emergency Preparedness, Engineering, Environmental Affairs, Environmental Services, Infection Control, Police and Security, and Telecommunications. External participants included Fallon Ambulance and the Massachusetts Department of Public Health (DPH).

“During an actual crisis, we know it would be extremely challenging to remember every detail of our Emergency Management protocol,” said Eric Goralnick, MD, MS, medical director of Emergency Preparedness. “This was a chance for us to activate and implement our Ebola response plan, ask and answer questions, and identify barriers and successes as a team.”

This exercise was the culmination of a yearlong Ebola planning process, which included a tabletop drill — a meeting to discuss a simulated emergency — last month and the development of a viral hemorrhagic fever disease and Ebola virus disease control plan.
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Since May 2018, the Democratic Republic of Congo has faced the world’s second-largest Ebola epidemic in history, resulting in 676 deaths and more than 400 untreated cases to date. According to the World Health Organization, the outbreak is spreading faster than ever throughout the country as medical responders and care providers do everything they can to mitigate it.

Like most U.S. hospitals, the Brigham would serve as a frontline health care facility during a local outbreak. In this role, the hospital would identify and isolate patients with possible Ebola, notify Infection Control and public health officials, and have enough personal protective equipment (PPE) on hand for staff to provide at least 12 to 24 hours of care. The Brigham would also prepare patients for transfer to an Ebola assessment hospital or treatment center, such as Massachusetts General Hospital, if needed.

Simulating a Crisis

The latest Ebola preparedness exercise began with a 7 a.m. briefing in the Zinner Board Room, during which participants discussed these objectives and other pertinent protocols, such as establishing the definition of a suspected Ebola case (also known as a patient under investigation, or PUI), the characteristics of Ebola and the process for Emergency Department (ED) evaluation and management of the patient.

After the briefing, the on-call Infectious Disease attending was notified that a mock patient was under investigation with symptoms consistent with Ebola and a travel history to an area with active Ebola cases. Response staff quickly donned training vests to signal they were part of a planned exercise and sprang into action in the ED.

During an initial screening process, triage staff learned the patient had recently traveled to the Democratic Republic of Congo and was a public health researcher who visited Ebola treatment centers and had contact with people evaluated for Ebola. The patient received a surgical mask to wear and was directed to the triage room while the triage nurse and ED attending were immediately notified that a patient had screened positive for Ebola. From there, role-players carried out the next steps for safely isolating and providing care to the patient actor while wearing the appropriate PPE and communicating the situation to other teams.

Key Takeaways

Reflecting on the event while still in character as the patient, Mark Litvak, program coordinator in Emergency Preparedness, expressed his appreciation for the team’s response. “They were stellar in that I came in as a ‘father’ and they kept me up to date on how my ‘daughter’ was doing throughout the process,” he said. “They brought her to the ED Family Room to keep her healthy and safe while ensuring I received the care I needed.”

Other reported strengths included excellent teamwork, clear communication and troubleshooting on the fly, and the identification of unmet needs and real-time solutions.

While the Ebola response plan laid a good foundation for the multidisciplinary response, there are always lessons to be learned when a plan is activated, said Chris Smith, MHA, MEP, senior manager in Emergency Preparedness. Looking ahead, the Brigham will refine its ED incident command framework, create a more inclusive and structured coordination call with DPH and streamline the intake of patient data across teams to support effective communication and decision-making.

“These valuable insights will ultimately strengthen our response and better prepare us for the future,” Smith said.

PIE Awards Celebrate Exceptional Faculty and Staff

Honorees from the Emergency Radiology team share a moment during the PIE Awards reception in Carrie Hall.

Honorees from the Emergency Radiology team share a moment during the PIE Awards reception in Carrie Hall.

Among her colleagues at Brookside Community Health Center, nurse Darlin Liriano, BSN, RN, is fondly known as “the mayor of Brookside” — a lighthearted but sincere expression of the appreciation and respect they have for Liriano’s expertise, leadership and the caring relationships she builds with her patients, their families and the center’s faculty and staff.

These are just a sample of the traits that inspired multiple colleagues to nominate Liriano for a Partners in Excellence (PIE) Award this year. The annual awards program recognizes individuals and teams for their outstanding contributions to Partners HealthCare’s mission.

Hundreds of members of the Brigham community were honored during the 23rd annual PIE Awards ceremony on Feb. 27. This year, awards were presented to 81 individuals and 855 members of 40 project teams throughout Brigham and Women’s Hospital and the Brigham and Women’s Physicians Organization.

“[Darlin] is one of the greatest nurses I know. Her devotion to her nursing career is inspiring. You would think you were working with Florence Nightingale herself,” wrote one colleague in her nomination for Liriano’s PIE Award. “The patients love and request her by name, and I can see why. Darlin is an advocate, a leader and a problem-solver.”

We pursue excellence logoAlso recognized this year was Matthew O’Connor, PA-C, an inpatient physician assistant (PA) in the Department of Neurosurgery, who was nominated by a colleague for his extraordinary leadership in making changes that have improved professional satisfaction, collaboration and patient care within his team.

“He has demonstrated leadership skills, interpersonal skills and mentoring above and beyond what we could have asked for,” wrote a colleague in O’Connor’s nomination. “The result has been the development of a cohesive, well-trained team that feels supported and recognized. Matt has become the ‘go-to’ person for the team and is respected by the PAs, nurses, residents and attendings who work with him.”

Cierra Zaslowe-Dude, a clinical research coordinator in the Department of Radiation Oncology, was nominated by colleagues for her outstanding teaching and leadership capabilities, especially in onboarding and mentoring new research staff.

“She has made a lasting impact on these employees; even though many are no longer ‘new,’ they continue to seek her mentorship and guidance each day,” her nominator wrote. “Her contributions span across the department at all levels, and we are grateful for Cierra’s dedication to our research program, her generous heart and her compassion in serving others.”

PIE honorees from the Brigham and Harbor Medical Associates Reference Lab Testing Consolidation team

PIE honorees from the Brigham and Harbor Medical Associates Reference Lab Testing Consolidation team

Among the teams honored was the Garden Café’s grill staff — which includes Michael Hines, Ewa Kania, Alex Murcia and Shon Way — for their tremendous professionalism, teamwork and skill, even in the face of a peak-hour rush of customers.

“No matter how long the line is, they are always warm and friendly to everyone. It is wonderful to start the day with a smile and kind word from them,” wrote their nominator. “I watch them every morning and am astounded at how they remember orders from the ‘regulars.’ It is like watching choreography.”

Ron M. Walls, MD, executive vice president and chief operating officer of Brigham Health, invited attendees to look around the room and take a moment to recognize the incredible contributions of those who make the Brigham such a special place.

“We’re so proud to have you be a part of our community,” Walls told honorees. “Walking through these doors every day, I know that whatever challenges our patients and their families face, they’re on their way to see someone really great — in fact, they’re going to see a great team of people committed to helping them.”

Paula Squires, MBA, SHRM-SCP, SPHR, senior vice president of Human Resources, who emceed the ceremony in Bornstein Amphitheater, thanked PIE Award recipients for everything they do to make the Brigham an exceptional place in which to work and receive care.

“Quite simply, and without exaggeration, because of you, we are and will remain one of the finest hospitals in the world,” Squires said. “Every day, your passion, your purpose, your skill and your innovative spirit touches the life of a patient, a co-worker or someone in our community. For that, we are all deeply grateful and proud.”

View the full list of 2018 PIE Award winners.