Posts from the ‘education’ category

Reflecting on Supportive Colleagues, Professional Growth

Compared to many of my colleagues, I am a relative newcomer to the Brigham, with just 13 years of service. I have been very fortunate to be surrounded by nursing and allied support colleagues who took the time to answer my many questions, share their knowledge and collaborate. It was these frequent interactions that led me to not only become a better critical care nurse, but also to challenge myself in ways I had not considered.

My most moving memory is from almost 12 years ago – when I saw the confidence my nurse director, Shaun Golden, had in me after I applied for the nurse educator position.

To prepare, I read the professional literature daily and discussed cases with the experts around me. At BWH, we have complex, challenging and interesting patients as well as clinical situations that were like what I was reading about in the literature. From that realization, I tried my hand at writing for professional nursing journals, and submitted abstracts for local, regional and national nursing conferences. I was fortunate enough to find some success there.

I will always treasure my colleagues in the Neuroscience Intensive Care Unit, my fellow nurse educators, all the incredible nurses I’ve had the privilege to work with over the years from all departments for their confidence in me and faith in what I could achieve. Most especially, I will remember that any success I’ve enjoyed as a nurse educator would not have been possible without the confidence and support that Shaun gave me, and for that I will always be grateful.

Vince Vacca, MSN, RN, CCRN, Clinical Nurse Educator, Neuroscience Intensive Care Unit

BWHers Study How to Best ‘Stop the Bleed’

Pablo Uribe Lietz (center) demonstrates for Harvard Medical School students how to properly apply a tourniquet.

Even if you have no medical training, you might be able to save the life of someone experiencing a heart attack if there’s an automated external defibrillator (AED) nearby. Designed to be used by those with minimal or even no training, these devices automatically detect an abnormal heart rhythm and administer an electrical shock after sensors are applied.

Now, a group of BWHers plans to develop a similar kit for treating uncontrolled bleeding that anyone can use during an emergency before medical personnel arrive. The project is part of Stop the Bleed, a national awareness campaign about how to stop life-threatening bleeding.

In this Q&A, Eric Goralnick, MD, medical director of Emergency Preparedness, discusses the innovative ways BWH is contributing to Stop the Bleed in partnership with The Gillian Reny Stepping Strong Center for Trauma Innovation, Gillette Stadium and several local partners.

What gave rise to this initiative?

EG: Stop the Bleed was started in the wake of the Sandy Hook shootings by a group of clinicians, the Hartford Consensus, whose goal was to find what we can do as a society to minimize preventable deaths after mass shootings or other mass-casualty events.

To do that, they looked at the success the military has had in preventing deaths from extremity injuries by training many ground forces in trauma combat casualty care. The focus is on teaching lay individuals to recognize life-threatening bleeding and intervene – either applying pressure to a wound, packing a wound and then applying pressure or, if it’s an extremity, applying tourniquets. From this, the Hartford Consensus recognized the need to empower laypersons to intervene.

How is the Brigham contributing to the campaign?

EG: Where we think Brigham can particularly add value is in innovation, education and operationalizing the concepts of Stop the Bleed.

We’re working to identify the equivalent of the defibrillator for hemorrhage control, starting with trials of a few commercial “just-in-time training” kits for bleeding control. Potentially, we may design our own.

We’re also developing training programs. When we look at these horrible events, they have traditionally occurred in places like stadiums, public transportation hubs, schools and shopping malls. We want to work with these organizations to train their staff in bleeding control.

This program’s success is possible thanks to our collaboration with the Department of Emergency Medicine and Trauma Service at BWH and Massachusetts General Hospital, the Center for Surgery and Public Health, Fallon Ambulance, South Shore Hospital and Boston MedFlight.

Tell us more about the research and training.

EG: At our first event, we trained more than 50 health care professionals, followed by a series of similar events in the community.

We also launched a randomized study at Gillette Stadium, where we’ve enrolled more than 560 staff, including security officers, vending station operators, parking attendants and others. Each staff member was randomly assigned to one of four groups comparing the effectiveness of tourniquet application after receiving traditional training, “just-in-time training” kits with audio or diagrams or no advance training.

Through focus groups, we’re learning how to design a more intuitive kit. Roughly 90 percent of the people got it right after in-person training, and we think we can develop a kit that’s equivalent.

In addition, Stepping Strong and Gillette purchased 525 first-aid kits that will be worn by personnel who have been trained. They’ve also purchased public-access tourniquet kits that are hung next to AEDs.

Next, we will retest and reevaluate these individuals to gauge how often they should be retrained. Finally, we’ll describe best practices for training a stadium’s workforce, as this is the first Stop the Bleed program in a professional sports stadium that we’re aware of.

This is an opportunity for science to guide us, and the science we have is from the battlefield – and the many soldiers, sailors, airmen and Marines whose lives have been saved because of tourniquets.

‘Stop the Bleed’ at HUBweek

BWH is participating in HUBweek, a weeklong festival celebrating innovation in Boston. On Wednesday, Oct. 11, 3-5 p.m., explore innovation at Brigham Health through an interactive scavenger hunt, which includes a training session with BWH’s Stop the Bleed project. The event is free to attend and open to all staff. Register and learn more here.

Brigham Health’s Strategy in Action: Scalable Innovation
Learn more about our strategic priorities at BWHPikeNotes.org.

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BWH Student Intern Takes Clinical Research to Heart

Kate Marra interned in a BWH lab studying the same cardiovascular condition from which she recently recovered.

In addition to her naturally warm demeanor and educational background, nursing student Kate Marra possesses another quality that made her uniquely suited for a summer internship in the Division of Cardiovascular Medicine. She has an innate empathy for cardiovascular patients, having been one herself.

Marra, a junior at Linfield College in Oregon, recently worked under the guidance and mentorship of investigators in the MacRae lab, where researchers are striving to unravel the mysteries of cardiovascular disease. She worked directly with investigators who are trying to pinpoint the earliest signs of impending cardiovascular issues long before symptoms appear. They hope to intervene as early as possible to prevent cardiovascular events from ever occurring. Marra spent much of her summer internship speaking with patients in the Watkins Cardiovascular Clinic about the lab’s research projects and opportunities for them to participate in clinical trials.

“I was surprised so many people said yes when I asked them if they’d like to participate in a research study,” she said. “Most people in the waiting room are enduring very stressful situations. And yet, patients told me, ‘I want to help others,’ and ‘I want to contribute to research.’”

Marra can certainly relate to their sentiments.

One of the conditions the MacRae lab is studying is a rare disease of the heart muscle known as arrhythmogenic right ventricular cardiomyopathy (ARVC). Although Marra’s work this summer was not related to ARVC, she is very familiar with the condition. At the age of 15, she was hospitalized and diagnosed with it. She has since recovered, but the experience shaped her goals and interests.

“I knew I wanted to give back,” said Marra. In addition to pursuing a nursing career, Marra, along with her father, began searching for labs that were researching ARVC. That’s how the family came across the work of Calum MacRae, MD, PhD, chief of Cardiovascular Medicine.

Marra and her family have been fundraising for the MacRae lab for several years. Marra’s father competes in long-distance running and cycling events, and Marra does everything from teaching swimming lessons to helping organize garage sales to raise funds for the lab’s research.

Last year, the Marras came to the Brigham to visit and tour the MacRae lab and the zebrafish facility where most the lab’s ARVC research was being conducted. During that visit, Marra had the opportunity to see zebrafish lines with the same cardiovascular condition she had been hospitalized for not long ago.

Marra and MacRae talked about her burgeoning interest in nursing and about the possibility of coming back to the Brigham for a summer internship. After her application was accepted, she returned to the MacRae lab in June and worked with Cardiovascular Medicine fellow Sunil Kapur, MD, helping to recruit participants for a research study using innovative biomedical devices.

Marra, who completed her internship in August, said she loved being a part of the research team and seeing the work that goes on behind the scenes to collect and interpret data, publish papers and polish presentations. But, above all, her favorite part of the internship was the opportunity it gave her to interact with patients.

“The patients I talked to were wonderful. I loved learning about them, and they were so supportive,” said Marra. “One of them told me, ‘You’re going to make a great nurse.’ I have lots of good memories from the summer, but that one is my favorite.”

Congrats, Grads! Celebrating Student Success Jobs Program Graduates

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As a shy and unsure high school sophomore beginning her BWH internship through the Student Success Jobs Program (SSJP) three years ago, Laureen Chalumeau froze when her supervisor instructed her to make her first phone call to a patient for an appointment reminder.

“I’m not ready for this,” she thought. But after a few months of working closely with her supervisor and mentor, Caroline Melia, BSN, RN, nurse care coordinator at Brigham and Women’s Advanced Primary Care Associates, South Huntington, something shifted for Chalumeau.

One day, a patient who only spoke Haitian Creole arrived for an appointment, but an interpreter was not immediately available. Chalumeau, who speaks Haitian Creole as well, jumped in to help translate without hesitation. Looking back now as one of this year’s 31 graduating SSJP seniors, she remembered how pivotal that moment felt and how surprised she was by her confidence.

“I don’t think I would ever speak Haitian Creole to anyone outside my family before that,” said Chalumeau, 18, who was recently awarded a six-year, full scholarship to attend Northeastern University, where she will study pharmacy. “SSJP just shook my world. I was so shy and introverted. Now I’m more outgoing and ready to challenge myself because SSJP supported me and put me in situations where I felt I could push myself.”

A program of the BWH Center for Community Health and Health Equity (CCHHE), SSJP matches Boston-area high school students with mentors across the Brigham for paid internships. The program is focused on fostering the next generation of talented, diverse health care workers. More than 40 departments host SSJP interns. All students who have completed the program enroll in college, and 75 percent study health or science.

Joined by their families, colleagues and SSJP underclassmen, this year’s seniors were honored during a graduation ceremony held at the Joseph B. Martin Conference Center on June 19. Attendees heard reflections from SSJP alumna Nakia Ellies, their peers in the program and keynote speaker Cheryl Clark, MD, ScD, director of Health Equity Research and Intervention at CCHHE and a hospitalist in the Division of General Medicine and Primary Care. Clark advised graduates to find strength in community, believe in themselves and “take the long view” on what they seek to achieve or change.

Donell Rankins Jr., a sophomore at the John D. O’Bryant School of Mathematics and Science in Roxbury, told the audience how valuable his first year interning with inpatient Radiology has been.

“I was able to truly see that teamwork really does make the dream work,” he said. “Not only have I had the pleasure of being on the Radiology team but also the SSJP team. I have made so many friends from a plethora of different backgrounds and experiences that all come together and form a diverse SSJP community.”

Mentorship Builds Bonds

Reflecting on her three years in the program, Chalumeau said the most important component for her has been her relationship with her mentor.

“Caroline has always been there for me. No matter what issue I have, I could easily come to her,” said Chalumeau, who graduated from the Urban Science Academy in West Roxbury this month. “I look up to Caroline and aspire to be as great as she is. She’s a one-woman army in my eyes.”

At South Huntington, SSJP interns are treated like any other team member, whose ideas and contributions are all valued, Melia said. Last year, Chalumeau led an effort to create a team newsletter to better communicate information from staff meetings.

“They’re not just students. They’re people with great ideas, and they add a lot to the patient experience,” Melia said. “This program is really important not only for the students as a learning opportunity but also for the community, the hospital and the future of health care.”

Melia said it has been rewarding to see Chalumeau grow as a person and professional over the past three years and take the next steps in her studies and career.

“I’m so proud of Laureen and so happy for her. She’s such a special person,” Melia said.

SSJP is actively seeking departments and enthusiastic staff members to support its efforts. To learn more about how to become a mentor and host an SSJP intern, contact Pamela Audeh at 617-264-8740 or paudeh@bwh.harvard.edu.

Brigham Health’s Strategy in Action: Teaching & Training
Learn more about our strategic priorities at BWHPikeNotes.org.

Trainees Help Expand the Reach of Pharmacy Services

Channel De Leon (center) chats with pharmacy students Hannah Kwon and Ryan Fan on Shapiro 8W before seeing patients.

When Channel De Leon, PharmD, BCGP, joined the Integrated Care Management Program (iCMP) four years ago as a senior pharmacist – and the program’s only pharmacist – one thing quickly became apparent to her. There wasn’t a way she could manage 3,000 medically complex patients on her own, especially given that an average iCMP patient takes 17 medications.

De Leon realized the best way to expand the breadth of the program and enhance patient care was to bring pharmacy students on board and teach them about enhancing transitions of care. In partnership with BWH Pharmacy Services, she began training students from Northeastern University and the Massachusetts College of Pharmacy and Health Sciences in 2014.

Since then, dozens of pharmacy students have completed rotations with De Leon. The students have contributed to improving medication reconciliation and adherence, helping patients save thousands in out-of-pocket costs and resolving hundreds of medical discrepancies at critical transitions of care.

For patients with complex medical conditions or multiple co-morbidities, navigating the health care system can be a challenging experience. The goal of iCMP is to help patients stay healthy through proactive care coordination and interdisciplinary support. In addition to a pharmacist, the iCMP team includes registered nurse care coordinators, social workers, community resource specialists and community health workers – all of whom work closely with a patient’s primary care physician.

“Having students as part of the program means there is more time to provide education directly to patients about their medications, and this is also a great learning experience for students before graduating,” De Leon said.

Lower Medication Expenses, Better Health

Pharmacy students on the team have a lot of face-to-face conversations with patients about medication management. Students counsel patients about their medications and assess barriers to medication adherence.

“A big factor is the cost of certain medications. We teach patients about insurance deductibles and look for resources that will help patients access the medications they need,” De Leon said.

If a patient goes home from the hospital on a new medication, the student ensures it’s affordable for the patient and, if not, works to resolve the issue prior to discharge. This process avoids gaps in treatment and unexpected out-of-pocket costs upon discharge. One student recently helped a patient save more than $10,000 in out-of-pocket costs by identifying a different insurance plan with better coverage for the patient’s specific medications.

The program is mutually beneficial to students and patients. Magie Pham, PharmD, who completed a rotation with De Leon last fall and graduated from Northeastern’s pharmacy program in May, said the skills she learned at BWH were invaluable to her training.

“While you’re in pharmacy school, you think to yourself, ‘I have to study and memorize all of these drugs,’ but communication is an equally key skill on a day-to-day basis,” Pham said. “Channel gave us guidance on everything from how to appropriately email someone to how to best communicate with patients. I never felt lost.”

Pham was among the group of pharmacy students who helped host a Medicare Part D Fair at BWH last fall. During the event, patients were paired with a student who walked them through the various Medicare D plans and identified the most affordable options based on the patient’s medication list and pharmacy preferences. By the end of the fair, students had helped patients collectively save nearly $7,000 in out-of-pocket costs.

De Leon hopes to offer the fair again this year and send students into community settings, such as senior housing complexes, which are more convenient to many patients.

Incorporating pharmacy students into iCMP has enabled the program to extend the reach of its pharmacy services, which are vital to safety and quality of care, said Lisa Wichmann, MS, RN, ACM, NC-BC, nursing director of Ambulatory Care Coordination.

“In some of our specialized programs, such as the End-Stage Renal Disease Program, Channel and her students review the medications for opportunities to reduce polypharmacy (the use of multiple drugs or more than are medically necessary) and enhance medication safety,” Wichmann said. “They’ve been able to make recommendations about simplifying the medication regime taken by some of our high-risk patients.”

BWH Welcomes New Interns on Match Day

Incoming interns from the Boston area, joined by Joel Katz (far right), celebrate their BWH match during a recent reception.

When Wilfredo Matias (pictured above: back row, second from left) and his family immigrated to the U.S. and settled down in New York, he was troubled by the inequities facing underserved residents in the city, particularly around health care quality and access.

He thought often of his grandfather, a physician serving the local community back in their home country, the Dominican Republic. Those two sources of inspiration – a desire to help those in need and a role model for doing so – led Matias to pursue a career in medicine and landed him at Harvard Medical School.

Now, Matias looks forward to continuing his training and helping care for patients in local communities the Brigham serves as one of the hospital’s 74 incoming interns selected for BWH’s Internal Medicine Residency Program on Match Day, March 17.

“The mission of the hospital is fantastic, and the community we serve is incredibly diverse,” said Matias, who completed a rotation at BWH as a third-year medical student. He had especially enjoyed the opportunity to interact with patients from Brazil, the Dominican Republic and Haiti.

“When I opened the envelope and saw the words ‘Brigham and Women’s Hospital,’ I went from feeling super stressed to thinking, ‘Yes, I get to be part of a place that truly invests in their people and has a culture I really admire,” he added. “Everyone here wants to help you figure out the kind of doctor you want to be, the impact you want to have and the means to accomplish that. That is pretty exceptional.”

Feels Like Family

Those feelings of welcoming and support were echoed by other newly matched interns who celebrated their acceptance into the program with BWH residents, faculty and staff that evening during a reception in the Zinner Breakout Room.

“What distinguishes the Brigham is the sense of family you feel here, which is truly unique,” said Aaron Cohen, who also graduates from HMS this spring. “When I’m here, I feel like I am part of a strong community that’s supportive and loving. That’s what has struck me most.”

Friend, classmate and fellow incoming intern Chijioke Nze, MPH, agreed that while BWH is a large hospital, he was moved by how it feels like a tight-knit community.

“There’s something very genuine about the family feeling I get from here,” said Nze. “A lot of my mentors are at the Brigham, most notably Dr. Fidencio Saldaña, so I’m very excited to work somewhere he calls home.”

Similarly, Ellen Nagami, of Tufts Medical School, said she couldn’t stop smiling when she learned she had matched to BWH.
“I’m really excited to work with the Brigham residents and attendings,” Nagami said. “I was able to rotate at BWH and BWFH, and I really loved the people with whom I worked and the experiences I had here.”

Jennifer Yeh, of HMS, who will begin her preliminary medicine residency at the Brigham this year, was elated to be matched to BWH, her top choice during the selection process.

“Medical education is a strong priority here, and this feels like an environment where I could develop my own skills at becoming a good teacher,” Yeh said. “This was my first choice because I liked working with all of the residents here as a medical student. Not only are they great physicians, but they’re also incredibly intelligent and caring people.”

Joel Katz, MD, director of the Internal Medicine Residency Program, has welcomed interns to the Brigham on Match Day for the past 17 years. He says seeing so many talented, enthusiastic and altruistic people who want to pursue a career in medicine is an inspiring experience each year.

“It’s an incredible privilege to be a doctor, and we matched 74 people who will be great doctors,” Katz said. “My advice for them is to concentrate on the unique, intimate learning experiences possible in the intern year: Accept it, embrace it, devote yourselves to the well-being of your patients, find what’s good, pass over what’s bad and turn to colleagues and friends for help when needed. Medicine is very much a team sport. We’re like family.”

DPH Commissioner Speaks at First Opioid Grand Rounds

Monica Bharel speaks at the first Opioid Grand Rounds at BWH.

Monica Bharel speaks at the first Opioid Grand Rounds at BWH.

The number of opioid-related deaths in Massachusetts has increased fourfold over the past decade, with data showing that five people in the state die every day due to an opioid overdose. Behind these staggering statistics are patients, families and communities struggling to get the help they need, and clinicians have an opportunity to help fill that gap, said Monica Bharel, MD, MPH, commissioner of the Massachusetts Department of Public Health, during BWH’s inaugural Opioid Grand Rounds on Feb. 2.

The event, sponsored by the Brigham Comprehensive Opioid Response and Education (B-CORE) program, kicked off a bimonthly speaker series about issues around the prevention and treatment of opioid use disorder.

Data is playing an important role in how the state is responding to the opioid epidemic, with the goal of analyzing it in a way that provides specific guidelines for frontline clinicians, said Bharel.

Getting to that point involves pulling information and seeking out experts from multiple sources, ranging from hospitals to law enforcement. Among the more revealing findings has been the overlap between a sharp increase in opioid-related deaths since 2014 and the presence of fentanyl at the time of death. Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine. Nearly three out of four people who died from an opioid overdose in Massachusetts between 2015 and 2016 had fentanyl in their system.

“We’re talking about the numbers in a big picture today, but it’s important to know that behind each one of these is an individual, family and community, and this disease has such profound impacts,” Bharel said.

This is not the first opioid-related epidemic the country has endured, but it has been the deadliest, mainly due to the widespread presence and potency of fentanyl, Bharel said. Another difference this time: Most people who die were introduced to opioids through the use of prescription painkillers, she said.

Focusing on Prevention, Education and Treatment

Prevention and education – for patients and prescribers – are key to turn those trends around, Bharel said. At the Brigham, B-CORE recently developed guidelines and best practices to educate prescribers about new laws related to prescribing, ways to help prevent addiction and where to direct patients seeking treatment.

Another major focus statewide has been removing the stigma associated with addiction and  changing the way it’s viewed, by the public and providers alike, “from a choice or moral decision somebody makes to a medical illness” that should be properly treated, Bharel said. If communities and health care providers regarded opioid use disorder the same way as other life-threatening illnesses, it would change patient outcomes, she added.

“I would really urge us, in terms of what we can do within the medical system, to take a deep look at why we treat substance use disorder so differently,” Bharel said.

One example of that is the proactive distribution of naloxone, a fast-acting medication that reverses an opioid overdose. New laws have made it available more broadly – at BWH, it can now be obtained without a prescription from the Outpatient Pharmacy and is carried by Security officers – but Bharel’s hope is that it’s also provided to patients at the same time they’re prescribed an opioid.

Even if the patient isn’t at risk for developing an addiction – most opioids are prescribed to people over 50, whereas most opioid-related deaths occur in people under 44 – the patient may live with someone at higher risk who has access to those painkillers, she said.

“When we start to decrease the number of deaths, individuals suffering from substance use disorder can get an opportunity to receive treatment and recovery. And unlike something like chronic alcoholism, we have an antidote when someone is acutely at risk for fatal overdose,” Bharel said. “If this was a blood pressure medicine, we would all be using this all the time, so I urge us to think about ways we can enhance the use of naloxone throughout our communities.”

The next Opioid Grand Rounds is March 23, 8-9 a.m., in Carrie Hall. David Kelly, RN, a nurse who developed opioid use disorder and underwent recovery, will share his story.

BWH Establishes Division of Medical Toxicology

From left: Edward Boyer, Peter Chai, Timothy Erickson and Susan Farrell

From left: Edward Boyer, Peter Chai, Timothy Erickson and Susan Farrell

Traditionally, when a patient arrives at the BWH Emergency Department (ED) with a possible poisoning or overdose, the care team calls the Regional Center for Poison Control and Prevention based at Boston Children’s Hospital. A clinical toxicologist – a health care professional with specialized knowledge of the adverse effects of drugs and other chemicals – provides guidelines and advice to the care team on how to best treat the patient.

This year, the Brigham will bring its own medical toxicologists directly to the bedside to share their expertise and care for patients facing adverse effects from medications, drug overdoses and substance abuse issues, thanks to a new division within the Department of Emergency Medicine: the Division of Medical Toxicology.

“Toxicology has been a well-known subspecialty for 20 years or more,” said Michael VanRooyen, MD, MPH, Emergency Medicine chair. “We’re taking a new twist on it through the addition of biotechnology and oncology toxicity research. The division will provide an innovative and unique way of looking at emergency toxicology.”

In addition to providing direct clinical care in the ED and inpatient units, the team will also educate clinical teams and trainees, provide staffing for the Regional Center for Poison Control and Prevention at Boston Children’s Hospital and pursue a variety of toxicology research, including biotechnology research that can share insights on medication compliance.

BWH emergency medicine physician, educator and medical toxicologist Susan Farrell, MD, EdM, is part of the new division, as well as medical toxicologists Edward W. Boyer, MD, PhD, and Peter Chai, MD, MMS, who both recently joined BWH from UMass Medical School in Worcester. Their expertise includes adverse drug events, toxicity, drug interaction and poisoning, and drug overdose. Medical toxicologist Timothy Erickson, MD, who joined BWH last September, serves as division chief. His areas of interest include the study of environmental toxins, venoms and the development of poison control centers in low-resource settings globally.

Once the new clinical service is up and running, medical toxicologists will follow and discuss the management of patients, says Chai. Not only will the bedside service provide personalized care for patients who are poisoned, but it will also help to reduce length of stay and decrease costs. Two examples of how medical toxicologists can achieve this: identifying which patients need to be observed, rather than admitted, and recognizing a poisoning early enough to provide an effective antidote.

Medical toxicology also encompasses opioid abuse, and clinicians have an important role to play in combating the opioid epidemic, says Boyer. “In general, we have to be much more cognizant of how we prescribe medications,” he said. “Research shows that writing somebody an extra handful of medications can have downstream effects on patients and families for decades. Understanding how patients use medications and the ways in which they take them has become ever more important in last few years.”

As director of Academic Development for Emergency Medicine, Boyer is also charged with growing the academic pipeline of new research in the department, toxicology-related and otherwise.

The expansion of Emergency Medicine into toxicology also includes plans to support cancer patients who are dealing with toxicity issues from chemotherapy and other medications. The initiative, which is expected to launch next year, will provide emergency care for cancer patients, as well as care coordination and palliative care for all cancer patients with toxicologic issues.

“We have a personal mission to help cancer patients, and our relationship with DFCI puts BWH at the cutting edge of how to care for them quickly and compassionately,” said Erickson.

Healing Globally, Partnering Locally

nicholas2

Our shining moment is highlighting our partnership with nurse colleagues from Haiti who are pursuing master’s degrees at Regis College and completing clinical work with BWH nurses, including Michaelle Renard, MSN, RN; Cherlie Magny-Normilus, MSN, RN; and Nadia Raymond, MSN, RN.

It is a shining moment for Nadia, Michaelle and Cherlie, as they have engaged in the theory-based and clinical education of the nurses from Haiti. It is also a shining moment for me as the director of the BWH Global Nursing Program and International Nurse Visitor Program in welcoming the Haitian nurse visitors to BWH!

Patrice Nicholas, DNSc, MPH, RN, FAAN
Director of Global Health and Academic Partnership

Program Helps Providers Discuss Patients’ Long-Term Care Goals

From left: SAGE team members Arjun Rangarajan, Joshua Lakin, Adam Schaffer, Rebecca Berger, Rachelle Bernacki, Catherine Arnold and Rebecca Cunningham

From left: SAGE team members Arjun Rangarajan, Joshua Lakin, Adam Schaffer, Rebecca Berger, Rachelle Bernacki, Catherine Arnold and Rebecca Cunningham

Death is an uncomfortable topic, even – and often especially – for clinicians, whose first priority is to improve health.

But avoiding discussions about goals and preferences in serious illness is a disservice to patients. An innovative program at BWH aims at improving the quality of care for such patients by encouraging earlier conversations about their personal goals and values, as well as fostering a better understanding of their prognosis.

“We recognized that some patients were dying without ever receiving the palliative care services they needed,” said Joshua Lakin, MD, a physician in the Division of Adult Palliative Care at Dana-Farber/Brigham and Women’s Cancer Center. He believes this was largely due to the fact that conversations between providers and patients about long-term care goals were happening too infrequently, and when they did occur, they were often very late in the illness course.

In response to a need to promote these “goals of care” conversations, an interdisciplinary leadership team representing Social Work, Palliative Care, the Hospitalist Service and Population Health Management formed the Speaking About Goals and Expectations (SAGE) program. The team used the Serious Illness Care program, originally created by Ariadne Labs – a joint initiative of BWH and Harvard Medical School – as a framework for a training program to help physicians engage hospitalized patients in discussions around their goals and values, and incorporate patients’ wishes across all aspects of care. The program earned a 2016 Success Story Award from Press Ganey last month.

“The idea is to get doctors to ask patients about their goals in a big picture view of their illnesses,” said Lakin, a member of the SAGE team.

“What are their worries? If their conditions worsen, what can they not live without? We strive to help patients receive long-term care that aligns with their values and preferences, and ensure that all providers involved with their care are part of these conversations.”

The SAGE team has trained 83 percent of the 35 hospitalists it initially identified as eligible for training. The team plans to complete more trainings within that group and expand the program to other departments.

COMMUNICATING GOALS OF CARE

The two-and-a-half-hour group training sessions cover communication skills and best practices for talking with patients about long-term goals related to their care. Participants have the opportunity to practice these discussions with medical actors who play the roles of patients. SAGE instructors provide feedback and offer ways for trainees to better promote and talk about goals of care.

Adam Schaffer, MD, a hospitalist in the Division of General Internal Medicine and Primary Care, completed the training and is now a champion for the program.

“The simulation with the actors is incredibly valuable,” Schaffer said. “Having these types of conversations can be intimidating because it’s something physicians often receive minimal training for. Practicing with an actor really helped me gain confidence.”

Physicians who complete the training continue to receive support from SAGE’s interdisciplinary leadership team, including clinical social worker Catherine Arnold, MSW, LICSW. Arnold lends her expertise to doctors who may experience difficulty in keeping these conversations moving forward. She also ensures information is shared across transitions of care so that ambulatory and post-acute providers understand patients’ goals for their treatment after discharge or upon readmission.

“Some cases can be more challenging than others, which really emphasizes the importance of an interdisciplinary approach. Our physicians know they can always come to me for support interacting with patients and their families,” Arnold said.

Nurse-Led STRATUS Course Improves Care for Sexual Assault Victims

A sample evidence kit used in the Sexual Assault Simulation Course for Healthcare Providers (SASH) at the STRATUS Center

A sample evidence kit used in the Sexual Assault Simulation Course for Healthcare Providers (SASH) at the STRATUS Center

More than one-third of women and more than one-fourth of men in the U.S. experience rape, physical violence or stalking by an intimate partner during their lifetimes.

To help lessen the health consequences associated with violence, trauma and abuse, a group of BWHers developed a training program for care providers, the Sexual Assault Simulation Course for Healthcare Providers (SASH).

SASH, which is the first nurse-led simulation at BWH, allows providers to gain hands-on experience in a safe environment and understand their roles as members of an interprofessional sexual assault response team.

Meredith Scannell, RN, MPH, of the Department of Emergency Medicine and the Center for Clinical Investigation; Annie Lewis-O’Connor, PhD, NP-BC, MPH, FAAN, a nurse scientist and founder and director of the Coordinated Approach to Recovery and Empowerment (C.A.R.E.) Clinic at BWH; Amanda Berger, MSN, SANE-A, and Andrea MacDonald, BSN, both forensic liasons in Emergency Medicine; and Ashley Barash, a former medical simulation specialist at BWH, began offering the course at the Neil and Elise Wallace STRATUS Center for Medical Simulation in 2013.

Scannell identified a need to improve care for sexually assaulted patients who arrive in the Emergency Department (ED). Her first priority became developing an enhanced, comprehensive education for ED nurses. After seeking out the expertise of fellow forensic nurses and nurse scientists, Scannell and others ultimately developed SASH for nurses, physicians and physician assistants. The team received BWH’s Mary Fay Enrichment Award in 2012, which funded the course’s development.

The four-house course, offered to clinical teams working in the ED, focuses on the medical, psychological and forensic needs of patients who have been sexually assaulted. It is divided into four sections: didactic teaching, evidence-collection skills acquisition, simulation (with a standardized patient actor) and debriefing. Participants learn how to collect components of the sexual assault evidence collection kit, perform a forensic examination and provide effective care for patients who have experienced intentional violence.

The course uses a trauma-informed framework, which helps providers understand how a patient’s exposure to intentional violence and trauma may influence care.

“Historically, this patient population has experienced disproportionate gaps in the delivery of their care in emergency departments and once they leave,” Lewis-O’Connor said. “This kind of intentional violence – sexual assault, domestic violence or human trafficking – is a serious public health epidemic in the U.S. and worldwide.”

Scannell, Lewis-O’Connor and Barash published a paper on SASH in the Journal of Forensic Nursing, “Sexual Assault Simulation Course for Healthcare Providers: Enhancing Sexual Assault Education Using Simulation,” which received the journal’s Article of the Year award this fall and now serves as a blueprint for other institutions to follow.

“Our goal is for every ED nurse to go through SASH,” said Scannell. “Each year at BWH, we see about 60 to 70 patients treated for an acute sexual assault – meaning the assault occurred up to five days prior – in the Emergency Department. It’s critical at least one member of a care team, and hopefully more, is trained in a comprehensive, quality care approach for this particular patient population.”

In the future, Scannell and her colleagues hope to offer training to participants from other disciplines, such as social workers and pharmacists, who may interact with patients who have been sexually assaulted.

“I am so proud of the program we’ve created,” said Scannell, who credits the course’s success to the passionate support it received from clinical staff across the hospital. Those supporters include Dorothy Bradley RN, MSN, program director in BWH’s Center for Nursing Excellence; and Patti Dykes RN, PhD, MA, a senior nurse scientist in the Center for Nursing Excellence; Janet Gorman, RN, BWN, MM, nurse director for Emergency Medicine; Nancy Hickey, MS, RN, former associate chief nurse, who passed away last year; and Charles Pozner, MD, medical director at the STRATUS Center.

In addition to the gaps in care that SASH is addressing in the ED, Lewis-O’Connor’s C.A.R.E. Clinic provides post-ED support to men and women who have experienced intentional violence. Through a trauma-informed care model, the C.A.R.E. Clinic helps patients create an individualized plan of care that is based on their unique needs.

Lewis-O’Connor said she also appreciates the partnership between the C.A.R.E. Clinic and BWH clinicians such as Hanni Stoklosa, MD, MPH, an emergency physician in Emergency Medicine and an internationally recognized expert in human trafficking.

“Partnerships are so important to ensuring that patients who present with intentional violence in the ED receive the highest-quality and safest care possible, both while they are here and after they leave,” Lewis-O’Connor said. “My work is dependent on others. It’s all about collaboration and doing what’s best for the patient.”

StrategyIcon_WordpressBWHC’s Strategy in Action: Highest-Quality, Safe Care
Learn more about our strategic priorities at BWHPikeNotes.org.

BWH Chief PA Leads on Statewide Opioid Epidemic Task Force

U.S. Surgeon General Vivek Murthy meets with Sheri Talbott.

U.S. Surgeon General Vivek Murthy meets with Sheri Talbott.

Physician Assistant Week is held Oct. 6–12 each year to honor physician assistants’ substantial role in improving health. PAs are involved in nearly every facet of the care at BWH.

Sheri Talbott, MS, PA-C, chief physician assistant for Renal and Pulmonary Transplant Medicine, says that learning medicine is akin to being handed a glass and asked to drink an entire lake.

“You’re never done drinking,” said the Army National Guard captain, who first joined BWH as an Emergency Department EMT in 1995 when she was a pre-med biology student at Tufts University. “There’s always more to learn, and I am really passionate about it and do it willingly.”

This passion for learning is clear in the variety of roles Talbott has taken on in service to patients at BWH and beyond, including her work at the state level to combat opioid addiction.

“Sheri embodies the very essence of what a PA represents in the health care community,” said Jessica Logsdon, MHS, MHA, PA-C, director of PA Services. “She has been a tremendous influence to the profession at the local, state and national levels.”

In February, Talbott was asked to join Massachusetts Gov. Charlie Baker’s task force on the opioid epidemic. As then-president of the Massachusetts Association of PAs, Talbott was charged with bringing together all PA program directors in the state to establish a set of core competencies for educating future PAs about recognizing, treating and preventing opioid addiction. Talbott says that the program directors and deans embraced this work from the beginning.

“How do you go after something so large?” she asked. “You start in lots of places, one of which is to teach clinicians who are going to be prescribing opiates how to do it thoughtfully and responsibly and how to talk to patients about it.”

The governor and other state leaders, including Health and Human Services Secretary Marylou Sudders and Department of Public Health Commissioner Monica Bharel, met again this August with Talbott and others to announce the finalized education program. The new curriculum will reach Massachusetts’ 900 enrolled PA students and 2,000 nurse practitioner students, according to State House News Service.

“I hope this work reduces the stigma associated with opioid addiction and brings it out of the shadows so it becomes something we’re able to look at in the light,” said Talbott. “Once we start having open conversations with patients about opioids, we can treat them more effectively. The more aware we are and the more we’re talking about it, the more successful we can be.”

Pozner Receives Lown Award

From left: Charles Pozner and Michael VanRooyen

From left: Charles Pozner and Michael VanRooyen

Praised as an innovator in medical education and for his warmth and sincerity as a mentor, Charles Pozner, MD, medical director of the Neil and Elise Wallace STRATUS Center for Medical Simulation at BWH, was honored with the Bernard Lown Teaching Award earlier this month.

Pozner led the development of the Simulation, Training, Research and Technology Utilization System (STRATUS) Center in 2004 as a single-specialty simulation center in the Department of Emergency Medicine. More than a decade later, it has grown into a multidisciplinary hub for hands-on training for thousands of physicians, nurses, physician assistants, residents, fellows, students and other clinicians across 14 departments throughout the hospital and beyond.

In addition to providing clinical training, STRATUS has also been used for assessment, process improvement and research purposes. More than 100 peer-reviewed studies have been published using data obtained in STRATUS; among those was the first simulation-based paper in the New England Journal of Medicine.

Pozner received the Lown Award on Sept. 12 during the 2016 Daniel D. Federman Teaching Awards Ceremony in the Carl W. Walter, MD, Amphitheatre at Harvard Medical School.

Through his work in the STRATUS Center and involvement in other projects, Pozner has redefined medical education at BWH, wrote Michael VanRooyen, MD, MPH, chair of Emergency Medicine, in a letter nominating Pozner for the award.

“I can honestly say that there are few clinicians whose contributions have affected as many learners, in as many disciplines and areas of clinical importance, as have the contributions of Dr. Pozner,” VanRooyen wrote. “His pioneering work has greatly improved the quality and safety of patient care in the entire hospital and beyond.”

The Lown Award was established in 2009 and named after Bernard Lown, MD, to celebrate physicians who are outstanding clinical leaders and recognize the significant role that education plays in BWH’s mission. Lown is a renowned senior physician at BWH, professor emeritus at Harvard School of Public Health and a Nobel Peace Prize recipient.

Pozner, named Clinical Innovator of the Year at BWH in 2008, said he was deeply moved to receive the award.   

“The fact that I’ve been recognized as a teacher is so unbelievably rewarding,” he said. “I love the interaction involved in teaching, and I love learning with the students.”

Simulation offers a safe space for clinicians to practice, learn and—perhaps most importantly, Pozner says—to make mistakes.

“No one comes to work to make mistakes, but we’re human, and humans have flaws,” he said. “In this environment, mistakes don’t hurt anyone—we can always just reboot the computer—so you should feel comfortable making them here because we’re going to use the mistake as a means to improve your practice.”

The supportive atmosphere in STRATUS is emblematic of Pozner’s passion for teaching and exceptional mentorship, wrote Andrew Eyre, MD, of Emergency Medicine, in a nomination letter.

“I cannot think of a clinician more deserving of this award,” Eyre wrote. “While I and others have learned a huge amount of information from him directly, nearly every provider at Brigham and Women’s has had their education and practice enhanced indirectly by Chuck’s leadership of STRATUS.”

BWH Welcomes 2016 Deland Fellows

Elizabeth Stanley and Collin Brady

Elizabeth Stanley and Collin Brady

Collin Brady, MBA, MEng, and Elizabeth Stanley, MBA, BSN, RN, CCRN, may have diverse interests and backgrounds, but there’s one thing they have in common: a passion to improve health care.

This year, the pair will serve as BWH’s newest Deland Fellows. The Deland Fellowship in Health Care and Society is a one-year administrative experience at BWH and BWFH that prepares early-career professionals to be leaders of health care institutions.

Throughout the fellowship, Brady and Stanley will work closely with senior leaders at BWHC. Brady’s mentor is Rich Fernandez, MBA, BWH’s senior vice president of Ambulatory Services. Stanley is working with Julia Sinclair, MBA, senior vice president of Clinical Services at BWH. Both Sinclair and Fernandez are former Delland Fellows.

Just a few months into the program, Brady and Stanley say they have already developed a great appreciation for the opportunities available to them at BWH.

“My parents always instilled in me to leave something better than I had found it,” said Brady. “The people I have met here all share this same ambition. I plan to learn as much as I can from the Brigham community so that I can add to the current transformation taking place in health care.”

Brady earned his MBA from Northwestern University’s Kellogg School of Management and a Master of Engineering from the Massachusetts Institute of Technology. He received dual bachelor’s degrees from Pennsylvania State University.

Brady says he is looking forward to working on several different projects, including helping teams and departments transition into the new building at 60 Fenwood Road. He’s also interested in learning more about how the hospital will develop its physician network, interacting with the Brigham Innovation Hub and Brigham Research Institute, and understanding how strategic decisions are evaluated financially.

“My family has been personally affected by neurological diseases,” he said. “I believe that the Brigham is a leader in innovation in these areas, among others, and I am proud to be a fellow here.”

For Stanley, she looks forward to working with BWH’s new Gillian Reny Stepping Strong Center for Trauma Innovation to further develop its organizational strategy and growth.

The more experiences Stanley has in health care, the more she realizes how interested she is in hospital operations. She enjoys exploring how and why things are done certain ways in hospitals.

Wherever she might land in her career, Stanley says she’s certain the fellowship experiences will serve her well.

“The Deland Fellowship adds to my nursing foundation for a career in health care leadership and affords me an opportunity to accelerate my professional development,” Stanley said. “The comprehensive mentorship and engaging project work allows me to distinguish myself in a rapidly changing health care environment.”

Stanley received her MBA, with a focus in health care administration, from the University of Colorado, Denver and her bachelor’s from Northeastern University.

The fellowship honors the memory of former board President F. Stanton Deland, Jr., a key figure during the merger of BWH’s predecessor hospitals.

BWHers Continue to Help Bring Health Equity to Rwanda

HRH

From left: Paul Farmer and Ira Magaziner

Traumatized by years of civil war and a devastating act of genocide in the early 1990s, Rwanda used to be a place where hope was in short supply.

Over time, however, the country came back stronger than ever—investing in education, infrastructure and regional trade—and Rwanda’s economy enjoyed one of the largest growth rates in the world last year. Still, one critical resource remained scarce: health care.

In 2010, the World Health Organization reported that Rwanda had one of the lowest rates of physicians per capita in the world. A country of nearly 11 million people, Rwanda was home to about 600 physicians at that time. Most were concentrated in large cities like Kigali, leaving rural areas underserved, especially in terms of specialists.

Now that picture is changing, thanks in large part to the Human Resources for Health Program, a collaborative, seven-year project with Brigham and Women’s Hospital and Harvard Medical School (HMS), the Rwandan Ministry of Health and more than 20 other academic institutions in the United States.

Currently in its fifth year, the program sends physicians and faculty from multiple specialties to Rwanda to train the country’s next generation of clinicians, researchers and medical instructors. BWH is the lead institution for clinical faculty for all Harvard affiliates from the Boston area, and it has recruited and deployed more than 50 specialists and sub-specialists over the last four years. To date, more than 340 clinicians have participated in the program.

“This partnership was forged by something very powerful: shared convictions about health equity,” said Paul Farmer, MD, PhD, chief of the BWH Division of Global Health Equity and co-founder of the nonprofit Partners In Health. The Human Resources for Health Program was the result of partnerships that Farmer helped establish in Rwanda.

When the program concludes in two years, its organizers hope to see significant increases in the total number of care providers in Rwanda and bring more specialists to rural areas. By 2018, the number of physicians is expected to reach 1,182—nearly double the physician census in 2011. Organizers expect to see the number of nurses grow by about 34 percent, with the goal of reaching 11,384 nurses by 2018.

Representatives from across the HMS-affiliated hospitals involved with the program—including BWH, Massachusetts General Hospital, Boston Children’s Hospital and Dana-Farber Cancer Institute—shared milestones and challenges over the past year at the “Symposium on Rwanda Human Resources for Health Program: A Success Story of a True Partnership” on June 10.

Capping off the half-day event at HMS’ Joseph B. Martin Conference Center was a panel discussion with Farmer and Ira Magaziner, CEO and vice chairman of the Clinton Health Access Initiative. Agnes Binagwaho, MD, PhD, Rwanda’s Minister of Health, joined via video conference.

“After the 1994 genocide against the Tutsi, almost no one believed in the future of Rwanda,” Binagwaho said. “We created a future that was defined by innovation—doing what nobody expected of us—because we believed that each and every person deserves the best future.”

The HRH program aims at replacing a culture of foreign aid with one of self-sufficiency. The expectation is that greater access to high-quality health care will improve the country’s economy—whether that means ensuring children’s physical and intellectual growth isn’t stunted by malnutrition, or by creating an environment that attracts biotech companies, Magaziner said.

“What we’re aiming for is sustainability,” he said. “We want to work ourselves out of a job, ultimately.”

 

Cultivating Interest and Instruction in Anesthesiology in Rwanda

Jill Lanahan

Jill Lanahan

Training residents in anesthesiology is not only about teaching them the medicine behind the specialty, says Jill Lanahan, MD, of the BWH Department of Anesthesiology, Perioperative and Pain Medicine. It’s also about sharing a passion for the profession to inspire them to join the field.

Lanahan has done exactly that at the Brigham since March 2014, and for the next year she will share that same expertise and enthusiasm for anesthesiology with the next generation of physicians in Rwanda as part of the Human Resources for Health (HRH) Program, a collaborative, seven-year project between the Rwandan government, BWH, Harvard Medical School and more than 20 other academic institutions in the U.S. The program recently began its fifth year.

Lanahan—who relocated with her family to the Rwandan capital, Kigali, on Aug. 2—will spend one day each week doing didactic training with her new crop of residents. The other four days will consist of clinical training in the operating room. During her year-long position, she will offer three months of training in cardiac anesthesia, her primary area of clinical interest.

Although she has long had a desire to get involved in global health, Lanahan says HRH piqued her interest after chatting with two BWH colleagues in her department who were alumni of the program: Stewart Chritton, MD, PhD, and Ramon Martin, MD, PhD. She felt compelled to participate after learning just how scarce anesthesiologists are in Rwanda.

“There are fewer than 20 anesthesiologists in the whole country, and we have more than 100 in our department at the Brigham,” she said. “There’s a critical need for anesthesiologists in Rwanda.”

In Rwanda, there may only be one anesthesiologist per hospital, Lanahan explained. In addition, anesthesia is often administered by technicians—whose highest level of education is typically a high school diploma—rather than physicians or nurses, she said. In comparison, only licensed anesthesiologists and nurse anesthetists may provide anesthesia to a patient in Massachusetts.

The lack of specialized training can be deadly, Lanahan said.

“People fear anesthesia in Rwanda, and part of it is because there’s a higher morbidity and mortality rate associated with it,” she said. “By training specialists in anesthesia, we can increase the likelihood that it will be administered safely to patients.”

As part of its broader goal to build a more self-sustaining health care system in Rwanda, the program has gradually sent fewer U.S. clinicians each year to train residents.

Lanahan is one of a handful of anesthesiologists in attendance this year.

“The idea is that if a resident from a country such as Rwanda goes elsewhere to train, they might not come back to their home country,” Lanahan said. “So by bringing doctors to Rwanda, you can train them in their own environment and expand the number of physicians there.”

What Are Our Strategic Priorities and Areas of Focus?

BWHC Strategic Priorities Slide 2016 v4

Strategic Priorities

We have prioritized these seven objectives to ensure that we are a high-performance health care organization that meets patient needs and remains competitive in the marketplace. The examples listed below are meant to illustrate one instance—not a comprehensive review—of how we meet these goals. For more examples of how we achieve these priorities, visit BWHPikeNotes.org. As our strategic priorities evolve in fiscal year 2017, read BWH Bulletin for the latest updates.

Scalable Innovation
LIGHTCHASER PHOTOGRAPHY -- BRIGHAM AND WOMEN'S HOSPITAL STAFF WORKINGS

The remarkable discoveries and innovations at BWHC improve our understanding, prevention and treatment of diseases.

BWH researchers were the first to study the long-term effects of multivitamins, discovering in 2012 that men over 50 who take a daily multivitamin reduce their risk of cancer, but not cardiovascular disease—a finding that affects millions.

Advanced, Expert Care
SOG_2401_13

Patients from around the world seek out the expertise of our highly specialized clinical and research staff, who pioneer medical breakthroughs and provide individualized care.

Launched  as an initiative of the Dana-Farber/Brigham and Women’s Cancer Center, PrecisionCancerMedicine.org serves as a hub for physicians and patients looking for resources, including clinical trials, to help pinpoint therapeutic agents designed to precisely target and treat an individual’s cancer.

Improve Health
Global healthcare

Healing and caring for patients locally and globally means not only treating disease, but also preventing it and improving a patient’s quality of life.

The Center for Community Health and Health Equity works with community partners to reduce health care inequities and increase access to care for vulnerable populations. Our primary care and specialty services enable us to help patients sustain good health and prevent disease.

Timely Access
Medical register

Our ongoing efforts to optimize operations, productivity and efficiency mean we can help more patients in need of BWHC’s expert care and in their preferred timeline.

Our Epic system helps make scheduling for appointments and procedures easier for patients and families. We also aim to assign patients to a room as quickly as possible and ensure we can rapidly accept direct transfers of patients who need our care.

Exceptional Experience
Environmental Services4

BWHC is committed to providing patients and families with the best possible care experience—from their first interaction with BWHC to follow-up care they receive after leaving the hospital.

This includes valet services when patients or family members arrive, a seamless registration process, clean inpatient rooms, high-quality meals, compassionate and highly skilled care, among many other elements.

Highest-Quality, Safe Care
Close up of nurse caring for a senior patient

Our patients and families deserve the best possible care, which means the right diagnosis and treatment, coordinated communication with care teams, transparency and prevention of harm.

We are improving patient safety by fostering a Just Culture, where staff feel comfortable reporting errors so that we can prevent them from reoccurring. Our Safety Matters initiative encourages transparency and sharing stories about mistakes we made, what we learned from them and the improvements we are making as a result.

Affordability
HiRes

The effective use of clinical, research and administrative resources and processes helps reduce the cost of care.

As part of a hospital-wide effort to reduce costs and improve efficiency, the BWH Audiovisual Service team began providing furniture moving assistance last year for internal events. The hospital had previously relied on an outside vendor. Using our in-house staff is expected to save the Brigham $60,000 this year.

Areas of Focus: Fiscal Year 2016

These areas of strategic focus position BWHC to achieve the seven objectives outlined above. Included with each description are examples of how we’re bringing these to life. For a full list of objectives, visit BWHPikeNotes.org.

Discovery & Innovation
8977_©Maglott_BWH_010509 copy

BWHC will continue to build on our rich legacy as pioneers in patient care and research.

FY ’16 goals: Brigham Building for the Future will be completed this fall on time and on budget. Increase our number of invention disclosures from 200 in 2015 to 210 this year to advance academic, clinical and financial progress.

Leading-Edge Care Redesign
BWH Buildings_100815_1991

We never stop looking for ways to improve patient care.

FY ’16 goal: Implementing an initiative called “Active Asset Management,” focused on improving the effective utilization of surgical, procedural and inpatient resources; improved transfer of patients; more efficient and supportive discharge processes; and improved referral management and ambulatory access.

Business Development
Stock market price display

Sustaining our mission requires an ongoing commitment to revenue growth and financial stability.

FY ’16 goals: Partnering with Bermuda Cancer and Health Centre to construct the island’s first radiation oncology facility. The business development team has also identified opportunities in China to lend Brigham expertise to new health systems there, greatly benefiting both organizations. Locally, we will meet our target of providing primary care for more than 200,000 patients in Greater Boston and Southeastern Massachusetts.

Our Foundation

People, Education, Skills and Capabilities
Longwood Primary Care

We seek to attract and retain the best staff, whose talents make our work possible.

FY ’16 goal: Strengthen the newly launched Brigham Education Institute—a central, cross-department organization launched earlier this year to coordinate medical education opportunities for our health care providers and trainees.

Financial Strength
stock graphy on screen

Without a solid financial foundation, our work in carrying out our mission and achieving our vision simply isn’t possible.

FY ’16 goal: Use our existing assets wisely to generate margin and operate within our budget so that we can continue to provide exceptional, leading-edge care, regardless of external challenges.

 

 

Q&A: Understanding Our Institutional Strategy

Betsy Nabel discusses BWHC’s institutional strategy with Medicine residents.

Betsy Nabel discusses BWHC’s institutional strategy with Medicine residents.

As health care institutions navigate an increasingly complex environment, it is imperative that we, as an organization, continue to differentiate ourselves through discovery, innovation and excellence in patient care. Having a clear strategy with specific goals will ensure our organizational strength for generations to come.

BWH Bulletin sat down with BWHC President Betsy Nabel, MD, to talk about our strategy and what it means for the BWH community.

Could you briefly summarize why having a strategy is important?

Our strategy articulates what we believe in as an organization, who we want to be in the future and what we need to accomplish today in order to realize our goals over the next five years.

Walk us through the framework image.

BWHC Strategic Priorities Slide 2016 v4

The image resembles the exterior of the historic Peter Bent Brigham entrance at 15 Francis St., emphasizing that our values are the same today as they were more than a century ago when our predecessor hospitals were established. You’ll see our vision at the top of the framework—that is who we aspire to be—and our mission is underneath, describing what we do and why we’re here.

The seven boxes below represent our strategic objectives—in other words, what we need to do to achieve our mission and vision. Three pillars underneath those boxes outline the priorities that we will focus on to meet our strategic objectives. Our people and our financial strength are at the foundation, as we cannot accomplish any of our goals or carry out our precious mission without continued development of our talented, dedicated staff and a strong financial foundation.

Why is it important for all employees to know our institutional strategy?

Our people have a deep-seated connection to our mission of patient care, research, teaching and community engagement. It’s equally important that they connect with our strategy. If all 18,000 of us understand the big picture and the goals, we’re better positioned to achieve them. Having conversations with each other about what the goals are and how we contribute to achieving them reaffirms our sense of engagement, unity and commitment.

Is having a strategy new for us?

We have always set strategic goals, but this framework gives us a way to make difficult choices based on where the Brigham should be in five years, not just this year or next. This builds on the strategic commitments we laid out in 2011. Once everyone understands the strategy and feels connected to it, we can all work together to ensure that we succeed.

Can every staff member have an impact?

Absolutely. Our clinicians are among the best in the world and can ensure every patient receives the advanced, expert care that sets us apart by working and communicating as a team to deliver truly patient-focused care. In addition, we all can have an impact on affordability, for example. You can be more efficient in your work, regardless of your role, and look for cost-savings ideas to share with your manager or submit to Bold Ideas, Big Savings at BoldIdeasBigSavings.org.

Exceptional experience is another goal where we all can contribute. Each one of us can be on the lookout for patients who are lost and offer to help them. Offering words of encouragement, empathy and kindness, providing support to patients and families, and going above and beyond what is expected—these are the things that profoundly affect how our patients feel about their care and their experience at the Brigham.

Not every role or department has a direct impact on every area of the strategy, but we can all affect some of these areas. I encourage everyone to use the worksheet in this issue to think through how you connect to our strategy and talk with your colleagues about it.

Will this change how we do things?

Yes, our strategy will guide us as we consider new initiatives and programs. We realize that we can’t do everything and, going forward, this approach will help us determine what new things we will take on and also what we will discontinue or decide not to do. These decisions, guided by our strategy, will also help us set priorities during our budgeting process.

Can you elaborate on how changes in the budgeting process will affect us?

We know every year that our expenses are higher than our revenue, so each year we begin with a gap that we need to close. We want to be more strategic and thoughtful as we consider what we should be doing more or less of in order to differentiate ourselves in the market, rather than just focusing on the numbers for one year. We need to think about the big picture so that we can be successful for years to come.

Where does the education component of our mission fit into the strategy?

Education is a vital part of our mission. The newly formed Brigham Education Institute is mapping out our strategy for education and training programs. As that matures, we will be able to set specific objectives in this critical area as well.

At Town Meeting, you discussed the strategic priorities that differentiate us. Can you elaborate on that?

As you look at the strategy framework, you’ll see that two of the seven boxes below the mission are shaded: “Scalable Innovation” and “Advanced, Expert Care.” In the other five boxes are goals we know we must achieve to be competitive, but they don’t necessarily distinguish us. All hospitals must ensure safe care, for example. But scalable innovation and advanced, expert care are what make us different from many other hospitals in the nation.

People come to the Brigham from all over the world because of the outstanding, highly specialized care they receive here—we take care of many patients whose cases are too complex for other hospitals. And our research community continually innovates and makes discoveries that we can rapidly translate to the bedside and the clinic to improve care for many patients at the Brigham and beyond—that’s scalable innovation.

We have always excelled in these two areas, and we know that they need to be a focus of our strategy going forward.

Does focusing more on these initiatives mean we’re focusing less on others?

Yes. As ideas or proposals for new initiatives and programs come to us, we will look to our strategy to guide us. That means there are some things we will discontinue or downsize and new projects we will implement.

How will we measure our success relating to strategy?

Strategy constantly evolves and adapts to the environment. As we set our strategic objectives, we are also committing to consistently measuring our progress in these vital areas and the performance of the hospital as a whole. That way, we will know if we have selected the right programs and priorities, and whether we are moving in the right direction. If we don’t see the progress we anticipated, we will course-correct.

How will these efforts benefit our patients?

Patients are at the center of everything we do, and articulating our strategy is no exception. Our strategy is designed to help us be successful for generations to come, which will ensure that we can continue to provide patients with care they simply can’t receive anywhere else. In addition, our focus on discovery and innovation will help accelerate the prevention, treatment and, ultimately, cures for many of the health concerns that those who depend on us face. The strategy not only positions the Brigham for success; in doing so, we believe that it will also improve the health of patients around the world for generations to come.

Improving Surgical Care in Resource-Limited Countries

Filming an NOTSS training video in Rwanda

Filming an NOTSS training video in Rwanda

All physicians want to provide the best possible care to their patients, but clinicians in parts of the world where resources are limited can face many challenges in doing so.

Recognizing this challenge, John Scott, MD, MPH, a general surgery resident and research fellow at the Center for Surgery and Public Health, teamed up with surgeons in Rwanda to improve surgical care for patients through the Non-Technical Skills for Surgeons (NOTSS) training program. This program—originally designed in Scotland by a team of psychologists, surgeons and anesthesiologists—was created to assess and improve surgeons’ non-technical skills, such as situation awareness, decision-making, communication, teamwork and leadership.

With the help of his mentors Robert Riviello, MD, MPH, of Trauma, Burns and Critical Care, and Steven Yule, PhD, of the STRATUS Center for Medical Simulation, Scott redesigned the NOTSS program to be used in a resource-limited setting for the first time. Additionally, they collaborated with students at the KWETU Film Institute in Kigali, Rwanda, to produce an on-location video series to complement the curriculum.

“Surgery is very technical, but expert performance takes more than just cutting and stitching,” said Scott. “Before the NOTSS program, we didn’t have a reliable way to teach these critically important non-technical skills.”

Having training in skills like situation awareness, leadership and decision-making makes it easier for doctors in resource-limited settings to resolve problems that may be specific to their operating rooms, Scott says. For instance, surgeons in Rwanda see variability in the equipment they use, the personnel and assistance they receive, and the support systems they work within. This makes it difficult for surgeons to plan ahead, and they must think creatively and deal with changes very rapidly, as their access to these medical resources can change quickly.

“The long-term goal is to improve the surgical service in Rwanda so that resource variability is no longer an issue,” said Scott. “But NOTSS enables us to improve patient safety and surgical performance here and now, without waiting around for more money and technology.”

For more information about BWH’s global health initiatives, visit BWHGlobalHealthHub.org.

Pursuing a Career Path—and Passion—With PCWD

Adelina Peña

Adelina Peña

Adelina Peña had been interested in working in health care for years, but it wasn’t until learning about the Partners in Career and Workforce Development program at a job fair a few years ago that she discovered how to make it happen.

PCWD is a free eight-week training program designed to help local residents prepare for, obtain and succeed in entry-level employment at Partners institutions, including BWH. The training program includes four weeks of classroom instruction and a four-week internship in a clerical or support staff position at a Partners hospital.

In addition to invaluable training related to résumé writing, interviewing skills and medical terminology, the program also focuses on other professional skills, including communication, problem-solving, customer service, attitude, and professional dress and appearance.

Graduates of the program have been matched in positions such as office assistant, unit coordinator, patient service coordinator, practice secretary, laboratory aide, medical records clerk and operating room assistant at BWH and Massachusetts General Hospital.

After applying to the program and completing a screening and testing process, Peña was accepted into the July 2013 PCWD class. Her internship was spent working as an anesthesia technician in BWH’s Department of Anesthesiology, Perioperative and Pain Medicine, where she was offered a full-time job after completing the program. She says that her BWH internship was the first step in a long journey of personal and professional growth.

Today, Peña is a BWH anesthesia technician and nursing student at Lawrence Memorial/Regis College in Medford. She is also the mother of 3-year-old Amelia.

“The PCWD program jumpstarted everything for me and enabled me to go to the next level,” she said. “It opened up job opportunities and networking relationships I had never thought would be available to me. I have received incredible coaching from BWH career coach Amy Zydanowicz, who helped me brainstorm the types of career paths I might want to explore.”

Working as an anesthesia technician has exposed Peña to different career growth opportunities. She is pursuing her associate’s degree in nursing, which she expects to earn next May. From there, Peña plans to enroll in a bachelor’s degree nursing program and aspires to become a certified registered nurse anesthetist at BWH someday.

Peña says her proudest accomplishment was getting accepted into nursing school and surviving the first year, especially with the intense clinical work.

“It was extremely difficult to balance school, work and being a mom, but I am very grateful to have an incredibly supportive manager and supervisor who have been very accommodating with my work schedule, especially around exam times,” said Peña. “In addition, I never could have done this without the support of my mother, who helps me take care of my daughter.”

Indian Health Service: At the Heart of Patient Care, Teaching and Community Outreach

From left: Michael Givertz, Arnold Ketchum, Nicolette McDermott-Ketchum and Lynne Stevenson

From left: Michael Givertz, Arnold Ketchum, Nicolette McDermott-Ketchum and Lynne Stevenson

At Northern Navajo Medical Center in Shiprock, New Mexico, physician assistant Nicolette McDermott-Ketchum, PA-C, cares for patients who are part of Navajo Nation, the largest Native American tribe in the U.S. at about 175,000 people.

About 37 percent of Navajos live in poverty. Access to specialty and preventive medical care is limited, with patients often having to travel a long distance to obtain medical services. Adding to these challenges is a lack of primary care physicians and specialists in New Mexico, Arizona and Utah, where Navajo Nation is based.

Clinicians like McDermott-Ketchum, who are part of the Indian Health Service (IHS)—a federal agency within the Department of Health and Human Services—provide care to nearly 2 million Native Americans at 35 hospitals and more than 300 health centers across the country. In 2008, the BWPO formed the Brigham and Women’s Outreach Program with the Indian Health Service. The outreach effort enables BWH clinicians to provide ongoing training and up-to-date clinical knowledge to IHS clinicians, with the goal of expanding IHS clinicians’ expertise in managing a spectrum of conditions.

McDermott-Ketchum and her husband, Arnold Ketchum, PA-C, a fellow IHS physician assistant, visited BWH last month to sharpen their cardiac care skills and heart disease knowledge in service to their patients in New Mexico. Many of their patients suffer from diabetes, high blood pressure and high cholesterol.

“I married into the tribe, and I love serving the Navajo people, who are kind, patient, resilient and family-oriented,” said McDermott-Ketchum.

During their visit, the couple shadowed Lynne Stevenson, MD, director of the Cardiomyopathy and Heart Failure Program, and Michael Givertz, MD, medical director of the Heart Transplant and Mechanical Circulatory Support Program.

“It was an amazing opportunity to observe Drs. Givertz and Stevenson in the Watkins Clinic and see the compassion and skill they demonstrated in every patient encounter,” said McDermott-Ketchum. “It is one thing to hear didactics about how clinical cardiology practice is supposed to operate, but viewing the interactions between BWH staff and their patients reinforced the knowledge with a human element. This is something I will keep in mind during my patient sessions.”

As part of the three-pronged Outreach Program, more than 100 Brigham clinicians have traveled to the Navajo Reservation in Shiprock and Gallup, New Mexico, and Chinle, Arizona, to care for patients and teach members of the local medical staff. Dozens more lead remote teaching and patient consultation sessions by video conference or volunteer to host IHS visitors here in Boston for more focused learning, says Ellen Bell, MBA, MPH, senior project manager for the Brigham and Women’s Outreach Program.

During the past seven years, 14 IHS clinicians have visited BWH to shadow clinicians across a wide range of specialties, including Emergency Medicine, Dermatology, Gynecology, Radiology and Cardiology.

“The Brigham and Women’s Outreach Program is the perfect reflection of the core values of the hospital in that we have been able to apply the expertise of our senior clinicians to improve the health of the community through teaching and clinical care,” said Tom Sequist, MD, MPH, medical director of the Brigham and Women’s Outreach Program. “Most importantly, this is not a one-way street, as our clinicians have been very vocal in expressing that they gain as much, if not more, from their experience volunteering in the program. In many ways, our program offers a life-changing experience.”

To learn more about the Outreach Program and how you can participate, visit http://www.brighamandwomens.org/ihs.

In Memoriam: H. Richard Tyler, MD, Neurology

Dr.TylerBWH and the Department of Neurology mourn the loss of H. Richard Tyler, MD, former chief of the Division of Neurology and BWH’s first full-time neurologist. He passed away May 9 at the age of 88.

“Known as a brilliant clinician and memorable teacher, Dr. Tyler made enormous contributions to the Brigham community, its patients and the field of neurology,” said Martin Samuels, MD, chair of the Department of Neurology.

Dr. Tyler, who lived in Brookline, is credited with building BWH Neurology from the ground up, serving as chief from 1956 to 1988. Under Dr. Tyler’s leadership, the department added a major basic research program in 1985, led by Dennis Selkoe, MD, and Howard Weiner, MD, co-directors of the Ann Romney Center for Neurologic Diseases. The Neurology Division at BWH became an independent department in 1995.

Dr. Tyler received his MD from Washington University School of Medicine in 1951. He interned at the BWH predecessor Peter Bent Brigham Hospital in 1951, followed by a neurology residency at Boston City Hospital. He then spent two years abroad at The National Hospital for Neurology and Neurosurgery, Queen Square in London and at the Pitié-Salpêtrière Hospital in Paris. He later worked at The Johns Hopkins Hospital before returning to BWH in 1956. He was appointed professor of Neurology at Harvard Medical School in 1974 and became emeritus professor in 1999.

During his time as chief, Dr. Tyler helped to develop the field of renal neurology, based on his experience with early dialysis and organ transplantation. He also characterized the physiological basis of asterixis, one of the cardinal signs of metabolic encephalopathy, also known as brain disease, damage or malfunction. He was an expert in the neurological aspects of congenital heart disease in adults and the neurological aspects of alcohol and malnutrition.

He always felt that his greatest contribution was not his personal work but rather the generations of medical students, residents and faculty he trainedmany of whom went on to assume major leadership positions in neurology, locally and throughout the nation.

After stepping down as chief in 1988, Dr. Tyler continued to maintain a busy neurology practice until 2015, and he remained a valued consultant for internists and neurologists. He continued to develop one of the great modern collections of books related to neurology and neuroscience.

Samuels said generations of Harvard Medical School students have vivid memories of Dr. Tyler’s prodigious teaching skills. He was one of the founders of the Harvard Longwood Neurology Training Program and recruited a group of distinguished neurologists to join him at BWH, including Selkoe and Weiner.

“Rick Tyler was the single most influential teacher in my quest to become an academic neurologist and to develop my career at BWH,” said Selkoe. “I will greatly miss his remarkable depth of insight into how brain diseases work and how to humanely care for those suffering chronic neurologic illnesses.”

Weiner said he learned neurology from Dr. Tyler at a time when all doctors had to work with were a patient’s medical history and physical exam.

“He was a master clinician who made neurology come alive for me,” Weiner said.

He is survived by his wife, Joyce; children Kenneth Tyler and wife, Lisa; Karen Tyler; Douglas Tyler and wife, Donna; and Lori Spisak and husband, Ken; 12 grandchildren; eight great-grandchildren; brother-in-law, Edward Colby; nephews David and Geoffrey Colby; and many friends and colleagues.

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Operation Walk Boston Volunteers Go the Extra Mile

Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients

Kara Burge (center), a staff nurse in Orthopaedic Surgery, with two Operation Walk Boston patients

year had passed since a young man came to the clinic with severe joint disease in his hips that left him unable to stand up straight, his torso pitched forward about 45 degrees as he steadied himself on a crutch.

But thanks in part to a group of volunteer clinicians from the Brigham, he was now running laps up and down a hallway at a hospital in the Dominican Republic, where he had received bilateral hip-joint replacement surgery through Operation Walk Boston—an orthopedic medical mission founded by Thomas S. Thornhill, MD, former chair of the BWH Department of Orthopaedic Surgery.

The program partners with Hospital General de la Plaza de la Salud in Santo Domingo to perform hip- and knee-joint replacements for patients who can’t afford the procedures. It completed its ninth mission last month.

Seeing that young man run down the hall when he came back for a follow-up visit was an unforgettable moment—one that illustrates why BWH volunteers give their time to give back, said Judith Nagle, MSN, RN, CNOR, nurse-in-charge in the Orthopaedics Operating Room who has gone on every Operation Walk Boston mission since its launch in 2008.

“When people come back and show you what they can now do that they couldn’t do last year, it just overwhelms you,” said Nagle, who took on the role of scrub nurse in the Operating Room during the trip. “I only did my job; these patients did the hard work.”

The latest mission served 37 patients and resulted in 56 replaced joints over five days. To date, Operation Walk Boston has provided 380 people with joint replacements. Clinicians perform the procedures pro bono, and all supplies are donated.

Each year, the mission takes about 50 volunteers, including surgeons, anesthesiologists, nurses, physical therapists, pharmacists and Operating Room staff. That group also includes residents from Orthopaedic Surgery, the Department of Anesthesiology, Perioperative and Pain Medicine, and Pharmacy. Additionally, the team trains about 70 medical students in the Dominican Republic to help support local care providers.

Daniel Tobert, MD, a third-year resident in Orthopaedic Surgery, went on his first Operation Walk Boston mission this year. Although the days were long, often starting at 4:30 a.m., he says the experience was fulfilling both personally and professionally.

“Everyone on the trip is giving up their free time to do hard work—and, in some respects, harder work than we’d do in a normal week—but it’s an incredibly rewarding experience,” said Tobert, who will be the mission’s chief medical officer next year.

Sarah Kelly, PT, DPT, a senior physical therapist in the Department of Rehabilitation Services, also joined Operation Walk Boston for the first time and says she was humbled by not only how grateful the patients were, but also how hard they worked during recovery. Because the volunteers are there for such a short time, they have to get patients walking as soon as possible, sometimes within a few hours of surgery. 

“It’s one of those trips that reminds you why you wanted to be a physical therapist in the first place,” Kelly said. “Patients who haven’t walked in years can finally get up and sit at the edge of the bed, stand on two feet or bend their knee a little more. To help somebody do that for the first time is unbelievable.”

Julia Rodriguez, RN, a staff nurse in the Post-Anesthesia Care Unit who has gone on several Operation Walk Boston missions, says she enjoys connecting with the patients and the Dominican clinicians and medical students. She also appreciates having the opportunity to speak her second language, Spanish.

“It appealed to me: going to a country that had fewer medical services than we have and being able to do mission work for patients who can’t afford this surgery on their own,” Rodriguez said.

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Taking the Lessons Home

Volunteers say the mission also provided learning experiences they wouldn’t normally be exposed to and fostered a deep sense of teamwork. Nagle appreciated the opportunity to attend a grand rounds-style meeting where doctors discussed their plans for surgery that week.

“You get to hear their thought process, which adds a whole other dimension to my practice here at home,” Nagle said.

Learning is also a two-way street, she said. Over the years, BWH volunteers have trained hundreds of medical students in Santo Domingo and helped local practitioners improve their quality of care. 

The limited resources during the mission can be challenging, but volunteers say they enjoyed having the chance to think critically and creatively to find solutions.

“It presents a situation we don’t normally have here, where you have an isolated opportunity to intervene surgically,” Tobert said. “This gives me experience in how to deal with more complex care decisions, which is something they don’t teach you in medical school.”

BWH Hosts ‘States of Grace’ Film Screening

From left: Mark Lipman, Grace Dammann and Helen Cohen

From left: Mark Lipman, Grace Dammann and Helen Cohen

On April 19, BWHers attended a screening of the documentary film “States of Grace” and had the pleasure of meeting the subject of the film, Grace Dammann, MD, along with the film’s directors.

The film shares the story of Dammann, an HIV specialist in San Francisco who was seriously injured in a head-on collision on the Golden Gate Bridge in 2008.

“The film is one of the most honest, informative and inspiring documentaries about illness and recovery that I have ever seen,” said Carolyn Becker, MD, of the BWH Division of Endocrinology, Diabetes and Hypertension, who saw the film at a conference in Portland, Oregon, last year. “When I first saw it, I knew it could carry great appeal for our housestaff and faculty, showing how a severe and sudden life event can lead to disability, family tensions, loss of sense of self and ultimate healing and renewal.”

Thanks to the generous financial support of Marshall Wolf, MD, emeritus vice chairman for medical education at BWH, and his wife, Katie, the film was shown at the hospital. Wolf believed the film was especially important for medical students and residents to view and learn from because it includes many lessons about caregiving and recovery.

Following the screening, Dammann and directors Helen Cohen and Mark Lipman answered questions from the audience about the documentary and Dammann’s journey.

BWH chaplain Monique Cerundolo, of Spiritual Care Services, said it was an honor to learn more about Dammann’s story as she responded to questions.

“The program was greatly pertinent to the work we do at the Brigham every day, portraying through Grace’s story the feelings, challenges and needs of patients and caregivers,” said Cerundolo. “Her journey is as profound, painful and inspiring as her strong spirit. Her presence was a gift.”

Abbie Engelstad, also a chaplain in Spiritual Care Services, meets patients and their families at particular moments on their journey, whether it’s just after experiencing trauma, returning to the hospital following a setback or during a routine check-in that has become part of a patient’s daily life.

“Watching Grace move through all of those moments in the film, and the huge range of emotions she and her caregivers felt along the way, reminded me of the deep reserves of strength and resilience our patients and their families need in order to move through each day, much less thrive,” Engelstad said. “Most inspiring of all was witnessing Dr. Dammann transform when she went back to practicing medicine. This strengthened my conviction that a sense of purpose is vitally important for the dignity, healing and well-being of all of our patients.”

To learn more about “States of Grace” and view the trailer, visit www.statesofgracefilm.com.

Department of Pathology Honors Young Investigators

Jeffrey Golden, left, announces the award winners, including Matthew Rose, right, at the Department of Pathology’s annual research celebration.

Jeffrey Golden, left, announces the award winners, including Matthew Rose, right, at the Department of Pathology’s annual research celebration.

The Department of Pathology recognized several young investigators at its 10th annual research celebration for their basic, clinical and translational research being conducted both in the department and in collaboration with other departments. In total, more than 30 posters were presented at the April 15 event.

Dozens of clinicians and investigators gathered in the Miller Atrium to listen to Jeffrey Golden, MD, chairman of the Department of Pathology, as he announced the Posters of Distinction Awards, including the first to be chosen by using a crowd-sourcing app developed in the department specifically for scientific meetings.

The event is an exciting opportunity to recognize trainees and junior faculty, Golden said.

“The annual Department of Pathology Research Celebration accentuates the extraordinary depth and breadth of research that is conducted in our department each year,” he said. “Every year, I am awed and impressed by what is done in this tremendous department.”

Lori Ramkissoon, PhD, Matthew Rose, MD, PhD, and Gurpanna Saggu, PhD, received the Posters of Distinction Awards. Saggu’s poster was chosen through the crowd-sourcing app. Distinguished guests Thomas J. Gill III, MD, and Simon J. Simonian, MD, ScD, were also in attendance to present the Thomas J. Gill III, MD, and Simon J. Simonian, MD, ScD, Prize for Research Excellence to Sankha Basu, MD, PhD, and his mentor Scott Lovitch, MD, PhD. This award recognizes the accomplishments of young investigators and how their relationships with mentors have influenced their success.

“This was a remarkable showcase of the cutting-edge nature of the research activities ongoing in our department,” said Michael Gimbrone, MD, former department chairman and the director of the Center for Excellence in Vascular Biology.