Posts from the ‘collaboration’ category

Behind the Scenes at the Brigham: Audiovisual Services

From left: Christopher Fenton and James Crowley manage audio and video broadcasts in the Zinner Breakout Room and Zinner Boardroom.

From left: Christopher Fenton and James Crowley manage audio and video broadcasts in the Zinner Breakout Room and Zinner Boardroom.

High-definition video of face-transplant surgery. Aerial footage of the helipad. Livestreamed events with hundreds of webcast viewers. These are just a few examples of the highly creative work produced by the Brigham’s Audiovisual Services (A/V) team in Office Services, which comprises several talented videographers, photographers, technicians and administrators who support every major service line and department.

“Our work is really fulfilling and fun,” said Peter Linck, manager of Office Services, which is part of Materials Management. “We get to work with so many people, and we also have a lot of creative freedom; when someone dreams up an audiovisual idea, we can help make it happen.”

And they do just that. Often spotted behind a camera or soundboard, the team supports dozens of events and multimedia projects in any given week. One moment, they could be broadcasting a hospital-wide event like Town Meeting or a tribute to the Rev. Dr. Martin Luther King Jr. from the A/V booth in Bornstein Amphitheater. The next, they could be filming neurosurgery cases in the Operating Rooms.

In addition to providing audio and video services, the team also assists the Brigham community with room reservations and event bookings. To make it easier for staff to determine the right venue for their event, the A/V team has made interactive, 360-degree online “tours” of many common meeting spaces, including the Zinner Conference Center and the Hale Building for Transformative Medicine.

From left: Elton Toska, Steven Kyriakidis, James Crowley, Benjamin Lee, Angel Ayala and Christopher Fenton (not pictured: John Bourque)

From left: Elton Toska, Steven Kyriakidis, James Crowley, Benjamin Lee, Angel Ayala and Christopher Fenton (not pictured: John Bourque)

When all-hands requests arise, Linck enlists the help of their colleagues in the Mailroom, which also sits under the Office Services umbrella, to assist with coverage needs. He noted that everyone on the team works to expand their skillset and is eager to lend a hand—including being willing, at a moment’s notice, to support press conferences and large events, such as the Magnet celebration and Discover Brigham.

Many A/V staffers began their careers in the Brigham’s Mailroom and have diverse professional and freelance backgrounds spanning television, photography and graphic design. Also noteworthy is the team’s retention rate. Many have been part of A/V for over a decade, with the longest-tenured member, John Bourque, coordinator in Office Services, celebrating 39 years at the Brigham.

Angel Ayala, senior technician in Office Services, credits Linck with reinforcing the Brigham’s culture of innovation, collaboration, excellence and treating setbacks as opportunities to grow together—fostering an environment that Ayala says inspires the team to do their best every day.

“We have a really great, understanding manager who supports our growth,” he said, adding that whatever technology and skills are needed for the job—such as video adapters, GoPros, software tools and HTML programming classes—Ayala and his teammates are given what they need to produce high-quality content and provide exceptional service to the Brigham community.

“Behind the Scenes at the Brigham” is a monthly photo series in Brigham Bulletin that provides a glimpse of the people whose everyday contributions help make the Brigham a world-class institution. Is there an individual or team you’d like to see featured? Send your ideas to BWHBulletin@partners.org.

Strengthening the Brigham Experience

bwh values logoLast summer, faculty and staff were invited to share their impressions of the Brigham’s organizational culture through the Brigham Experience: Culture, Diversity & Inclusion Assessment survey, focus groups, interviews and more. The message was clear: Our foundation and our people are strong, and we have opportunity to do even better, together.

The assessment revealed that Brigham Health has numerous strengths and areas of opportunity that will help grow the current culture to become even more transparent, diverse, inclusive and innovative.

Our strengths include our status as a leading academic medical system; our history and reputation; our shared passion for patient care; our progress in restoring financial health; and our ability to come together in a crisis.

Our areas of opportunity include the need for a more unifying vision and inspiring purpose statement that connects with all members of our workforce; the elimination of competition where there should be collaboration; more transparent and forthright communication; more diversity in leadership positions; a culture of respect and inclusion in every part of the organization; and a shift from a top-down structure to an empowered, shared decision-making approach.

Another takeaway from this effort was that the Brigham Health values as previously defined—collaboration, empathy, inclusion, integrity and professionalism—did not fully resonate with all faculty and staff. Building off feedback from across the Brigham, hospital leaders sought to redefine the institution’s values so that they better reflect who we are as a community.

The result is four newly articulated values:

We care. Period. We embrace a culture of shared humanity and dignity, where our diverse community of patients, families and employees all feel welcome, cared for and valued.

We create breakthroughs. It’s in our DNA. Since our founding, we’ve been discovering ways to make tomorrow better—for the health of people, here and around the world.

We’re stronger together. We all play a role. We take pride in teamwork, partnership and community. We value everyone’s contributions. We find inspiration in each other.

We pursue excellence. Because our patients deserve our best. We share a passion for learning and continuous improvement.

These four values also represent the theme of Brigham Bulletin’s 2019 calendar (published on the reverse side of this issue).

Looking ahead, hospital leaders are creating a “culture squad” to address the opportunities identified in the assessment and will then articulate behaviors that represent our aspirational culture.

Visit BWHPikeNotes.org and stay tuned for more information about our culture work.

Bulletin Bullets

Register for the 2019 B.A.A. 5K

Registration for the 2019 Boston Athletic Association (B.A.A.) 5K race opens Wednesday, Jan. 16, at 10 a.m. All runners and walkers are invited to take part in the excitement of Boston Marathon weekend while supporting trauma research and care at The Gillian Reny Stepping Strong Center. Click here to register for the race and become part of the Stepping Strong 5K team.

Brigham Health Opens Hingham Clinic

Brigham and Women’s Harbor Medical Associates opened a Brigham Health adult primary care clinic in Hingham on Jan. 2. The office, which is accepting new patients, contains 14 clinical rooms in a 9,000-square-foot space. Located at 6 Shipyard Drive in Suite 2A at the Hingham Shipyard, the clinic offers primary care services and a phlebotomy lab. To make an appointment, call 781-952-1303.

Reminder: Severe Weather Policy

With winter weather approaching, all faculty and staff are encouraged to review the Severe Weather, Emergency Policy or Significant Event policy (HR-406). All Brigham Health faculty and staff are expected to report to work as scheduled in severe weather, and decisions for individual sites, practices, departments, programs and units to remain open or to close are determined by Brigham Health leadership.

Coming Soon: Windows 10 Upgrade

Beginning in January and throughout 2019, Brigham Health will roll out the Windows 10 operating system to every eligible Partners standard desktop and laptop. Windows 10 offers a faster startup speed, improved layout, customizable user experience and improved security features. To learn more about new features and functionality with Windows 10, visit the Partners HealthCare Windows 10 Resource Center. For information specific to the Windows 10 roll out at Brigham Health, visit the Brigham Health IS Portal. Additional details and communications will be shared in the coming weeks. If you have questions or feedback, contact bhwindows10support@partners.org.

A Shared Commitment to Improving Diabetes Care

Hudson and colleages

From left: Lauren Godsoe, Margo Hudson and Maricruz Merino

I have been going annually to New Mexico with the Outreach Program with Indian Health Service since 2009, and each year gets better. I have primarily been involved with the diabetes program at Gallup Indian Medical Center in Gallup, N.M.

A former Brigham internal medicine resident, Maricruz Merino, MD, is now their chief of Medicine, and we have been working together closely over the years developing inpatient and outpatient glucose-management protocols. We are both close friends as well as colleagues, and we have shared the joys of the birth of children and grandchildren with each other in addition to seeing the growth of the diabetes program.

This past March, I had the pleasure of traveling with Brigham Health nurse practitioner Laura Godsoe, NP, for a week of lecturing and consulting on patients. I am so proud of the work we have done and thankful to Outreach Program for continuing to support this opportunity.

Margo Hudson, MD
Division of Endocrinology, Diabetes and Hypertension

The ‘Antidote to Burnout’: Helping Underserved Communities

Jason Frangos and team

From left: Zachary Holcomb, John Mohs, Jason Frangos, Margaret Cavanaugh-Hussey, Toby Crooks and Diana Woody

I made my second trip to Shiprock, N.M., in November 2018 as part of the Brigham and Women’s Outreach Program. Working alongside the dedicated doctors and staff at the Indian Health Service hospital in Shiprock has truly inspired and motivated me in my life and work. Contributing much-needed clinical care to the Navajo community has re-energized me with a sense of meaning and purpose as a physician. Volunteering at Shiprock has been my antidote to burnout and has revitalized my spirit.

Jason Frangos, MD
Director, Program for Infectious Diseases of the Skin
Department of Dermatology

Thankful for Our Friends in Shiprock

Carlson with Shiprock members

Alissa Umana (far left), Sally Carlson (second from left), Loren Day Lewis (second from right) and Kyle Dale Walters (far right)

In November, I had the privilege of traveling with three of my team members to the Northern New Mexico Navajo Medical Center in Shiprock, N.M., as part of the Brigham and Women’s Outreach Program with Indian Health Service. This is the second year that we have been able to travel with the Outreach Program to provide training in customer service and communications for clinical and administrative staff throughout the hospital. It is an incredibly rewarding experience to deliver our training to such an eager and enthusiastic audience—and to know that, in some small way, we are helping them improve the quality of care delivered to the Navajo population on the reservation.

This year, our trip happened to coincide with Native American Heritage Month, and as part of the celebration, Navajo dancers of all ages performed for staff and patients. Wearing intricately detailed costumes and accompanied by traditional music, the dancers offered moving performances of ceremonial dances to a crowd gathered in the hospital atrium. After the performance, we had the honor of being photographed with one of the dancers, who is also a supervisor at the hospital. It is a wonderful memento from the trip and a reminder of our friends in Shiprock.

Sally Carlson
Senior Manager, Training and Communications, BHIS

Bulletin Bullets

Gift-Wrapping Fundraiser to Support the NICU

The Brigham Young Professionals group is hosting a gift-wrapping fundraiser outside of the Shop on the Pike throughout December. Bring your unwrapped holiday presents and a volunteer will wrap them for you. Donations will benefit the NICU Friends of BWH, a group that support the families of the Neonatal Intensive Care Unit (NICU). Hours of operation will be Tuesday, Dec. 11–Friday, Dec. 14 and Tuesday, Dec. 18–Thursday, Dec. 20, 11 a.m.–1 p.m.

Shop on the Pike Holiday Sale, Dec. 13-14

The Shop on the Pike will celebrate its 10th birthday by offering 20 percent off most items, including select Brigham apparel, during a holiday sale on Thursday, Dec. 13, and Friday, Dec. 14. The discount does not apply to flowers/plants, balloons, candy, food, magazines, greeting cards, website orders, phone cards, gift cards or paperback books. Call 617-732-7878 for more details.

‘Flooded: Lessons Learned from a Major Hospital Flood,’ Dec. 13

The Department of Quality and Safety hosts “Flooded: Lessons Learned from a Major Hospital Flood” as part of the Quality Rounds. Ronald Iverson Jr., MD, MPH, of Boston Medical Center will present. Attendees will learn about planning and practice for a large-scale flood, as well as the use of outside resources during a response to such an event. Thursday, Dec. 13, noon-1 p.m., in Bornstein Amphitheater. Learn more.

Holiday Reminder: Personal Package Policy

With the holidays fast approaching, the Receiving & Distribution and Office Services teams remind employees that personal package deliveries cannot be accommodated. The priority of these departments is delivering items directly related to patient care and hospital business. Due to the large volume of these deliveries alone, the added responsibility of processing personal packages delays the turnaround time on products that may directly affect patient care. Please make alternate arrangements for the delivery of personal packages. For questions, contact Jonathan Santiago at jmsantiago@bwh.harvard.edu.

In Remembering Leonard Nimoy, Lung Center Highlights COPD Awareness

Julie Nimoy with her father, Leonard Nimoy

From left: Julie Nimoy with her father, Leonard Nimoy

When actor, director and artist Leonard Nimoy was diagnosed with chronic obstructive pulmonary disease (COPD) in 2013, the beloved Star Trek icon dedicated his time to raising awareness about this devastating, progressive lung disease until it took his life two years later. Through a documentary directed and produced by his daughter, Julie, and son-in-law, David Knight, Nimoy’s mission continues to live long and prosper.

In honor of COPD Awareness Month in November, the Brigham Health Lung Center partnered with Julie and David to screen the 2017 film, Remembering Leonard Nimoy: His Life, Legacy and Battle with COPD, on Nov. 29. The screening, held at the Joseph B. Martin Conference Center at Harvard Medical School, was followed by a panel discussion and question-and-answer session with Brigham clinical and research experts specializing in pulmonary care and thoracic surgery.

Ranking as the fourth-leading cause of death in the U.S., COPD is a family of chronic lung diseases that permanently damage the airways and, over time, make it increasingly difficult to breathe. In patients for whom the disease is in the most advanced stages, everyday activities like walking across a room can become extremely taxing. COPD is most commonly caused by smoking but also appears in nonsmokers, suggesting environmental and genetic links.

While preventable and treatable, especially in the earlier stages, there is no cure for COPD.

The Need for Early Detection

Told through interviews with Nimoy and his family members, the hour-long documentary features stories from the actor’s childhood in Boston, early career in Hollywood and breakout role as Spock in Star Trek. It also provides a candid look at his experiences living with COPD, his passionate support for smoking cessation and the toll the disease took on his family.

One poignant message the film underscored was that COPD is believed to take root at a young age, but patients often mistake its early signs—when treatment would be most effective—as the normal effects of aging or an inconvenient consequence of smoking. The takeaway resonated with Brigham experts who participated in the panel discussion.

“This is a disease that is difficult to diagnose early, and yet it’s medically important to do so,” said Bruce Levy, MD, chief of the Division of Pulmonary and Critical Care Medicine and co-director of The Lung Center. “It destroys the lung tissue, so the more that occurs as time goes on, the less responsive it is to medical therapies.”

Speakers highlighted the Brigham’s innovative research in the field and the comprehensive, multidisciplinary services offered through The Lung Center for patients with COPD—including medical therapies, such as pulmonary rehabilitation, and procedural interventions, such as lung transplant.

Internationally renowned COPD expert Bartolome Celli, MD, a physician-investigator in Pulmonary and Critical Care Medicine, said it is imperative that COPD screening become part of routine preventive care. The test for it, known as spirometry, should be as common as mammograms and colonoscopies to maximize the likelihood of early detection and long-term survival, he noted.

“It is our duty to go out and preach that this disease is treatable and preventable,” Celli said.

‘This Is Always New’

Nimoy’s granddaughter, Morgan Pearson, who attended the event, recalled how eye-opening it was to see her grandfather’s rapid decline between his diagnosis and his death at age 83.

“Even to those of us who knew him very intimately, he was larger than life and didn’t seem destructible,” she said. “I can’t say that, as a family, we were really prepared for that.”

Hilary Goldberg, MD, clinical director of Pulmonary and Critical Care Medicine, said the film reinforced the powerful role empathy plays in caring for COPD patients and their families.

“Initiating something like oxygen therapy or new medication seems fairly routine to us, but it is very, very life-altering to patients,” Goldberg said.

“The film really highlighted that it’s important to remember that this is always new to each patient that you see.”

Among the other Brigham panelists who participated in the discussion were Raphael Bueno, MD, chief of the Division of Thoracic Surgery and co-director of The Lung Center; Dawn DeMeo, MD, MPH, a physician in Pulmonary and Critical Care Medicine and a senior respiratory genetics researcher in the Channing Division of Network Medicine; Craig Hersh, MD, a physician-investigator in the Channing Division; and Scott Swanson, MD, director of Minimally Invasive Thoracic Surgery at the Brigham and associate chief of Surgery at Dana-Farber/Brigham and Women’s Cancer Center. Filmmaker Ron Frank also offered remarks.

Learn more about the documentary at rememberingleonardfilm.com.

B-PREP Program Aims to Stop Breast Cancer in Its Tracks

Bprep

From left: Mil Pierce reviews information about a clinical trial with Shivam Dua at the Comprehensive Breast Health Center.

As far as she can tell, Mil Pierce, 55, of Belmont has done everything right in terms of leading a healthy lifestyle. She never smoked. She goes to the gym twice a week and walks her dog nearly every day. She doesn’t drink alcohol in excess. And she’s eliminated red meat from her diet.

Pierce has made these choices with the knowledge that she has a strong family history of breast cancer. The disease has affected her mother, maternal grandmother and a maternal great aunt, among many other relatives.

Yet after Pierce underwent genetic testing to see if she had an inherited mutation in the BRCA1 or BRCA2 genes – an alteration that greatly increases a woman’s risk of breast cancer – the lab results showed she didn’t have the harmful mutation.

That’s why Pierce was stunned to learn two years ago, following a biopsy, that there were precancerous cells in her breast tissue. If left untreated, the abnormal cells could develop into breast cancer.

“When I got that diagnosis, it hit me like a brick. I thought, wow, there’s something else going on,” she said. “Genetically speaking, there’s no explanation for it.”

Today, Pierce is hopeful not only for her own continued health but also that of her two teenage daughters, thanks to the care, resources and guidance she’s receiving through the Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) Program at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).

Launched about two years ago and led by Tari King, MD, chief of Breast Surgery at DF/BWCC, the B-PREP Program develops a comprehensive, customized risk profile for every patient and a personalized plan aimed at reducing the likelihood of developing breast cancer. Upon entering the program, patients complete a survey that asks not only about their medical history but also a wide range of lifestyle factors that experts believe can contribute to breast cancer risk, including diet, physical activity, sleep, weight changes, whether they work a night shift and more.

“Assessing individual risk for breast cancer is complicated,” King said. “Breast cancer is not just one disease; it is a family of diseases, and the risk factors that can lead to the development of different types of breast cancer also vary.”

King emphasized that the program is open to all patients, including – and perhaps especially – those who don’t know their breast cancer risk.

“Many women think that if breast cancer is not in their family that they don’t have to worry about it, and that is not true. In fact, most women who come in with their first diagnosis of breast cancer don’t have a family history,” King said. “Our doors are open to anyone who wants to learn about their risk.”

Novel Trials

Another big misconception the B-PREP Program is working to dispel is that people at increased risk are at the mercy of their biology, King said. Based on what B-PREP’s multidisciplinary team learns from an assessment, each patient receives personalized recommendations and is connected to relevant resources, such as a referral to the Brigham’s Program for Weight Management or information about clinical trials currently enrolling patients.

One such novel trial is looking at how exercise affects breast cancer risk in women who have dense breast tissue and do not currently engage in regular exercise. Led by Jennifer Ligibel, MD, a medical oncologist specializing in breast cancer at DF/BWCC, the study pairs participants with a personal trainer for 12 weeks. Researchers will collect a breast tissue sample from participants before and after they complete the exercise program.

“We know that women who exercise more have a lower risk of developing breast cancer, but we don’t know why. We also know that denser breast tissue – that is, tissue containing more glandular elements to it and less fatty tissue – is linked to a higher risk, and, again, we don’t know why,” Ligibel said. “In a previous study we conducted looking at women who already had breast cancer, we saw that exercise actually changed the immune system within the cancer. Now, we’re looking at whether those same types of changes from exercise can be seen before a tumor has even emerged.”

Pierce learned about her eligibility for the study from her B-PREP providers and became one of the first patients to enroll. She appreciates how comprehensive the B-PREP Program is, including the opportunities to participate in clinical trials that explore wellness-based approaches to prevention.

“This breast density and exercise study was music to my ears,” she said. “I’m really excited about being on the cutting edge of research, especially since there’s a mystery here.”

Brigham Health’s Strategy in Action: Advanced, Expert Care
Learn more about our strategic priorities at BWHPikeNotes.org.

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Insufficient Sleep Associated with Risky Behavior in Teens

Elizabeth Klerman

There’s more at stake than puffy eyes and fatigue for teens skimping on shuteye, according to a recent study by Brigham investigators.

Adolescents require eight to 10 hours of sleep at night for optimal health, according to experts, including the National Sleep Foundation and the U.S. Centers for Disease Control and Prevention (CDC); yet more than 70 percent of high school students sleep less than that. 

While previous studies have shown that insufficient sleep in youth can result in learning difficulties, impaired judgment and risk of adverse health behaviors, new research from the Brigham’s Division of Sleep and Circadian Disorders found a negative association between sleep duration and personal safety risk-taking among high school students nationwide.

Compared to students in the eight-year study who reported sleeping eight hours at night, those who slept less than six hours were twice as likely to self-report using alcohol, tobacco, marijuana or other drugs, and driving after drinking alcohol. They were also nearly twice as likely to report carrying a weapon or being in a fight. 

Researchers found the strongest associations were related to mood and self-harm. Those who slept less than six hours were more than three times as likely to consider or attempt suicide, and they were four times as likely to report an attempted suicide that resulted in treatment. Only 30 percent of the students in the study reported averaging more than eight hours of sleep on school nights.

“We found the odds of unsafe behavior by high school students increased significantly with fewer hours of sleep,” said lead author Matthew Weaver, PhD, an associate epidemiologist in the division. “Personal risk-taking behaviors are common precursors to accidents and suicides, which are the leading causes of death among teens. These findings may have important implications for the health and safety of high school students nationally.”

Matt Weaver

The CDC administers biannual Youth Risk Behavior Surveys at public and private schools across the country. Brigham researchers used data from more than 67,000 high school students collected between 2007 and 2015, examining personal safety risk-taking behaviors individually and as composite categories. All analyses were weighted to account for the complex survey design and controlled for age, sex, race and year of survey in mathematical models to test the association between sleep duration and each outcome of interest. The results were published in a JAMA Pediatrics research letter in October.

“Insufficient sleep in youth raises multiple public health concerns, including mental health, substance abuse and motor vehicle accidents,” said senior author Elizabeth Klerman, MD, PhD, director of the Analytic Modeling Unit in Sleep and Circadian Disorders. “More research is needed to determine the specific relationships between sleep and personal safety risk-taking behaviors. We should support efforts to promote healthy sleep habits and decrease barriers to sufficient sleep in this vulnerable population.”

‘We’re All in It Together’: BWHers Prepare for Joint Commission Survey

From left: Wanda Ramos and Lauren Mazzone review readiness tips for the upcoming Joint Commission survey.

For a moment during the Joint Commission Staff Readiness Fair last week, Lauren Mazzone, MBA, paused and looked around Cabot Atrium, admiring her peers as they educated each other about the work they do each day to improve patient care and safety at the Brigham.

“It was great to see staff from various roles and areas across the hospital stopping by the readiness fair,” said Mazzone, program manager in Clinical Compliance. “In many instances, folks shared something new they had learned from visiting the different departments’ tables, which is fantastic. The feedback we received about the fair during and after the event reiterated to us that we’re all in it together.”

Between now and January 2019, The Joint Commission (TJC) surveyors are expected to arrive at BWH to conduct a hospital-wide accreditation survey. TJC, which accredits the Brigham every three years, is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. The survey is conducted through the tracer methodology, a means of evaluation in which surveyors select a patient and use that individual’s record as a roadmap to assess an organization’s compliance with certain standards and its systems of care and services. The visit to the Brigham will include observation, medical record review and interviews with staff. In addition, an engineer from TJC will examine the environment of care and fire safety standards.

In preparation for the visit, BWH’s Clinical Compliance team held a staff readiness fair in Cabot Atrium on Sept. 13, enabling champions from various departments to educate staff about their work and offer TJC preparedness tips. Among the many departments with information tables at the event were Ambulatory Services, Biomedical Engineering, the Bretholtz Center for Patients and Families, Environmental Affairs, Engineering, Food Services, Health Information Services, Patient Safety, Privacy, and Police, Security and Commuter Services.

Kelly Doorley, MS, RN, director of Clinical Compliance, said she was thrilled with the strong turnout at the fair. She added that the Brigham’s upcoming TJC survey is an opportunity to demonstrate the institution’s commitment to delivering safe, high-quality care every day.

Doorley emphasized that all staff play a role in keeping patients safe. To prepare for the TJC visit, she suggested that BWHers remain focused on the basics, including always wearing your ID badge; knowing where emergency equipment is located; understanding your role during any emergency code or drill; and practicing hand hygiene before and after every patient interaction.

‘Readiness Is Our Responsibility’

Beth Baldwin, MSN, MHA, RN, program director in Nursing Informatics, said she decided to attend the fair to better understand how she can prepare for the survey. In addition to overarching tips, she appreciated the opportunity to learn more about proper responses to specific situations, such as how to access a locked bathroom in the event of a patient emergency.

“This, and the other tips and tricks the teams reviewed at the readiness fair, help me feel more prepared to talk with surveyors when they are on site. It’s our responsibility to patients, their families and each other to be compliant every day.”

Jon Boyer, ScD, CIH, director of Environmental Affairs, said his team is committed to working with BWH staff to develop creative solutions to the Brigham’s complex safety, health and environmental compliance requirements.

Now through Sept. 28, Environmental Affairs is hosting a “Safety Selfie Challenge” in which staff are encouraged to take a selfie in three safe situations and submit them for a chance to win a prize. Any photos with patients must have proper consent, and staff must be mindful of private information that could inadvertently appear in the background.

“When we work together, safety can be fun,” Boyer said. “It’s everyone’s job to help keep our clinical, research, support and administrative spaces safe and compliant for patients, their families, visitors and staff at all times.”

Stephanie Peña, a service coordinator in the Center for Patients and Families, enjoyed the opportunity to ask questions and educate herself about the work of many other departments.

“It was a great chance to meet with people you speak with regularly by phone,” Peña said. “The readiness fair helped facilitate communication, which in turn will benefit all of us as we work to continuously improve patient safety and care at the Brigham.”

For more information about TJC readiness, visit BWHPikeNotes.org.

‘This Is What We Do’: Teamwork Shines amid Baby Boom

A few of the many BWHers who helped care for multiple complex patients during an unusually busy shift, from left: David Beadles, Andrea Oulton, Mandy Belfort, Nichole Young and Tammy Hyre

In her 22 years as a Brigham NICU nurse, Debby Schlehuber, RN, has seen her share of busy shifts. But few compare to the night she and her colleagues recently experienced when they helped deliver and care for extremely premature twins and triplets – in addition to arranging emergency transfers for two other patients – all in the span of just three hours overnight.

Despite the challenges of managing so many complex cases in rapid succession, BWHers involved said the remarkable outcome is all thanks to a large multidisciplinary team from the NICU and Labor & Delivery whose expert care, collaboration and communication ensured everything fell into place.

Staff across the Mary Horrigan Connors Center for Women and Newborns (CWN) said they were grateful to be part of such a collaborative interprofessional team, which included administrative staff, anesthesiologists, Environmental Services staff, midwives, nurses, physicians, respiratory therapists, trainees, unit coordinators and many more. In addition to staff from the overnight and day shifts, the team was supported by several BWHers who offered to assist before or after their shift.

“After that night, I was never prouder to be a Brigham nurse. Everybody came together, and we all knew we needed to work as a team,” said Schlehuber, who was the NICU nurse-in-charge that evening. “I didn’t for one second think, ‘How are we going to do this?’ We always find a way – because it’s all about our patients.”

Nichole Young, BSN, RNC-OB, the Labor & Delivery nurse-in-charge that night, added that while she too had never experienced such an exceptionally busy shift in her 15-plus years as a Brigham nurse, she was not surprised by the professionalism, dedication and skill demonstrated by all.

Like her colleague, Young emphasized that the extraordinary teamwork across many disciplines was pivotal to their success.

“It was a picture-perfect example of what we do when we’re at our best,” Young said. “It made me feel really proud and honored to work among such amazing colleagues.”

Mandy Brown Belfort, MD, MPH, of the Department of Pediatric Newborn Medicine and the attending neonatologist that night, remembered getting the call from Labor & Delivery that triplets were on the way moments after getting the critically ill newborn twins settled in the NICU.

“The whole team kicked into action,” Brown Belfort said. “Nobody got flustered. We are a very team-oriented specialty – this is what we do.”

Keith Hirst, MS, RRT-ACCS, RRT-NPS, AE-C, neonatal respiratory manager, agreed that the series of events highlighted remarkable collaboration among multiple disciplines, noting he was especially proud of the contributions made by respiratory therapists.

“It was an incredible night, and each of the respiratory therapists helped make it success,” Hirst said. “It was a team effort to make it as successful and as smooth as possible while continuing to deliver outstanding patient care.”

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SEQaBOO Study Aims to Unlock Genetics of Hearing Loss in Newborns

From left: Linda Johnson, Yvonne Chekaluk, Cynthia Morton, Anne Giersch and Jun Shen display buttons promoting SEQaBOO.

As part of routine universal newborn screening, every baby has a hearing test before leaving the hospital. From the moment an infant is diagnosed with partial hearing loss or deafness, a clock starts ticking.

The speech and language center of the brain rapidly develops early in life, and anything that interrupts this process can have lifelong consequences. Because of this, babies with hearing loss or deafness experience the greatest benefits when interventions – such as sign language, hearing aids or cochlear implants – are begun as soon as possible.

It can be difficult, however, for clinicians and families to anticipate which intervention will be most effective. That’s because there are multiple types and causes of hearing loss, many with genetic origins. While standard newborn screening techniques are effective at detecting the absence of hearing, they don’t account for each baby’s unique genetic makeup, which may affect how well a therapy or strategy works for them.

Hoping to chart a new frontier in personalized medicine, a team of BWH researchers recently launched a first-of-its-kind study to perform whole-genome sequencing in newborns who do not pass the newborn hearing screen. The project, called SEQuencing a Baby for an Optimal Outcome, or SEQaBOO, aims to enroll annually about 100 otherwise healthy babies, including those born at BWH as well as babies born elsewhere and referred from Boston Children’s Hospital (BCH) after not passing their confirmatory hearing test.

“Infancy is a critical window in development of speech and language, and we want to ensure babies are optimally habilitated,” said medical geneticist and SEQaBOO principal investigator Cynthia Morton, PhD, of the departments of Obstetrics and Gynecology and of Pathology. “To do this, we need the most information about the underlying etiology, or causes, of the baby’s deafness right from the start. We hope that implementing genomic sequencing into newborn screening for hearing loss will reduce the timeframe for determining how to best manage care.”

More than 150 genes can contribute to hearing loss, and as many as 800 genes could ultimately play a role in hearing, Morton explained. Researchers expect that identifying such variants early in life will help clinicians refine care and avoid unnecessary testing.

For instance, while a common variation in a gene known as GJB2 is tied to deafness at birth, it doesn’t cause abnormalities in the inner ear’s structure. If an otolaryngologist (an ear, nose and throat specialist) is aware a baby has this genetic variant, they may not choose to order a CT scan, Morton said.

In other cases, knowing the genetic variant up front may reduce the incidence of hearing loss, said Yvonne Chekaluk, MSc, MB(ASCP), project manager for the study. Certain antibiotics in conjunction with specific genetic variants can cause hearing loss, and understanding which newborns might be vulnerable is important, she explained.

Collaboration at the Core

Due to its many facets, SEQaBOO has generated several multidisciplinary collaborations at the Brigham and beyond. The team includes medical geneticists Anne Giersch, PhD, and Jun Shen, PhD, and Richard Kaufman, MD, medical director of the Adult Transfusion Service, as well as members of Pathology’s Crimson Core.

They are also partnering with staff in the Audiology Program, including Lauren McGrath, AuD, CCC-A, and with those in the Department of Pediatric Newborn Medicine, including Katherine Gregory, PhD, RN. Researchers also work closely with nurses in the Mary Horrigan Connors Center for Women and Newborns for their vital role in patient education and interactions, Morton said.

Beyond the Brigham, the team works with otolaryngologists at Massachusetts Eye and Ear, where newborns enrolled in the study receive confirmatory testing and follow-up care. Whole-genome sequencing for the study is performed at the Broad Institute. In addition to the clinical component of SEQaBOO, researchers are also surveying parents about their opinions on genetic testing in collaboration with Harvard University. (Click here to learn more about SEQaBOO’s collaborators.)

The team hopes that their findings from both the clinical and survey components of the study will help chart the path for making genomics a standard part of newborn screening nationwide.

“As a scientist, it’s very important to me to make a difference,” Chekaluk said. “I love that this project has given me the opportunity to open up new doors and collaborate with so many different departments. It’s exciting and wonderful to be a pioneer in the future of personalized medicine.”

Morton added: “We look forward to Massachusetts leading the nation in this work. It’s a big project with contributions from many individuals, and BWH is an optimal setting for this endeavor.”

To learn more about SEQaBOO, visit seqaboo.bwh.harvard.edu.

Residents Support Local Community with ‘Wednesday Wellness’

Rich Joseph leads a class about creating a personalized health plan at Brigham and Women’s Center for Community Wellness.

When Christina Meade, MD, was invited by a fellow resident to give a talk about kidney health – one of her clinical interests – to people in the local community, she jumped at the opportunity.

“I love medicine, specifically preventive medicine, and to educate people in our local communities about their health and wellness is what makes my job so wonderful and exciting,” said Meade, a second-year resident in the Department of Medicine. “After I participated in the talk, my passion for primary care was rejuvenated.”

Last year, Rich Joseph, MD, MBA, a third-year resident in Primary Care and Population Medicine, approached Paul Ridker, MD, MPH, director of the Center for Cardiovascular Disease Prevention, about possibly launching an ongoing health and wellness series led by residents at Sportsmen’s Tennis and Enrichment Center in Dorchester. Ridker, who at the time was the board chair of Sportsmen’s, said he instantly loved the idea, knowing the series could benefit both Brigham residents and community members.

Ongoing since September 2017, the “Wednesday Wellness” series takes place twice a month at the Brigham and Women’s Center for Community Wellness, Dorchester, located within Sportsmen’s. Each course focuses on a different health- and wellness-related topic, with more than 20 sessions held to date. Courses have covered diabetes and hypertension, dementia and arthritis, among other topics.

Opened in 2015, the goal of the Brigham and Women’s Center for Community Wellness Center at Sportsmen’s is to advance health and chronic disease prevention in underserved communities of Dorchester, Mattapan and Roxbury. The facility includes both classroom space for educational activities and a full gym, free to anyone living in the area.

For Ridker, the center has been a “terrific way for the Brigham to have a positive impact on preventive health in underserved neighborhoods where so many of our patients live and work.”

Wanda McClain, MPA, vice president of Community Health and Health Equity, agreed, adding the “Wednesday Wellness” program shows the power of collaboration. “Bringing together health care providers, community residents and Sportsmen’s is a perfect trifecta for improving community health,” she said.

Toni Wiley, Sportsmen’s executive director, has seen firsthand how valuable the courses have been for attendees.

Attendees of a recent “Wednesday Wellness” course gather for a photo with Brigham resident Rich Joseph (back row, center).

“I’ve heard many success stories from our members who’ve attended the ‘Wednesday Wellness’ sessions,” Wiley said. “Some have lost a few pounds, and others have come to understand how their medications truly work. It has been truly gratifying to hear people talk about how attending these sessions has been life-changing for them.”

The series has a loyal following. William Mitchell, of Mattapan, has attended nearly every “Wednesday Wellness” session, even inviting friends to join him. A retired firefighter, Mitchell said he appreciates the residents’ thoughtful, insightful presentations.

“To me, it’s a great thing to bring health and wellness education into the local community,” he said. “I’m grateful that the Brigham and Sportsmen’s came together to bring this goodness to our community, which is helping many of us live a better life.”

The series has also benefited Brigham trainees by providing opportunities to “get outside one’s comfort zone” and talk about health and wellness in a setting other than the hospital, Joseph explained.

Since the series launched, Joseph has heard from many resident colleagues who are interested in getting involved.

“It feels good knowing our work is helping others,” said Joseph, noting the series is a collective effort and would not be possible without the support of his resident colleagues.

BWH Emergency Medicine residents and Boston Children’s Hospital pediatric residents are among those involved in the series. Since Sportsmen’s offers programs for all ages, Joseph said it has been valuable to have residents from different specialties share their expertise.

Joseph, along with a handful of other Brigham residents, including Joshua Lang, MD, MS, a third-year resident in Internal Medicine, are also teaming up with Sportsmen’s to launch related programs, including community health fairs and an educational series for children attending summer camp at Sportsmen’s. Lang said it has been wonderful to participate in this work. “I feel pretty lucky to have found out about it,” he said.

Joseph added: “Partnering with Sportsmen’s has been one of the best decisions I’ve made as a resident. For me, this is the type of work that keeps me going – it’s very motivating. I love showing people the process of discovering their own health and taking care of themselves.”

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

‘Endless Love and Dedication’: Dad’s Devotion, Discoveries Intersect at BWH

The Curhan family, from left: Talia, Alexa, Justin, Joshua, Sharon and Gary

In honor of Father’s Day on Sunday, June 17, BWH Bulletin is recognizing a heartwarming crossroads between fatherhood and research for one BWH dad and his family.

Soon after BWH physician-investigators Gary Curhan, MD, ScD, and Sharon Curhan, MD, MSc, first met as students at Brown University, they came up with a simple but powerful dream: to work side by side as researchers and make a meaningful contribution to health care.

Now married for 35 years and with four children, little did they know at the time how close to home that shared goal would take them.

In 1987, their oldest son, Joshua, was born three months premature. His high-risk birth and complex medical needs resulted in a two-month stay in the Brigham’s Neonatal Intensive Care Unit (NICU), and newborn screening revealed a diagnosis of hearing loss – a condition he continues to live with today.

Their family’s experiences have inspired Gary and Sharon – both epidemiologists studying chronic conditions with the Channing Division of Network Medicine – to dedicate much of their research over the past decade to uncovering lesser-known causes of hearing loss, how to diagnose it earlier and ways to slow or prevent its progression.

In 2011, they co-founded the Conservation of Hearing Study (CHEARS) and have since co-authored over 20 papers highlighting environmental and lifestyle risk factors for hearing loss and tinnitus, a condition that causes chronic “ringing” in the ears when no noise is present. Their work has found that hearing health is influenced by pain reliever use; overall dietary patterns, such as the Mediterranean and DASH diets, as well as intake of fish, caffeine and certain vitamins; hormone use; heavy metals exposure; physical activity; waist circumference and more.

“If you ask the average person what causes hearing loss, they would likely say loud noises and rock concerts. We’re not saying those aren’t important, but there are several other modifiable risk factors that have been underappreciated,” Gary said. “Hearing loss has been part of our life since we had Joshua. We’re thrilled we’re able to give back and hopefully prevent hearing loss in both children and adults.”

Finding Their Mission

Sharon said their journey as a family has given them a deep appreciation for the importance of healthy hearing and the challenges people with hearing loss encounter in their daily lives and over the long term.

“When the opportunity arose to channel our passion for improving efforts toward prevention, earlier detection and management of hearing loss – in a way that combines our research training in medicine, neuroscience and epidemiology – with our firsthand experience as parents of a child with hearing loss, we knew we had found our mission,” Sharon said.

Joshua, now 31 and an elementary school teacher in Lexington, said he is touched by his parents’ commitment.

“I am truly humbled to see that my parents view my hearing loss as inspiration for their research, rather than something to hide,” Joshua said. “To me, it validates the significance of hearing loss and the effects it can have, and I believe the work they are doing toward identifying risk factors and strategies to prevent hearing loss is critical.”

While the Curhans’ devotion to hearing health is a family affair, Sharon and Joshua recently reflected on what they treasured most about Gary as a husband, father, physician and researcher in honor of Father’s Day.

“I am so lucky to have Gary as my partner in every aspect of life – whether it’s family, work, community involvement, traveling or riding our tandem bike,” Sharon said. “His devotion, integrity, insight, intellect, generosity and heartfelt commitment to the people he loves, the patients he cares for, and improving science and health are unparalleled.”

Joshua described his father as one of the kindest, most caring and driven people he has ever known.

“Upon discovering my hearing loss after birth, he and my mom strived to support me as much as possible – from investing in hearing aids to advocating for the best educational settings to spending hours upon hours working with me to improve my speech,” Joshua said. “His demeanor was always upbeat, his words encouraging and his outlook steadfastly positive. I truly would not be where I am without the endless love and dedication of my dad.”

Award Breathes Life into Collaborative Newborn Medicine Project

Can a baby be stressed? While a baby doesn’t have responsibilities to worry about, the environment of a newborn – particularly an infant born preterm – can be full of stressors, including medical procedures and long-term separation from parents. Simple interventions, such as parent contact, music and breastmilk, are thought to ease stress levels, but how do you measure a newborn’s anxiety?

Terrie Inder visits with a young patient in the NICU.

Stress in the womb and in a baby’s environment is one of many aspects of newborn health that may affect health in adulthood. Adverse experiences early in development are thought to have a profound influence on one’s risk for chronic diseases later in life, but relatively little research has quantified these risk factors and their repercussions.

Researchers from the Department of Pediatric Newborn Medicine, led by its chair, Terrie Inder, MBChB, are hoping better understand how the first nine months can shape someone’s health for the rest of their life through the Healthy Start to Life project, supported by the Brigham Research Institute (BRI) Director’s Transformative Award. The $250,000 award funds groundbreaking, interdepartmental and interdisciplinary projects that will accelerate discoveries to improve human health.

Inder and her Pediatric Newborn Medicine colleagues, including Lianne Woodward, PhD, Mandy Brown Belfort, MD, and Katherine Gregory, PhD, RN, plan to develop the LifeCodes cohort to include new neonatal and childhood data and an expanded population of high-risk infants.

A Growing Resource for Newborn Research

The LifeCodes cohort, established by Thomas McElrath, MD, PhD, and David Cantonwine, PhD, of the Department of Obstetrics and Gynecology, is one of the nation’s largest pregnancy cohort studies. More than 5,000 are women enrolled, and the cohort grows at a rate of eight new women per week.

An extensive bank of biospecimens, including blood, urine and placenta samples, has been collected from study participants at 10 weeks, 26 weeks, and 35 weeks of pregnancy and at delivery.

To date, there has been limited neonatal and childhood data collected on the babies born to women enrolled in LifeCodes. Through the Healthy Start to Life project, Inder and her colleagues plan to recruit prospective LifeCodes mothers to participate in the expanded project and to collect neonatal and childhood data and biospecimens from their future children. The team will recruit women who come to BWH to give birth. Inder says that this aspect of the project has helped foster a new research partnership with Obstetrics and Gynecology.

“Even though we would see our colleagues from Obstetrics every day in the clinic delivering babies, we have never collaborated with them on cutting-edge research before,” she said.

A Special Focus on Preterm Newborns

The Healthy Start to Life team is also focusing on a smaller, targeted population to ask a more directed question: How does preterm birth affect health later in life?

In addition to studying blood samples, stool specimens and body composition in preterm and full-term infants, the team hopes to use a novel device, developed at Massachusetts Institute of Technology and based on lie-detector equipment, to measure skin conductivity and heart rate to quantify newborn stress.

Additionally, through a partnership with the Department of Radiology, Inder and her colleagues plan to use the neuroimaging facilities in the Hale Building for Transformative Medicine, along with a custom-built pediatric neonatal head piece, to take high-resolution images of newborns’ brains in the preterm birth study. This will allow the researchers to investigate not just the structure of the newborn brains but also the functional connectivity. The team hopes these images will help illustrate how preterm birth affects brain development.

BWH Pinning Ceremony Honors Newly Licensed Nurses

Newly licensed nurses at BWH celebrate with peers and colleagues at a reception after their pinning ceremony.

One morning following a long night shift at the Brigham, Becky LaMay, RN, then a patient care assistant in Palliative Care, stayed late to comfort a patient who had a difficult day. Before she left, LaMay asked the patient’s nurse if there was anything else she could do to assist him. He replied, “Yes, go to nursing school.” The brief interaction would become a defining point in her career.

“It was one of those seemingly inconsequential moments that he probably doesn’t remember, but I will never forget,” said LaMay.

Shortly after that day, LaMay had to unexpectedly leave her job at the Brigham to deal with her own health concerns. She urgently needed two spinal surgeries, which led to a monthlong hospital stay. Reflecting on her transition from caregiver to patient, LaMay remembered the nurses who were always there for her: “They fiercely advocated for me, treated me like a human and a friend and cheered me on, especially when I wasn’t cheering for myself. They assured me that I would be able to return to the medical field, and they were right.”

After a few detours in her career path, LaMay enrolled in nursing school – hoping that she would one day return to the Brigham for her first nursing job.

“And here we are,” said LaMay, now a newly licensed nurse (NLN) on Tower 11ABD, the Thoracic Intermediate Surgical Unit, and one of many new BWH nurses honored at the Department of Nursing’s Newly Licensed Nurse Pinning Ceremony on May 7. The event also celebrated the naming of the Newly Licensed Nurse Program in memory of Nora McDonough, a nurse who provided home care for the late Yousef Karsh, a BWH patient and world-renowned photographer. McDonough was also a special friend to Mr. Karsh’s wife, Estrellita Karsh, a supporter of the program.

Now known as the Nora McDonough Newly Licensed Nurse Program, the yearlong program provides new nurses with the foundation for a successful professional career and personal growth through a variety of orientations, classes, bedside simulations and case studies.

During the event, which kicked off the Brigham’s celebration of National Nurses Week, LaMay spoke about her experience in the Newly Licensed Nurse Program at BWH and how it has helped her navigate the first year of nursing practice.

“Between the NLN classes and orientation, BWH offers the most comprehensive NLN education that I know of,” said LaMay. Praising the nurses who lead the NLN classes, she added, “It is with their guidance that I have become comfortable in my new role and continue to grow during each shift. They are my teachers and have helped me learn to celebrate every victory and cope with each sorrow.”

A Special Connection

Underscoring the important contributions of BWH nurses, Brigham Health President Betsy Nabel, MD, congratulated the nurse honorees and reaffirmed the hospital’s commitment to providing a robust support system for new nurses that will set them on a path for success for years to come.

Gina Valeri is presented with a pin celebrating her recent graduation from nursing school.

“I hope you are all enjoying your journey,” Nabel said. “You have my gratitude for choosing to work at the Brigham.”

Emphasizing that nurses receive continued support from their colleagues and hospital leaders, Ron M. Walls, MD, Brigham Health executive vice president and chief operating officer, encouraged NLNs to take advantage of every opportunity to learn from their peers.

“We are proud of how nursing is practiced at the Brigham, and we are proud of you as newcomers,” he said. “You are going to learn from some of the very best nurses in the world.”

Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Patient Care Services, spoke about the importance of having a comprehensive NLN program at the Brigham and noted the special connection she feels with new nurses as she soon marks the completion of her first year at the hospital.

“I felt like a member of the Brigham family immediately, and I want every nurse to feel the same. I’m so proud of you, and look forward to watching you grow, becoming experts in your practice and, most of all, making a difference for our patients and their loved ones,” Pearson said.

Stephanie Ahmed, DNP, FNP-DC, executive director of Clinical Effectiveness, echoed these thoughts, asking the new nurses to think about what it truly means to be a nurse.

“It’s when the science, the skills and the heart are combined that the art of nursing is practiced and the essence will be encountered,” Ahmed said. “To me, that’s what it means to be a Brigham nurse. And today, with this pinning, it’s my hope that’s what you’ll aspire to and what you will become.”

Collaborators Take Steps Toward Muscle Regeneration

From left: Indranil Sinha and Su-Ryon Shin

When a person suffers a traumatic muscle injury – whether from a motorcycle crash, for instance, or an explosive device – there is no way to regenerate the muscle that has been lost as a result. When the injury heals, instead of new muscle, scar tissue forms. Indranil Sinha, MD, of the Division of Plastic and Reconstructive Surgery, had an idea for how to help these patients. 

He thought that by injecting skeletal muscle stem cells at sites of injury, he could help patients regrow lost or damaged muscle. In 2014, Sinha received a Stepping Strong Innovator Award to test his idea in the lab, but the stem cells wouldn’t grow and muscle wouldn’t heal. Sinha investigated further and found that growth factors critical for regeneration weren’t present where they needed to be, and muscles couldn’t grow back without them. 

But just as Sinha’s promising idea began to fizzle, something else rekindled it.

The following year, Sinha joined a panel to judge the 2015 finalists for the Stepping Strong Innovator Awards competition. That’s where he heard BWH bioengineer Su-Ryon Shin, PhD, present her work with 3-D bioprinting. Sinha sought her out immediately after the presentation, and the two started talking about how they could help one another – and, ultimately, patients who had sustained muscle trauma injuries. Their conversation has continued ever since. In 2017, they received an additional Stepping Strong grant of $100,000 to join forces to continue their work together.

Failure Is the Mother of Success

On a recent afternoon, Shin arrived in Sinha’s office with happy news to share: One of her grant submissions had been scored. Sinha beamed and congratulated his collaborator, and told her he had good news, too: His had received a high score as well. They shared a moment of relief and elation – one that stood out because it was hard fought. For two years, Shin and Sinha have experienced an essential and often unspoken part of science: failure.

“Nothing in the first half of my Stepping Strong grant worked. Even when I saw Su-Ryon’s presentation, there was never a guarantee that bringing our ideas together would work either,” said Sinha. “But the Stepping Strong grant gave us the ability to try something no one had ever done before. It was a safe space in which to fail, and then try something new again. Together, we’ve been able to accomplish what neither of us could have done alone.”

Sinha speaks passionately about the needs of his patients. Unlike other diseases or injury where treatment exists but may be limited, there are currently no treatments for muscle trauma. This means that investigators like Sinha and Shin cannot follow in the footsteps of others to build on their work; instead, they need to create entirely new approaches.

Shin is a trained bioengineer whose laboratory in Cambridge includes state-of-the-art equipment, including a 3-D printer, to create new materials that can be used in the body to promote healing. These “scaffolds” can mimic the architectural structure of skeletal muscle and be loaded with slow-release treatments.

Shin and her colleagues have designed many types of hydrogels – flexible, gel-like materials – over the years for medical applications. Based on discussions with Sinha, Shin has created a hydrogel loaded with substances they hoped would encourage muscle regrowth. At first, the hydrogel’s texture was like Jello, making it difficult for Sinha to suture it to a wound. Based on this feedback, Shin redesigned it to be more like fabric.

Sinha and Shin visit one another’s laboratories often, and their teams have virtual meetings to share new insights across the lab and clinic. Other collaborations have sprung up across their teams, too. Sinha is also working on a project with one of Shin’s colleagues on bone regrowth.

“We want to decrease that gap between clinicians and engineers,” said Shin. “The conversations I’ve had with the people I’ve met through the Stepping Strong network are so useful for me and have led to new funding and new collaborations.”

Trial Offers Hope for Cardiac Patients, Fosters Unexpected Collaboration

Patient Paul Bauer (center right), with the BWH clinical and research teams collaborating on a novel study in which he is participating.

When Paul Bauer, 74, became winded after climbing two or three flights of stairs, he didn’t initially give it much thought. No longer as active as he once was, he assumed lifestyle changes were to blame. Still, just to be safe, Bauer mentioned it to his primary care physician during a routine visit last year.

His offhand observation triggered a series of events that would result in Bauer learning he had cardiac amyloidosis, a disorder that causes an abnormal protein to build up in the heart tissue. These deposits can accumulate over time and result in serious complications, including heart failure. Treatment options are limited, and most focus on slowing the progression of the disease.

A patient in the Brigham’s Cardiac Amyloidosis Program, Bauer is the first North American patient to enroll in a clinical trial testing a novel therapy that BWH investigators hope will prove effective in dissolving this abnormal protein buildup. If successful, it could undo decades of damage to the heart in these patients. BWH is one of three sites worldwide participating in the study, led at the Brigham by Rodney Falk, MD, director of the Cardiac Amyloidosis Program, in partnership with BWH colleagues across several departments and disciplines, including Cardiovascular Medicine, Dermatology, Nursing, Pharmacy and Radiology.

“It’s still in the early days, but we do know that this drug works well in animal models and in humans with amyloid in other organs, particularly the liver. If we find that this is effective in the heart, it would be a huge breakthrough for the tens of thousands of patients affected nationwide,” Falk said.

Bauer, who is in the early stages of the disease, is cautiously optimistic about what results he may see. A semiretired aeronautics engineer at Massachusetts Institute of Technology, the Lexington resident says his primary motivation for enrolling was to help advance science and medicine.

“I’ve been a researcher all my life, and I spend most of my time working with students in the laboratory. When Dr. Falk asked if I would consider being the first patient in this study, I was happy to contribute to medical research,” Bauer said.

Nursing Partnership Forms

But the science underlying the trial isn’t the only thing that makes it distinctive. It has also led to a special collaboration between BWH clinical and research nurses due to how the study is conducted.

Trial participants receive the therapy monthly over a six-month course. However, they must remain hospitalized for two weeks each month for treatment and observation in the Shapiro Cardiovascular Center. Bauer, who recently completed his second round of hospitalization for the study, said his wonderful experiences with BWH staff have mitigated any inconveniences the time commitment has caused.

“The staff here is outstanding – offering to do anything that would make my stay as pleasant as possible,” Bauer said. “What makes it not only tolerable but also enjoyable are all the people I’ve met.”

While it’s not unusual for clinical trial participants to be hospitalized during a study, they typically are admitted to Tower 9AB, the Center for Clinical Investigation (CCI) inpatient unit, under the care of research nurses who specialize in collecting data and samples in accordance with research protocols.

Because the therapy for this study carries a potential risk of cardiac arrhythmia, Falk and the outpatient CCI staff partnered with Shapiro nurses to enlist their specialized expertise and ensure the safest-possible care for patients in the trial. The result: a close collaboration between two nursing teams who wouldn’t otherwise practice side by side.

“If a patient is participating in a study, there are many data collection points – investigational drug administration, blood and urine samples, EKGs – that must be timed very precisely to maintain the integrity of the protocol. It would be extremely difficult for a clinical nurse to collect all of that while performing the normal responsibilities of caring for not only this patient but their other patients as well,” explained Lauren Donahue, BSN, RN, an outpatient research nurse in the CCI working on the cardiac amyloidosis trial. “But because of the potential risks involved with this therapy, these patients needed to be in Shapiro. We thought, ‘Why don’t we bring our specialty to your specialty?’”

Participants are admitted to Shapiro 8 and receive day-to-day care from clinical nurses in the unit. When the research work is being conducted, the CCI team arrives on the floor to fulfill the study requirements.

“We didn’t want, in any way, to impinge on the duties of the clinical nurses. They were flexible and very enthusiastic partners,” Falk said. “There’s plenty of research going on in Shapiro, but those patients are there because they are very ill. This collaboration is unusual because our participants are in Shapiro as a precautionary measure, and the Shapiro nurses excel in managing potential cardiac issues.”

Karen Hanrahan, BSN, RN, a clinical nurse on Shapiro 8, said it has been gratifying to work with research nurses in this new, integrated way in support of the study.

“It’s a great collaboration,” she said. “It’s been so interesting to understand how the research nurses conduct clinical trials, and we’ve enjoyed being able to continue their work during off hours, when the research nurses are not available, by maintaining the precise timing of treatments and medications that the study requires.”

Jeanne Praetsch, MS, RN, CCRN, a professional development manager for Shapiro 8, said that early and ongoing communication between all the teams involved has been invaluable for clinical nurses.

“We met as a team to identify and address workflow and any possible barriers,” she said. “Education for the nursing staff and interprofessional collaboration resulted in a smooth process and satisfying experience for the patient and all members of the care team.”

Celebrity Golf Classic Supports BWH Cardiac Amyloidosis Research

ESPN’s Sean McDonough will host a two-day celebrity golf tournament to support cardiac amyloidosis research at BWH. McDonough’s father, legendary Boston Globe columnist Will McDonough, died suddenly from the disease in 2003. The event will be held Aug. 6-7 at The Ritz-Carlton Boston and Boston Golf Club. Learn more at SeanMcDonoughGolfClassic.org.

BWHers Respond to Nationwide Supply, Medication Shortages

Michaelle Dieuveuil prepares sterile epidural cassettes for patients in the Pharmacy Sterile Products Room.

Last year’s devastating hurricanes destroyed several key medical manufacturing plants in Puerto Rico, worsening existing shortages of critical medical supplies at hospitals across the country, including BWH and other Partners HealthCare institutions. At the same time, the Brigham is also among the thousands of health care organizations nationwide facing multiple medication shortages as U.S. drug manufacturers struggle to keep up with market demand.

The Brigham is currently facing a shortage of intravenous fluids (IV) and bags, as well as several frequently used injectable opioid medications. The Emergency Preparedness team, along with key unit leaders at BWH, have been meeting on a weekly basis for several months to actively monitor the situation and develop strategies for maintaining high-quality, safe care.

Charles Morris, MD, MPH, associate chief medical officer, has worked with the Emergency Preparedness team to address the shortages and described the crisis response as a “striking example of remarkable teamwork in action.”

“We’ve seen countless demonstrations of this collaboration. Materials Management pitches in to assist Pharmacy staff. The Information Services team provides real-time data about current supplies, allowing us to pinpoint areas of high utilization. Nursing staff works on implementing oral hydration strategies developed by Emergency Medicine faculty,” Morris said. “These efforts, along with so many others, have been truly collaborative.”

Mike Cotugno, RPh, director of Pharmacy Patient Care Services, has been involved in the many communications updating staff about the shortages and recommended solutions. Regularly partnering with care teams to work through any challenges, Cotugno said he is impressed every day by BWHers’ unrelenting support and patience.

“I’ve received dozens of emails from colleagues asking if there’s anything they can do to help,” Cotugno said. “They know how hard this has been for not only the Pharmacy team but also the entire hospital. There’s a lot of understanding, and everyone is supporting each other. It takes a team to get through difficult situations such as these shortages.”

Eric Goralnick, MD, MS, medical director of Emergency Preparedness, said it has been wonderful to observe various departments, professions and disciplines team up on a response to this longitudinal event. For example, pharmacists, responding clinicians and IS staff worked together to identify patients receiving IV fluids and an oral diet daily and explore opportunities to reduce IV usage.

“When events are prolonged, it is challenging to stay focused and maintain unity of effort,” Goralnick said. “We have so many committed professionals who are approaching these shortages by trialing new ideas, measuring their impact and changing practice in a new, improved way. We have also teamed up with Brigham and Women’s Faulkner Hospital and other Partners institutions on shared solutions. This is the model of how we need to combat similar events that require a multidisciplinary response.”

Each week, Katie Fillipon, MS, RN, OCN, FNP, associate chief nurse for Oncology and Medicine, has participated in calls with other members of the Emergency Preparedness team about the shortages. She agreed that shared decision-making within the working group has supported proactive changes that minimize any impact on patient care.

“Delivering high-quality, safe care is our collective priority, and being able to work alongside our Faulkner colleagues on these efforts has strengthened our commitment to supporting each other in achieving this, no matter what challenges we face,” Fillipon said. “There has also been a strong commitment to our communication strategy and a desire to ensure we provide information and decision support to our providers.”

Huddle Up: Care Coordination Improves Patient Outcomes

At the Brigham, nurses play a pivotal role in care coordination, especially for patients who will require post-acute care services or rehabilitation placement. Daily care coordination rounds, also known as interprofessional huddles, are one of several strategic initiatives launched in recent years to improve collaboration, enhance quality of care and ensure coordinated and efficient discharge preparation for patients.

During the rounds, which take place every day on several inpatient floors at the Brigham, members of a patient’s care team – including the charge nurse, resident, care coordinator, physical therapist, social worker and unit coordinator – gather to review and facilitate patient progression. This proactive planning enables the team to operate more cohesively and to collectively track completion of key activities or documents.

One example of how these rounds led to improved care involved a patient with a serious brain injury who spent one year at the Brigham as an inpatient.

Following the daily huddle, each member of the patient’s care team was responsible for following up on specific action items that came out each huddle, such as collaborating with Financial Services and care coordination nurses to explore discharge options. While the planned discharge date for the patient was pushed back on several occasions, per the family’s request, the interprofessional team continued to work with the family toward the shared goal of discharging the patient to his home with hospice care.

The patient’s wife later contacted the care team to inform them of her husband’s passing and express her gratitude for the services arranged by clinical nurse care coordinators, which enabled the patient to be at home with his family before he died.

Daily care coordination rounds ensure all members of an interdisciplinary team are brought up to speed on a patient’s care plan and goals, said Jane Grana, RN, of Care Coordination.

“We often each know something a little different, or see it from a different point of view, so it’s important that we collaborate,” Grana said.

Farah Abellard, MSN, RN, a nurse on Tower 10AB, agreed that improved multidisciplinary collaboration results in higher-quality, safer care: “Everyone plays a vital role in providing family-centered care.”

Visit BWHPikeNotes.org/magnet to learn more about the Brigham’s journey to Magnet designation and view instructions for accessing the body of evidence BWH submitted in its Magnet application; the interdisciplinary huddles are featured in the Exemplary Professional Practice (EP) 5 section of the submission.

Interdisciplinary Program Empowers Security Officers to Help Save Lives

From left: Kyle Herman and Robude Petit-Frere are among several BWH Security officers trained to administer naloxone.

To help staff prepare for the Magnet site visit occurring March 26-29, each week BWH Bulletin will feature an example of a hospital initiative that demonstrates how the Brigham exemplifies the hallmarks of a Magnet institution. 

When BWH Security Officer Robude Petit-Frere responded to a recent Code Blue, he encountered a frightening scene: A patient in a wheelchair was unresponsive and not breathing. Bystanders cried out for help and indicated the person had suffered an opioid overdose. The code team was on the way, but the patient’s condition was deteriorating quickly.

Every second counts during an opioid overdose. Rapid administration of the drug naloxone – a fast-acting medication that can reverse an overdose – can mean the difference between life and death.

Thanks to training he had received as part of an institutional protocol developed by an interdisciplinary team at the Brigham, Petit-Frere successfully assessed the situation and administered naloxone to the patient. The individual immediately resumed breathing and was soon treated by medical personnel.

Through this initiative, Security officers like Petit-Frere, who are often the first responders to emergencies around campus, and code team nurses are now trained to carry and administer this lifesaving medication at the earliest opportunity.

“I acted quickly. If it had been a few seconds longer, that patient may not have made it,” Petit-Frere said. “At that moment, I recognized how important this training is.”

The interdisciplinary nature of this work has been key to its progress, said Karen Griswold, MBA, BSN, RN, CPPS, a program manager in the Department of Quality and Safety and co-chair of the Emergency Response Committee. Code team nurses and nursing leaders have been important and supportive partners in this work, she added.

“By bringing everyone’s skills, experience and perspective to the table, we were able to create a much more robust program to deliver the best care to patients,” Griswold said.

Bringing Everyone to the Table

Massachusetts has been one of the states hit hardest by the nation’s opioid crisis, with the rate of opioid-related deaths seeing a fourfold increase between 2000 and 2015 across the state. In the span of just one year, 2013 to 2014, opioid-related deaths occurred in two-thirds of cities and towns in Massachusetts, according to the state Department of Public Health.

Recognizing that first responders like police officers and firefighters are often the first on the scene during an opioid overdose – and could be trained to safely administer intranasal naloxone – the state passed a law permitting nonclinicians to treat someone experiencing an opioid overdose with this fast-acting medication.

This paved the way for the initiative at the Brigham, explained Griswold. Officers are now trained at the Neil and Elise Wallace STRATUS Center for Medical Simulation, where they learn how to identify the signs of an overdose and use simulation manikins to practice administering of intranasal naloxone and performing other basic life support techniques.

Prior to this effort, there had been a handful of incidents involving an opioid overdose in public areas of the hospital between 2015 and 2016. In each case, Security officers had been the first on scene.

Although such events are rare, an interdisciplinary team recognized an opportunity to intervene sooner. Representatives from Emergency Medicine, Nursing, Pharmacy, Quality and Safety, and Security convened a task force to design and implement the naloxone protocol. It has already saved lives, and based on its success on the main campus, the program has since expanded to several locations across distributed campus.

“Depending on where they are in the hospital, it can take a code team six to eight minutes to arrive on scene,” Griswold said. “We know that Security officers are frequently on site much sooner, often being the ones to radio dispatch to report the code. This protocol empowers them, in the event of an overdose, to assess the situation, take action as soon as possible and give a patient the best chance for survival.”

Visit BWHPikeNotes.org/magnet to learn more about the Brigham’s journey to Magnet designation. Resources include informational videos, frequently asked questions, a countdown to the site visit and instructions for accessing the body of evidence BWH submitted to the American Nurses Credentialing Center. The naloxone protocol is highlighted in Structural Empowerment (SE) 1EO section of the submission.

Innovative Pilot Improves ED Access, Reduces Walkouts

Emergency Department staff gather to celebrate a year of a sustained reduction in walkout rates.

A cornerstone of any emergency department (ED) is to see the sickest patients first – a practice that has saved countless lives. But it has the unintended side effect of leaving patients with less-acute symptoms waiting to be seen by a physician when the department is at capacity.

“Previously, some patients waited several hours to be seen for an issue that takes five or 10 minutes to address, such as a medication refill or wound evaluation that doesn’t need an intervention,” said Christopher Baugh, MD, MBA, medical director of the ED in the Department of Emergency Medicine.

When the ED is at capacity, some patients leave after being seen by a triage nurse, but before being seen by a physician. When a “walkout” occurs – often due to long wait times – it not only leads to a poor patient experience, but it is also a safety concern, as nearly 30 percent of patients who receive care in the Brigham’s ED are sick enough to be admitted.

Over the past year, a multidisciplinary team has piloted a care delivery model that reduced door-to-physician time and sustained lower ED walkout rates. The intervention centered on turning two sections of the ED known as surge areas – nonclinical spaces that were temporarily used to see patients during high-volume periods – into regularly staffed areas where patients could be seen by a physician within about 20 minutes of arrival. In addition, ED Radiology partnered with the team to flag certain imaging orders to expedite a patient’s evaluation.

Now operational and staffed every weekday during peak times, the surge spaces consist of the “front end” – a curtained-off section of the waiting room – and one hallway inside the ED, where eight stretchers are separated by opaque dividers.

Faster Access to Care

Prior to the intervention, a patient who checked into the ED would be seen by a triage nurse and have their vital signs checked. If the patient wasn’t identified as critically ill and there was not an available treatment space, further care – such as lab testing, imaging or pain medication – was delayed until a room was available.

Lower-acuity patients, such as those who come in with a sore throat or sprained ankle, are now often able to be seen in the front end shortly after arrival. When in use, the area is staffed with a physician, nurse, nursing assistant and medical scribe. The area can accommodate four to five patients at a time. Most patients seen in the front end can be treated and safely discharged from there.

“It’s definitely a different way of doing things, and it’s much quicker,” said Sue Botsch, RN, an ED nurse who staffs the front end. “You’re not waiting for things to happen because the team is right here. I like that it’s a real-time application of care, and patients appreciate going home in an hour.”

Staff Support Drives Success

Prior to the intervention, ED walkout rates ranged from about 2.5 to 4 percent, with some individual days reaching as high as 8 or 9 percent. Since implementing the new model in December 2016, the walkout rate has consistently remained under 2 percent since January 2017, with one month as low as 0.7 percent.

“As soon as we opened this surge capacity as a regular practice every weekday, we saw the walkout rate drop dramatically and immediately,” said Jonny McCabe, BSN, RN, operations director in Emergency Medicine.

Pivotal to the initiative’s success has been a cultural change among ED staff, said Janet Gorman, MM, BSN, RN, executive director of the ED.

“We owe it to our community to be available for them, and if there’s no access, we’re doing them a disservice,” Gorman said. “I’m so proud of our staff, who truly took ownership of this work to improve how we care for our patients.”

Anna Meyer, DNP, RN, interim ED nursing director, said the pilot’s success reflects the team’s commitment to multidisciplinary collaboration.

“We definitely stepped outside our comfort zones, but everyone’s continued hard work has paid off for our patients,” Meyer said. “The sustained success shows how well we work together.”

Looking Ahead

Still, the team sees room for improvement. In monthly Press Ganey surveys, some ED patients report concerns regarding privacy and comfort – feedback the team takes to heart, Baugh noted.

“There is certainly a tradeoff,” he said. “Hallway and surge-area care are short-term interventions that improve patient safety by lowering our waiting room census and walkout rate. We track these metrics and share them with hospital leadership because we need everyone to understand how hospital crowding affects ED care.”

Although the upcoming ED expansion will add 30 beds and alleviate some of the current challenges, Baugh underscored the importance of taking what the team has learned from the pilot and incorporating those efficiencies into the new design.

“We have to change the way we engage with our patients – not just add more treatment rooms,” he said. “We think we can borrow from this process and continue to refine it to get even better use out of our new space.”

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

Exploring the Potential Healing Power of Cord Blood in Newborns

Mohamed El-Dib

Umbilical cords are, literally, the lifeline for babies in the womb. One BWH physician-scientist is hopeful that they also contain blood cells that can be given back a baby to reverse – not just stop – some forms of brain injury occurring at birth.

When infants’ brains don’t receive enough oxygen and/or blood, a condition known as hypoxic ischemic encephalopathy, it can lead to developmental issues that might not present until later in life. The current standard of care is to use cooling blankets, which safely lower the baby’s body temperature to 33.5 degrees Celsius (92.3 degrees Fahrenheit). While effective at preventing further brain injury, the therapy cannot undo damage that has already been done.

Mohamed El-Dib, MD, director of Neonatal Critical Care in the Department of Pediatric Newborn Medicine, is the principal investigator at BWH for a multi-institutional clinical trial looking at whether infusing babies with their own umbilical cord blood can indeed reverse tissue damage in the brain.

Known as the BABYBAC II Study, the randomized trial builds on a smaller-scale 2014 study that demonstrated infusing infants with their own umbilical cord blood was safe and possibly effective. BWH is one of 10 enrollment centers around the U.S. participating in the current study, led by Duke University.

Babies enrolled in the study will receive the current standard of care in addition to an infusion of their own cord blood cells.

“We believe these cells are not just protecting the brain – they’re actually helping the brain repair and recover,” El-Dib said. “If this is shown to be effective, it means each baby is born with his or her own treatment to repair damaged brain tissue.”

Discovery Depends on Teamwork

A special characteristic of the Brigham’s participation is the importance of multidisciplinary collaboration, El-Dib said. He noted that clinical teams in Labor and Delivery and the NICU play essential roles in enrollment and collection. He also partners closely with staff from the Cord Blood Donation Program, jointly operated by BWH and Dana-Farber Cancer Institute (DFCI). Launched in 2009, the program has several dedicated cord blood collection specialists.

“Without having this level of teamwork and dedication, this trial would’ve been almost impossible to start up,” El-Dib said.

Babies in the study will be randomly assigned to receive an infusion with a concentrated or diluted amount of the specific cells, known as mononuclear cells, believed to be responsible for tissue repair. El-Dib noted that one challenge is the limited time window in which cord blood can be collected; it must happen minutes after birth.

Researchers will follow the babies’ health for one year, with the hope of seeing improved outcomes related to cognitive- and motor-skill development.

“Exactly how this therapy works is not fully understood, but earlier studies have found that umbilical cord cells decrease inflammation, decrease delayed cell death, help the neurons repair mechanisms and help develop new vessels in the brain,” El-Dib said.

BWH NICU Reaches Milestone in Fight Against Infections

From left: NICU nurses Jessica Marchetti and Anna Huzar review procedures for central line insertion.

The Brigham’s Neonatal Intensive Care Unit (NICU) recently marked 365 days without a central line-associated bloodstream infection (CLABSI) – a milestone Christina Meehan, MSN, RN, a clinical nurse educator in the NICU, said was made possible thanks to the hard work and collaboration among a large multidisciplinary team.

“From nurses and physicians to staff in Environmental Services, everyone who works in the NICU played an integral role in ensuring we do everything we can to prevent CLABSI cases,” Meehan said.

CLABSI is a serious bloodstream infection that occurs when germs enter the bloodstream through a central line, also known as a central venous catheter. The catheter is often used to draw blood or deliver fluids and medications to patients. Newborns are most susceptible to CLABSI due to their developmentally immature immune systems, putting them at significant risk for infection, said Meehan.

In 2015, Nneka Nzegwu, DO, a neonatologist in Pediatric Newborn Medicine, observed an increase in the number of babies in the NICU with central lines who were developing infections. Following that, an interdisciplinary team was created to better understand – and then eliminate – the factors contributing to the increase in these infections.

Following many collaborative discussions and town hall-style meetings for NICU staff, team members developed a strategic plan and recommendations based on staff feedback and evidence-based best practices.

Nzegwu co-led the Getting to Zero! CLABSI Prevention team with Meehan. With support from departmental and hospital leadership, the group implemented several changes that contributed to the elimination of central line infections in the NICU. Among these changes was the creation of a stop-sign image that is placed outside of a patient’s room whenever staff place or change central lines. The sign informs staff, families and visitors that a sterile procedure is in progress and to wait until the procedure is completed before entering.

The team also began reinforcing the importance of following proper hand hygiene before, during and after patient care. Signage has been posted throughout the unit to remind staff, families and visitors to wash their hands according to those guidelines. 

NICU staff also attended multidisciplinary workshops last fall hosted by the team, which incorporated training videos for staff that depicted various clinical scenarios, including how to properly perform hand hygiene and sterile tubing line changes. They also demonstrated collegial ways to approach someone who had not performed hand hygiene and was attempting to touch a patient.

The NICU held a celebration for staff this month to thank them for reaching the recent milestone and for their continued efforts. “We are all in this together,” Nzegwu said. “We are committed to a culture of safety, for the protection and care of our tiniest and most vulnerable patients. To be CLABSI-free for one year is the result of dedication, hard work and a sustained commitment to following evidence-based best practices.”

Fellow team member Adriana Cecchini, MSN, RN, of Infection Control, worked closely with NICU staff on CLABSI education initiatives. She said the work that has been accomplished in the NICU is a model for other areas of the hospital and health care institutions around the country to follow.

Suzanne Fernandes, MSN, RN, nurse director of the Special Care Nursery in the NICU, commended the team for its dedication and commitment to keeping infants safe.

“This accomplishment is so much more than just a number,” Fernandes said. “The work completed to date speaks to the level of professionalism of the whole team. Everyone had a critical role to play in our success.”