Members of the mattress conversion project’s “Dream Team”

Over the course of a week in December, the Brigham replaced nearly 800 mattresses in patient care areas throughout the hospital. The logistically complex project was completed not only with minimal disruption to patient care, but also two and a half days ahead of schedule, thanks to the dedication of a multidisciplinary team representing many departments, including clinical and non-clinical staff.

Prior to distributing the mattresses throughout the Brigham, a large team, including the hospital’s pressure injury taskforce, assembled to research and trial different mattresses over the summer. The six-month-long project culminated with the deployment of the mattresses in December.

In addition to enhancing patient satisfaction and comfort, the mattresses, manufactured by Sizewise, will be an important factor in achieving the Brigham’s goal of reducing hospital-acquired pressure injuries, also known as bed sores, which can occur in patients who lie in bed or sit in chairs for long periods without moving.

The mattress conversion team, now known as the “Dream Team,” visited patient floors and swapped out the prior mattresses with the new product—all while working efficiently to minimize disruption for patients and their families. The team comprised approximately 75 people from more than a dozen departments. Sizewise was also a collaborator and recycled the prior mattresses at the end of the week.

Deploying nearly 800 mattresses in busy patient care areas can seem like a daunting task, but the team came together to make it happen—all while ensuring that safety of the patients and staff remained a top priority. Throughout the deployment period, the Brigham’s Patient Safety and Risk management team tracked the safety of patients and staff who were involved in the project and reported there were no safety events noted.

Witnessing the Dream Team complete the conversion earlier than expected was a very proud moment for Kerrie-Ann Jack of Biomedical Engineering, who helped oversee the project.

“It was absolutely phenomenal to see how well everyone worked together to make this happen,” Jack said. “On day one of the mattress rollout, I remember seeing the team come together and hearing someone say, ‘Let’s make this happen.’ And that’s exactly what we did.”

The Brigham ordered 855 mattresses from Sizewise in total. The 64 new mattresses that weren’t part of the conversion will be stored and remain available as spares.

In an email to Dream Team members, Sunny Eappen, MD, MBA, chief medical officer; Maddy Pearson, DNP, RN, NEA-BC, chief nursing officer and senior vice president of Patient Care Services; and Julia Sinclair, MBA, senior vice president of Inpatient and Clinical Services, expressed their deepest gratitude to the staff for their accomplishment.

They wrote: “Thank you, from the bottoms of our hearts, for your outstanding contributions to this project and helping us deliver the highest-quality care and an exceptional experience to the patients and families we serve.”

From left: Daniel and Martina Haaser

The day after undergoing a minimally invasive procedure to repair his heart, Daniel Haaser, 53, sat in his bed in the Shapiro Cardiovascular Center and wept tears of joy. After nearly four months of suffering and uncertainty, he finally felt like himself again.

“I had been at a point where I couldn’t even remember how my life was before,” Haaser said. “When I came out of surgery, there was no need for oxygen. I could walk. I could do things. I was completely and totally overwhelmed by this wonderful turn of events.”

That was a radical change from the weeks leading up to his procedure at the Brigham on Dec. 17 to correct a leaky mitral valve. This life-threatening condition affects a flap controlling blood flow from one chamber of the heart to another. When the mitral valve does not close properly, blood leaks backward through the circulation, driving up pressure in the lungs and potentially contributing to shortness of breath with activity.

While most patients with a mitral valve leak have it repaired through open-heart surgery, Haaser would require a different approach—one that hinged on the collaborative, multidisciplinary expertise of his Brigham care team. That’s because Haaser’s condition was discovered just a few weeks after he had undergone open-heart surgery at another hospital to address multiple severe blockages in his heart.

“From the end of November until the day of my procedure at the Brigham, I was just trying to survive,” recalled Haaser, a software engineer and a volunteer emergency medical technician. “I tried to get out of the house every day, but I ran out of breath so quickly. I could not work or even participate in a meeting. I would lose my stamina and focus. In 10 minutes, I was completely done.”

Otherwise healthy and active, Haaser wasn’t especially concerned when he first experienced chest pain while he and his wife, Martina, were visiting her family in upstate New York over Labor Day weekend. But when the pain persisted and worsened, the Connecticut couple went to the nearest emergency department. There, doctors told Haaser he needed coronary bypass surgery. A litany of complications followed the operation, resulting in a 45-day stay in the intensive care unit that included two weeks in a medically induced coma.

Once home, Haaser thought he was on the path to recovery, but soon his health sharply declined. That was when his cardiologist in Connecticut diagnosed the mitral valve leakage and referred Haaser to the Brigham for a MitraClip procedure, a minimally invasive treatment option for patients who are not candidates for open-heart surgery.

During the procedure, a multidisciplinary team—including interventional cardiologists and cardiac surgeons, anesthesiologists and nurses—works together to insert a catheter through an incision in the patient’s leg and guide it through the vein to the heart. The MitraClip is then positioned at the site of the leak. The team closes the clip’s arms to cinch the two valve flaps together, like a clothespin, explained Pinak Shah, MD, director of the Brigham’s Cardiac Catheterization Laboratory.

To improve Haaser’s health before the procedure, Shah enlisted the help of his colleagues in the Division of Cardiovascular Medicine’s Cardiomyopathy and Heart Failure Program. For days prior to the procedure, Haaser’s care team worked to treat his heart failure medically and prepare him for the MitraClip—ultimately draining 10 liters of excess fluid from his body.

“This is a great example of the collaborative care we that we provide to patients at the Brigham. The excellent outcome here is the composite result of the work done by the entire heart team,” said Akshay Desai, MD, medical director of the Cardiomyopathy and Heart Failure Program. “Having a team of physicians, nurses and cardiac subspecialists working together to attend to all relevant aspects of the patient’s care is the key to the success of these complex structural heart interventions.”

Discharged on Dec. 21—just in time to be home for the holidays—Haaser said he was deeply grateful for the compassionate, lifesaving care he received at the Brigham.

“I couldn’t be happier at this point,” he said. “I consider myself a Brigham and Women’s success story.”

From left: Panelists Kevin Farley, Monique Cerundolo, Mariya Kalashnikova, Beth Flanzbaum and Neldine Alexandre

Details have been altered in this story to protect patient privacy.

Kevin Farley, RRT, never imagined the first patient he’d care for on his initial day at the Brigham as a respiratory therapist would turn out to be someone who shaped his career.

“Claudia made me a better therapist,” Farley said. “She was the very first patient I had; she was the first patient I charted on. Her room was the first patient room I walked into. I had a lot to learn when it came to Claudia. Everything I do here goes back to her.”

During the Dec. 15 Schwartz Rounds, “When the Team Becomes Family: Caring, Celebrating and Grieving Together,” a panel of five Brigham staff members—representing just a few of the dozens of people on Claudia’s care team—discussed their experiences caring for Claudia and, ultimately, what it was like to lose her. The monthly Schwartz Rounds series is a multidisciplinary forum focused on optimizing compassionate care by exploring the human dimensions of health care.

Born with an incurable lung condition, Claudia left her native country and came to the U.S. in search of a second chance at life. As her health declined, doctors back home told her they couldn’t offer the advanced care she needed and advised that she travel to the States for treatment.

In addition to causing breathing problems, Claudia’s condition triggered other severe health issues. She passed away last year at the Brigham due to complications related to her lung condition.

Claudia had lived in the U.S. for more than a year and frequently came to the Brigham for care. Subsequently, she grew very close to the multidisciplinary experts who worked tirelessly to save her life. It was during this time that her team formed a tight bond with each other, too, as they navigated their patient’s challenging case. Together, they said, they felt like a family as they cared for Claudia, celebrated her life and grieved her loss.

Described as a kind soul whose smile could light up a room, Claudia was a patient the panelists said they’ll never forget. They reflected on the personal and professional struggles they grappled with when caring for her, as well as the emotional toll it took on them all as Claudia’s health failed to improve.

“Nothing helped her. We exhausted all of our resources,” Farley said. “I could only hold her hand and say, ‘I am here with you.’”

Forging Bonds

In the face of these challenges, providers looked for opportunities to lift Claudia’s spirits. One time, they hosted a small celebration for her following a procedure. On another occasion, panelist Neldine Alexandre, BSN, RN, of Thoracic Surgery, painted Claudia’s nails for her. They said these gestures might have been small, but they were significant to Claudia and to each of them.

The panelists spoke about the profound grief each of them experienced last summer when Claudia had died. Her death came as a shock because Claudia had been out of the hospital for some time before her health rapidly declined.

Monique Cerundolo, MA, BCC, of Spiritual Care Services, remembered the day she learned what happened. She was alerted that a family had requested a viewing of their deceased loved one. Not knowing the name of the patient, Cerundolo prepared to assist the family—a process she’s often involved in when patients pass away. When she received the paperwork and saw Claudia’s name listed, Cerundolo was stunned.

“I was heartbroken,” she said. “I had two minutes to gather myself together before I met the family. I had lost someone who was very important to me.”

Mariya Kalashnikova, MD, a fourth-year resident in the Harvard Brigham and Women’s Hospital/Boston Children’s Hospital Combined Internal Medicine-Pediatrics Residency Training Program, was Claudia’s primary care physician. She said losing Claudia was especially difficult because she was the first outpatient of hers who passed away. Kalashnikova reflected on how upsetting it was to hear about Claudia’s passing and the importance of being able to talk with her peers who had also been grieving.

“When I’ve lost patients in residency, they’ve all been inpatients and I had warning. I could be with them and their families,” Kalashnikova said. “It was hard not being able to be there for Claudia during her final moments.”

Healing Together

After grieving individually, the care team banded together again following Claudia’s death to begin the healing process. They comforted each other, wrote poetry and organized a remembrance gathering.

“It’s never easy to lose a patient,” said Alexandre. “But as long as we talk about her and learn from her case, Claudia will always be in our memories in a very special way.”

The panelists encouraged their peers to take the time to process their grief after a patient passes away and set aside even just a few moments to speak with a colleague about how they’re feeling.

“For the rest of my life, with every patient I treat, I will see a piece of Claudia in each of them,” Farley said. “She taught me so much about being a respiratory therapist. I am so glad that Claudia came in to my life—it’s just unfortunate the way that it ended.”

At the end of the discussion, Martha Jurchak, PhD, RN, director of the Ethics Services and coordinator of Schwartz Rounds, commended panelists for their candid reflections.

“It requires a certain kind of bravery to talk about events like this and to acknowledge the grief you experienced,” Jurchak said. “You have shown that we become better providers by sharing our loss and grief so that we can take care of the next patient we encounter. I want to thank you all for being brave in this way.”

Schwartz Rounds are held the second Tuesday of each month, noon–1 p.m., in the Anesthesia Conference Room.

Staff from the Brigham’s Lung Center gathered for a celebratory breakfast on Oct. 29 before welcoming the first patients in their new clinic space on the Pike. The eight exam rooms and additional flex space enables the Lung Center’s three major disciplines – Pulmonary and Critical Care Medicine, Thoracic Surgery and Thoracic Oncology – to provide comprehensive, interdisciplinary care for patients in a single location. The clinic is located between the 15 Francis St. and 45 Francis St. entrances.

Staff celebrate the opening of Brigham and Women’s Health Care Center, Westwood.

A new Brigham Health multispecialty, outpatient clinic in Westwood opened Oct. 1. Brigham and Women’s Health Care Center, Westwood, which encompasses two floors and 30,000 square feet, will provide local patients with access to high-quality care in a convenient community setting.

Located in the University Station development, the facility offers primary care service from BWH physicians, including access to X-rays, ultrasounds, mammography and lab services. In addition, Brigham Health providers offer many specialty services, including Cardiology, Dermatology, Endocrinology, Neurology, Obstetrics and Gynecology, and Orthopaedics.

“We are thrilled to bring the Brigham’s exceptional care to the town of Westwood and the surrounding communities,” said Cindy Peterson, MBA, vice president of Regional Ambulatory Operations and Business Development. “Patients can receive the right care at the right time, with the benefit and convenience of it all being under one roof.”

To schedule an appointment, call 1-877-WEST128 (1-877-937-8128). For more information, visit brighamandwomens.org/westwood.

Joseph Currier receives a visit from Linda Martin while recovering from surgery on Tower 15.

Nearly 30 years have passed since Linda Martin, 72, underwent surgery at the Brigham for a partial bladder removal and urostomy, a procedure that creates an opening in the belly through which urine can exit the body. Performed to bypass a diseased or damaged urinary tract, a urostomy siphons urine to a pouch on the body that patients need to regularly empty and change.

Martin, who had both procedures to treat bladder cancer, knew the urostomy would offer her the best chance at continued health. Still, as she prepared for discharge from the hospital, she worried about how her life would change. Like many patients with an ostomy – a category of procedures that also includes ileostomies and colostomies, which involve the intestinal tract – Martin would have the pouch for the rest of her life.

“No matter how excited I was to go home, see my son and husband and sit on my porch, I was afraid. I wondered, can I really take care of this at home?” she recalled. “The nurses were so helpful and encouraging in terms of my medical needs and progress, but at that point I would have loved to meet someone with an ostomy. I had so many questions, even simple ones like, ‘What kind of bathing suit can I wear?’”

Martin quickly learned she had nothing to fear, finding that her life and career would remain just as active and fulfilling as they were prior to the procedure. Inspired to help patients facing the same anxieties she once did, five years ago Martin connected with Wound and Ostomy Care nurses Diane Bryant, MSN, RN, CWOCN, and Mary Willis, MSN, RN, CWOCN. They worked together to establish the Brigham’s Ostomy Peer Visitor Program to support patients with new ostomies transitioning from hospital to home.

Central to the program are volunteers with ostomies who visit patients in their hospital rooms. Initially launched as a three-month pilot with Martin as the sole volunteer visitor, the program has since expanded to five volunteers who represent a diversity of age, gender, personal background and ostomy type.

Volunteers come to the Brigham on Mondays, Tuesdays and Fridays to speak with interested patients on Tower 8, 12 and 15 and CWN 8; they also speak with patients by phone during off-hours. Bryant and Willis work closely with volunteers to provide training and education, introduce them to care teams and collaborate with nurses on the units to identify interested patients.

“We’re a team – the nurses, physicians, social workers and volunteers. We all work together to ensure the patient has the best experience,” Bryant said.

Empathy and Compassion

Patients fearful about being in public or feeling normal again benefit greatly from hearing volunteers share their personal stories, explained Bryant and Willis.

“Ostomies can be life-changing experiences for patients, and we were concerned about quality of life for our patients,” Bryant said. “As nurses, we can provide that physical and emotional care, but often in the back of the patient’s mind is the thought, ‘Well, you don’t have one of these. How can you know what I’m feeling?’ This program supplements the care we provide by connecting patients with someone who can answer questions they may not feel comfortable asking a nurse.”

Willis noted that because having an ostomy often causes considerable anxiety around body image, it is especially meaningful for patients to hear volunteers talk about their experiences with an ostomy while enjoying some of life’s biggest milestones, such as marriage or the birth of a child, and finding accommodations for more routine activities like exercise and travel.

While speaking with volunteers can reduce patients’ anxiety, simply seeing them is equally powerful, Bryant and Willis added.

“When a volunteer goes into the patient’s room, you can see the patients giving them a once-over and looking for the outline of a pouch under their clothes,” Willis said. “It’s really helpful for them to see they’re dressed like everybody else, and you cannot tell there’s a pouch, even under fitted clothing.”

Martin said she feels honored to help others by sharing her story and being a compassionate listener.

“I’m comfortable with having an ostomy now, but I haven’t forgotten what it was first like,” she said. “Patients hold my hand and say, ‘You give me hope.’ I’m grateful to help their heart feel a little lighter.”

The 7 Tesla MRI is lowered by crane into the Hale Building of Transformative Medicine in this 2017 photo.

A 7 Tesla (7T) magnetic resonance imaging (MRI) scanner, added to the Brigham’s suite of imaging technologies last year, received federal and state approvals for clinical use and become available for patient care as of Sept. 10. Availability of this new technology provides clinicians and patients with an advanced diagnostic imaging tool that is more than double the strength of a conventional high-field scanner.

Part of a new generation of ultra-high field instruments, the 7T MRI at BWH is the second in the country to be approved for clinical use and can now be fully integrated into the MRI program at the Brigham, focusing on world-class research and advanced patient care.

Weighing almost 25 tons, the 7T was lowered by crane into the Hale Building for Transformative Medicine (BTM) when it arrived at BWH in May 2017. The system’s superior field strength and advanced electronics provide a stronger signal used to generate higher-resolution images that offer advanced clinical insights into neurologic diseases, including multiple sclerosis and epilepsy, and musculoskeletal conditions that involve the cartilage, muscle and fascia of the knee joint. Initially used for research, the 7T has allowed BWH researchers to identify lesions in 38 percent of epilepsy patients that were not readily discernible on high-quality 3 Tesla MRI scans.

“Clinicians who see patients with neurological conditions for the brain – such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, brain tumors, epilepsy, cerebrovascular diseases and traumatic brain injury – will be able to capture details about these diseases and address clinical questions that current, lower-field magnets have not fully answered,” said Srinivasan Mukundan Jr., PhD, MD, medical director of Magnetic Resonance Imaging in the Department of Radiology.

Added James D. Kang, MD, chair of the Department of Orthopaedic Surgery: “The 7T will allow orthopaedic surgeons to get a noninvasive, detailed picture of various structures within the knee that are often the source of pain and disability.”

Patients of the main campus ambulatory neuroscience and musculoskeletal clinics will be referred by their physicians for a scan using the 7T when it is clear that the advanced images will provide a clinically meaningful benefit. The amount that patients and their insurers are billed for diagnostic MRI examinations is the same regardless of the field strength of the MRI instrument.

“Our clinical deployment of the new 7T MRI scanner will be a resource for clinicians and researchers across our system, and we look forward to collaborations with our colleagues at Massachusetts General Hospital,” said Giles Boland, MD, chair of Radiology. “Technical expertise developed over the past decade by MGH researchers working with the first 7T MRI system located at their Charlestown Naval Yard facility will help facilitate clinical translation at BWH. Likewise, clinical advances made at the Brigham will inform research efforts.”

Brian and Laura Clay are interviewed by the media after Brian’s 18.5-mile run.

Brian Clay is no stranger to lacing up his running shoes.

What made his June 14 run unique, however, was that it marked the anniversary of a lifesaving open heart surgery he underwent at the Brigham last year.

“I always knew I wanted to start running again – it was never a question,” said Clay, who had been diagnosed with acute aortic dissection, a serious condition where the inner layer of the large blood vessel branching off the heart (the aorta) tears.

Initially believing his symptoms of chest discomfort and blurry vision could be caused by a panic attack, the New Bedford resident went to Good Samaritan Medical Center’s emergency department in Brockton at his family’s urging. His diagnosis, which is most common in men in their 60s and 70s, came as a shock to the 42-year-old long-distance runner.

Within minutes of his diagnosis, Clay was on a MedFlight helicopter to BWH.

“Aortic dissection is a pathology where minutes count,” explained Steve Singh, MD, of the Division of Cardiac Surgery, who was part of the multidisciplinary team that performed Clay’s procedure. “The expeditious work of several teams made all the difference.”

The surgery was a success, and Clay was eager to get back on the road.

With his doctors’ support, he began a cardiac rehabilitation outpatient program closer to home. Each week, Clay began to walk on the treadmill and use the elliptical, slowly increasing his heart rate, as his care team monitored his vital signs. He remembers the first day he could run at all – a 12-minute-mile pace for five minutes on the treadmill. Once he passed that milestone, he began thinking big.

“I had this plan in my head for a while that I would commemorate the one-year anniversary of my surgery,” Clay said. “Since the date fell on a Thursday and it’s tough to find a marathon on that day of the week, I decided to do something on my own.”

His motivation paid off. After months of running with a heartrate monitor at the gym, completing the New Bedford Half Marathon with his wife, Laura, Clay set out to run the 18.5-mile MedFlight route from Good Sam to the Brigham with his sister and close friend keeping pace.

And when the trio rounded the corner onto Francis Street, Clay was overwhelmed by what he saw.

“My wife, three children and extended family and two of my doctors were there, along with a crowd of reporters from every local TV station,” Clay said, adding that the day couldn’t have been possible without the help of BWH’s Development, Media Relations and Facilities teams. “This experience was way more than anything I could have ever imagined.”

Clay also used his training period to raise $9,000 for Wings for Falmouth Families, a volunteer-based charity that provides financial support to families experiencing medical crises. In the future, Clay plans to raise money for BWH in honor of his care team.

“For him to return to his passion of running and raise money for other patients was tremendous to see,” Singh said. “It’s rewarding to participate in a program so committed to restoring healthy lives to patients like Mr. Clay.”

From top: Michael Elliott of All Veteran Group skydives in tandem with Matthew Pierce at Fort Bragg. Photo courtesy of All Veteran Group.

When Matthew Pierce learned he had an aggressive form of cancer at age 19, he was crushed knowing that the diagnosis meant his lifelong dream of pursuing a career with the U.S. Marine Corps was over. A patient at BWH, he shared this with members of his care team, who became inspired to help Pierce heal in more ways than one.

On June 6, the now 22-year-old had his wish come true for a day by skydiving in tandem with the All Veteran Group, which consists of active and retired members of the U.S. Army’s Parachute Team, also known as the Golden Knights, based at Fort Bragg in North Carolina. Giving new meaning to the phrase “going the extra mile,” neurosurgeon Ian Dunn, MD, of the Department of Neurosurgery, joined Pierce and Pierce’s girlfriend, Emily Johnston, on the parachute jump out of an airplane at 15,000 feet. Another member of Pierce’s care team, Edward J. (E.J.) Caterson, MD, PhD, of the Division of Plastic Surgery, who helped organize the jump, was also there to cheer for them on the ground.

Dunn, who had never gone skydiving prior to this, said participating in the parachute jump with one of his patients was unforgettable and meant a lot to him personally and as a care provider.

“As surgeons, we want to restore patients’ lives and see them thrive post-surgery,” Dunn said. “It has been phenomenal getting to know Matt. He’s a very special young man, and I am honored that I could be there with him for this once-in-a-lifetime experience.”

Several years ago, Caterson contacted the Golden Knights and arranged a jump with them and one of the Brigham’s face transplant patients. To this day, Caterson remembers the awe-inspiring experience and said he felt privileged to help facilitate it for another patient.

Ian Dunn suits up for skydiving. Photo courtesy of All Veteran Group.

“Matt is an incredible human being who hasn’t let his obstacles define him,” Caterson said. “Instead, he has overcome adversity in his life with such grace. It was our pleasure to find a way to honor Matt for his bravery and courage. At the Brigham, many of us are quite fortunate to play roles in many multidisciplinary teams of diverse expertise – all working together for the betterment of our patients.”

In 2015, Pierce was diagnosed with Ewing’s sarcoma, a rare form of cancer affecting mostly children and teenagers that forms in the bones or in the tissue around bones. It is often treated with a combination of chemotherapy, radiation and surgery. Pierce’s grapefruit-sized tumor was situated at the base of his skull, a location Caterson noted is extremely rare, and needed to be removed.

Pierce was cared for by a multidisciplinary team at the Brigham and Dana-Farber Cancer Institute. He underwent 14 rounds of chemotherapy, 28 radiation treatments and surgery in 2016 to remove part of his skull and reconstruct the area where the tumor was growing. The 10-hour surgery involved three surgical disciplines working together: Neurosurgery, Plastic Surgery and Surgical Oncology.

Pierce has been in remission for almost two years. He’s currently a student at Norwich University in Vermont and hopes to one day become a federal law enforcement officer. Pierce thanked his care team at the Brigham – including Dunn, Caterson and Chandrajit Raut, MD, MSc, of the Division of Surgical Oncology – for believing in him and giving him a second chance at life.

“Without them, I would not be here today,” Pierce said.

Raut said he is moved by Pierce’s resilience: “Seeing Matt move forward with his life and live his dream motivates us as health care providers to do what we do each day.”

Samantha and Demetrius Armstrong with their daughter, Malece

As the snow piled up outside their Revere home during the region’s most recent nor’easter, Samantha and Demetrius Armstrong got ready to end a relaxing day off from work with a home-cooked meal on March 13. But Samantha, who was 36 weeks pregnant with the couple’s firstborn, quickly realized their night was going to go very differently than expected.

“As soon as I sat down to eat, my water broke,” Samantha recounted. The couple packed into their car – along with that evening’s lasagna – and drove carefully through the blizzard to BWH, where their daughter, Malece, was born several hours later.

“It’s funny because we were talking earlier that day about how relaxed we were, so maybe that jinxed it and encouraged her to arrive early,” Samantha said.

Demetrius also said he wasn’t completely surprised by how things turned out. “I was working on the blizzard baby theory,” he joked.

Paul and Kelsey Brogna prepare to go home with their son, Luca, last spring after he was discharged from the NICU.

This is the first article in a weekly series in BWH Bulletin profiling runners participating in this year’s Boston Marathon with BWH’s Stepping Strong Marathon Team on Monday, April 16. 

Like many expectant parents, Paul and Kelsey Brogna eagerly awaited the birth of their first child and the exciting milestones that would follow – the first glimpse of his face, the first touch of his hand and the first photo they would take as a family.

When several unforeseen complications occurred during labor and delivery, they feared the worst. But thanks to the advanced, expert care Kelsey and Baby Luca received at the Brigham last spring, including a 13-day stay in the Neonatal Intensive Care Unit (NICU), the Brogna family celebrated those joyous firsts and many more.

Next month, they will add two more milestones to their list. Paul will participate in his first marathon – running in support of the Brigham with the Stepping Strong Marathon Team – followed by Baby Luca’s first birthday a few days after the race.

“Brigham and Women’s saved our son’s life, and I wanted to give back to the hospital that has given our family this priceless gift,” Paul said. “This hospital is an amazing place, and we felt so blessed to be there. I wanted to do anything I could to pay it forward.”

Appreciation for ‘Unsung Heroes’

In addition to the expert medical care Luca received in the NICU, Paul said they were overwhelmed by the unwavering kindness, compassion and professionalism of BWH staff throughout their stay. Countless gestures – from a housekeeper’s warm smile to a surprise photo collage made by Luca’s care team – provided comfort during a stressful time, Paul recounted.

“Every single person we encountered did their job phenomenally,” he said. “The staff are unsung heroes and the glue that allows families like us to have a chance for healthy recoveries. Without them, none of this is possible.”

The Brogna family

The Brognas chronicled their experiences on a blog to keep family and friends updated. As time went on, it provided a therapeutic outlet for the couple as well as an opportunity to publicly thank Luca’s wonderful care team, Paul said.

The physical space of the NICU – which recently completed its third and final wave of expansion and renovation – also contributed to their exceptional experience, he added. They appreciated having a private, spacious room with a pullout couch and closet, allowing them to stay overnight.

“We tried to stay there almost every night,” Paul said. “We felt like we were in the best place in the world.”

Eager to find a way to support other BWH patients and families, Paul began searching for fundraising opportunities a few weeks after he and Kelsey brought Luca home. He was drawn to the Brigham’s marathon program.

Lacking much running experience, he was initially a little daunted by the team’s training schedule, which began in December with six- to eight-mile runs. To prepare, Paul started training on his own in October and November.

“I’ll never forget the first weekend. It took 12 minutes to run a mile, and I stopped three times. I thought I made a huge mistake,” he said. “But little by little, I added a mile each weekend and by December I did a half-marathon. The idea that I could knock out 10 or 20 miles now is unbelievable to me.”

With much to look forward to on Marathon Monday, Paul said he’s excited not only to accomplish something he once thought was impossible, but also to give back to the Brigham.

“While our experience ignited this journey, I’m not doing this for Luca or for us. It’s for the next person who will need help,” Paul said. “I’m so grateful and happy to be part of a much bigger cause.”

From left: Irina Filina and Sandy Cialfi

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. The following program reflects the hallmark of interprofessional collaboration. 

While regular screening is a powerful tool for prevention and early diagnosis of colorectal cancer – the third-leading cause of cancer-related deaths among Americans – patients avoid having a colonoscopy for various reasons, often related to the complexity and inconvenience of preprocedure preparations.

Patients in our local community with limited English, poor health literacy, socioeconomic challenges, physical disabilities, cognitive impairment or behavioral health disorders are at greater risk of delaying or missing preventive screenings. Colonoscopies, specifically, have the added challenges of coordinated testing and stringent prep requirements. But thanks to a collaboration between BWHers in Primary Care Central Population Management (CPM) and Endoscopy nursing, fewer of these patients are falling through the cracks.

Staff in these areas work together to identify and support patients in this demographic with who need preventive cancer screening and may be at risk for being “lost to follow-up,” explained Sandy Cialfi, MBA, BSN, RN, CGRN, nurse director of Endoscopy.

“These patients are part of our community, and we have a responsibility to make sure they understand the importance of this screening and to do everything we can to help them access it,” Cialfi said.

The initiative, launched in 2015, yielded immediate results. Prior to the intervention, 62 percent of patients in this demographic completed colonoscopy screening over a three-month period. That rate rose to 70 percent over the next three months when the intervention was implemented. One year later, more than 80 percent of these high-risk patients underwent colonoscopies.

Using a registry tool in Epic, CPM staff identify at-risk patients and help coordinate any necessary services or support. This includes assistance with scheduling, one-on-one coaching to address health literary or language barriers, or transportation within the Boston area.

Travel home after the procedure can be a common challenge for patients in this population, explained Mary Merriam, RN, director of CPM program operations. Because colonoscopies are typically performed under sedation, patients must have an escort home, even if they take public transportation. CPM staff known as population health coordinators and patient navigators can fulfill this role for those at-risk patients who live in the local community; the team often helps patients who live outside the city connect with municipal and volunteer groups in their area that provide similar services.

Merriam noted that other patients may need help understanding certain requirements, such as how to measure the prep solution, or more targeted assistance with booking the appointment in coordination with work, school or child care schedules.

“We’re like shepherds. We can see when patients are coming in, help the care teams get ready and do all sorts of activities in the background to help both patients and providers be as prepared as possible,” Merriam said.

CPM staff closely partner with Endoscopy triage nurse Irina Filina, RN, CGRN, to review clinical concerns, questions or challenges, ultimately forming individualized care plans to ensure patients are scheduled for a colonoscopy, adequately prepped for the procedure and followed up with after the procedure.

Filina said this interdisciplinary collaboration has been crucial to the program’s success.

“Before this program was implemented, there were obstacles I couldn’t overcome on my own with some patients. These screenings are logistically challenging, and I was struggling,” she said. “The population health managers and patient navigators have been a tremendous help, whether it’s arranging transportation to get a patient here for their procedure or accompanying them to the pharmacy to pick up a medication. The bottom line is that by working together, we are saving more people’s lives.”

Merriam agreed: “Our staff are trained to do chart reviews and interview patients to screen for potential risks, but ultimately their background is not clinical. Irina helps us look at the more complex cases and takes care of some of barriers around reaching out to physicians or securing prescriptions. What makes this program so successful is that we work as partners.”

From left: Tegan and Khang Nguyen with their daughter, Ruby, and Jennifer Riley, a lactation consultant

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. The following program reflects the hallmarks of high-quality patient care and clinical excellence.

Seeing a need to standardize patient education around breastfeeding and lactation, BWH nurses assembled and implemented an evidence-based curriculum in these areas. The result: higher patient satisfaction scores around breastfeeding support.

The program focused on physiology, education, simulation and peer-to-peer teaching. Clinical nurses completed 15 hours of training in a patient breastfeeding support class and participated in a two-year skills lab, where they advanced their knowledge of breastfeeding education and developed teaching strategies. Based on this program, the team spearheaded successful several initiatives:

• Investment of 20 new breast pumps and retrofitting all current breast pumps with specialized parts that promote milk supply in the first hour after delivery.
• Provided booklets to all clinical nurses to support standardization of education.
• Establishment of a donor milk program to support nurses’ assessments of those needing supplementation while promoting breast milk exclusivity.
• Revision of the Infant Feeding Policy to be consistent with support of breastfeeding exclusivity and improved maternal neonatal outcomes.

Following these interventions, Press Ganey patient satisfaction scores regarding breastfeeding education rose from 86.8 percent in 2014 to 90.3 percent in 2016.

From left: Jackie Savage-Borne and Jessica Loftus role-play a conversation between a provider and patient about domestic violence.

“Do you smoke? How often do you exercise? Do you feel unsafe in your relationship?”

Providers ask patients routine questions like these to assess their risk of disease or, in the case of the third inquiry, their physical safety. But, for some patients, asking about their experience with intimate partner violence in this manner can feel more like a checklist item than something that merits a longer conversation, according to speakers at BWH’s annual event honoring V-Day on Feb. 9.

The event, which included a panel discussion and a role-playing session between a mock provider and patient, explored challenges and opportunities clinicians face in caring for patients who have experienced intimate partner violence. The discussion also highlighted services and resources for BWH clinicians such as Passageway, which can provide consultations, in-service training and provider support in caring for patients who have experienced abuse.

Organized by the BWH V-Day Planning Committee, the event was among the hundreds that took place around the world that day to honor V-Day, a movement aimed at raising awareness about violence against women and girls.

“Intimate partner violence is ubiquitous, and there’s a role for all of us to increase our sensitivity to and understanding of these experiences,” said Jeffrey Katz, MD, MSc, who moderated the panel and has helped lead efforts to organize the annual event. “Those of us who work in a clinical environment have the special privilege and responsibility of identifying and providing appropriate care for these patients.”

Speakers advised clinicians to practice trauma-informed care – which recognizes the multiple symptoms and effects of trauma, incorporates that knowledge into practice and procedures, and avoids actions that may retraumatize the patient – when they suspect or learn a patient has experienced intimate partner violence.

“We’re often glancing at the computer as we ask a patient whether they have been hit, kicked or punched or experienced forced sex. As a result, the patient may not feel a connection,” said Annie Lewis-O’Connor, PhD, NP, founder and director of BWH’s Coordinated Approach to Recovery and Empowerment (C.A.R.E.) Clinic. “But if you sit beside them and say, ‘I ask all my patients about their relationships, and I have a few questions about your relationship,’ it becomes a conversation.”

Meeting Patients Where They Are

Patients frequently disclose abuse in vague or incomplete ways, and it’s important not to press for details that might be triggering, speakers noted. Allowing patients to say as much – or as little – as they’d like builds trust, said Jackie Savage-Borne, MSW, LICSW, hospital program manager for Passageway. When a patient discloses abuse, thanking the patient for sharing their story and acknowledging their courage is also vital, said Hanni Stoklosa, MD, MPH, a physician in the Department of Emergency Medicine and executive director of HEAL Trafficking.

If a physical exam is needed, it is helpful to first explain what you would like to examine and why, added Nomi Levy-Carrick, MD, MPhil, of the Division of Medical Psychiatry.

During the role-play portion of the event, Passageway staff acted out examples of how a provider-patient interaction could unfold based on the clinician’s tone and approach. Savage-Borne played the part of a primary care physician speaking with a patient, portrayed by Jessica Loftus, MSW, LICSW, community program manager at Passageway.

In the first scenario, Savage-Borne depicted a common way providers broach the topic of intimate partner violence: “There are some questions I need to ask you, and I’m sorry to do this, but we’re supposed to ask these. Are you safe in your relationship? Is anyone hurting you? Things are good in your relationship?” In the end, the patient disclosed few details about her abuser. She was handed a pamphlet with a list of resources, which she left behind after the encounter ended.

During the second round, Savage-Borne demonstrated a trauma-informed approach: “Part of my ability to care for my patients is to ask some questions about safety in relationships. I ask all my patients these questions because so many people experience control and fear in their relationships. Would you feel comfortable telling me a little more about your relationship?” The patient revealed details indicating she was at risk for domestic violence. The provider asked if it was OK to page a Passageway advocate to discuss available resources; the patient agreed.

“We should always offer options. If the patient declines to see an advocate, you can provide a brochure or put a note in their health record,” said Mardi Chadwick Balcom, JD, director of Violence Intervention and Prevention. “It might take a few times before someone is willing to say yes, so it’s important to revisit in intentional, caring ways.”

Stephanie Liang of the IPC meets with Ying Zhang and her family.

For seven years, conventional treatments kept breast cancer at bay for Ying Zhang* until a routine checkup found the cancer had spread to her lungs, lymph nodes and bones.

The cancer grew more aggressive, and eventually her physicians in China said there was no more they could do.

“I tried every drug available in China,” said Zhang. “When I ran out of options, I searched online and found a clinical trial at Dana-Farber/Brigham and Women’s Cancer Center in Boston.”

She met the qualifications for treatment. Interested in participating in the trial, Zhang requested a consultation with Eric Winer, MD, medical oncologist and director of Breast Oncology at DF/BWCC. Zhang then faced the daunting task of leaving her home country to seek care.

With help from an English-speaking friend, Zhang emailed the International Patient Center (IPC) at BWH. The program’s staff provide a range of support services for about 3,000 international patients each year – spanning more than 120 countries – who come to the U.S. to receive medical care at the Brigham.   

The IPC helps patients navigate the health care system – assisting with medical records, billing, transportation and appointment scheduling – and the logistics of international travel. In preparation for Zhang’s upcoming visit, IPC staff also assigned her an interpreter and wrote an invitation letter she could present to U.S. Customs and Border Protection at Logan International Airport.     

The center’s multilingual, multicultural staff provides a single point of contact to assist patients before, during and after their visit, said Yawei Kong, manager of the center’s International Patient Program.

“Many of our patients have run out of treatment options,” Kong said. “I find my role very rewarding because we offer these patients access to potentially lifesaving treatments that aren’t available where they live.”     

Lifting Barriers

Two weeks after reaching out to the Brigham, Zhang settled into an apartment in Boston with her family. Her biggest concern about coming to the U.S. was the language barrier she would face. But with the help of IPC interpreters who translated interactions with her care providers, she said those worries dissipated.

There were also questions about the visa process. Zhang needed a visa extension several months into her treatment. The IPC helped her gather the required documentation for the renewal process, and an extension followed shortly thereafter. 

IPC staff work collaboratively across all departments to make access to care as smooth as possible for international patients, especially during what is often a stressful time in their lives, said Kerin Howard, director of the center. 

“Our main purpose is to help patients navigate the health care system, because the way health care is accessed can be very different depending on your country of origin,” Howard said.

Zhang says having her family by her side in the U.S. has been crucial as she weathers the emotional ups and downs of living with cancer. Equally meaningful is the compassionate, expert care she has received from her providers and the comprehensive support from the IPC. 

“I’m not fighting this cancer alone, and that’s made all the difference,” Zhang said.

*The patient’s name has been changed at her request.

BWH is pursuing Magnet designation to be formally recognized for the everyday excellence, teamwork and innovation demonstrated at the Brigham. Magnet is the highest recognition given by the American Nurses Credentialing Center for health care institutions providing exceptional patient care.

BWH submitted a body of evidence in April that demonstrates how the hospital meets the Magnet model. The Brigham will be notified in the coming months whether it has met the requirements for a site visit. During a site visit, which would take place in early 2018, appraisers speak with employees, patients and families about the quality of care provided.

As part of this journey, BWH Bulletin will regularly share examples of projects and initiatives that reflect our commitment to quality, safety, collaboration and innovation in care to ensure that all staff are aware of how we meet the criteria for Magnet.

S.A.F.E. Response: A Model for Urgent Clinical Issues

• We care for patients with a variety of complex medical conditions that may cause changes in behavior and/or mental status, which can place patients and caregivers at risk for injuries.
• An interprofessional team was tasked with developing and implementing an inpatient clinical safety response model to improve care and reduce or prevent injury to staff and patients.
• This protocol, known as S.A.F.E. Response, engages interprofessional teams in a four-step process: Spot a threat, Assess the risk, Formulate a safe clinical response plan and Evaluate the outcome.
• S.A.F.E. Response provides members of the care team with a clinical response option instead of a Code Grey when spotting changes in behavior, coping or mental status of a patient, family member or visitor.

Learn more at BWHPikeNotes.org/Magnet.

Magnet Exemplary Professional Practice (EP) Standard 12