Posts from the ‘patient care’ category

BWH Ambulatory Services: Construction and Leadership Updates

An artist’s rendering of Brigham and Women’s Health Care Center – Westwood, which opens this fall

As Brigham Health advances its efforts to expand access to ambulatory care in communities around Greater Boston, BWH will open a new multispecialty outpatient clinic in Westwood this fall and is expanding the Outpatient Care Center at Brigham and Women’s/Mass General Health Care Center in Foxborough, which is slated for completion next year. To support these expansions, BWH has restructured and expanded the responsibilities of two roles in Ambulatory Services.

Ambulatory Regional Operations Expansion

Cindy Peterson

Brigham and Women’s Health Care Center – Westwood is scheduled to open this October at the University Station development. The center, which will add 30,000 square feet of outpatient care, will provide primary care through Partners Community Physicians Organization and embed Behavioral Health through the Brigham and Women’s Physicians Organization (BWPO) Department of Psychiatry. Additionally, Brigham Health providers will offer Dermatology, Obstetrics and Gynecology, Orthopaedics, Phlebotomy and Radiology services. A separate, multispecialty clinic within the center will offer Brigham Health Cardiology, Endocrinology, Gastroenterology, General Surgery, Neurology and Urology. Partners Urgent Care, an additional occupant of the Westwood site, will open later in 2019.

In Foxborough, a second, 60,000-square-foot building is being constructed across from the Outpatient Care Center at the Brigham and Women’s/Mass General Health Care Center. The additional space will double the size of its primary care practice in Foxborough, enabling further growth of the center’s nearly 30 medical and surgical specialties. Brigham Health is partnering with Dana-Farber Cancer Institute, which will occupy a floor in the new building to provide medical oncology and infusion services. The building is set to open in 2019.

New Roles and Responsibilities

Cindy Peterson, MBA, was named vice president of Regional Ambulatory Operations and Business Development. The new position will extend Peterson’s span to support and guide future ambulatory sites. She previously served as executive director at Brigham and Women’s/Mass General Health Care Center, Brigham and Women’s Health Care Center at 850 Boylston St. in Chestnut Hill and Brigham and Women’s Health Care Center – Westwood.

Julia Raymond

“Cindy has provided a regionally focused perspective, assuming ever-increasing responsibilities across the Brigham’s large off-site Ambulatory care centers in Foxborough, Chestnut Hill and soon, Westwood,” said William Johnston, MBA, chief operating officer and treasurer of the Brigham and Women’s Physicians Organization and senior vice president of Ambulatory Services. “She’s adept at utilizing external business development to grow the community’s awareness of our services in Foxborough, and her expertise will be integral to our efforts to expand regional access to ambulatory care.”

Peterson joined the Brigham in 2008 as administrative director for the Brigham and Women’s/Mass General Health Care Center in Foxborough. She received her MBA in health care management from Boston University and her bachelor’s degree from Amherst College.

In addition, Julia Raymond was promoted to director of Operations in Foxborough. She is responsible for all day-to-day operations at Brigham and Women’s/Mass General Health Care Center, and she will play a larger role in strategic planning, community outreach and supporting the Foxborough expansion efforts and new Westwood site. Raymond was previously senior operations manager in Foxborough.

“Julia has been an integral part of Foxborough operations from before our site opened in 2009,” Johnston said. “I’m excited to see how Julia will bring her unwavering commitment to continuous improvement, patient satisfaction and operational excellence to her new role.”

Raymond began her career at BWH in 2005 working with the Brigham and Women’s Physicians Organization as an application manager. Raymond received her bachelor’s degree in Health Management and Policy from the University of New Hampshire.

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

Heart & Vascular Center First in Region to Perform 1,000 TAVRs

Staff in the Brigham’s transcatheter aortic valve replacement (TAVR) program celebrate their recent milestone.

Less than a decade after performing the first transcatheter aortic valve replacement (TAVR) at the Brigham, a multidisciplinary team in the BWH Heart & Vascular Center recently became the first in New England to have completed 1,000 TAVR procedures.

Now with the largest program of its kind in the region – based on annual volume and total TAVRs performed – the Brigham’s TAVR team recently held a staff celebration in honor of its 1,000th case, which it achieved earlier this year. The program is now rapidly approaching 1,200 procedures.

“This milestone makes me realize that I am part of a progressive and talented group of individuals who have developed one of the country’s best TAVR programs,” said cardiac surgeon Marc Pelletier, MD, and the program’s surgical director. “The number 1,000 gives us pause to realize the amount of work needed to get here and how many patients and families have been helped by this groundbreaking technology.”

A minimally invasive surgical procedure performed in the Cardiac Catheterization Lab, TAVR is used to treat patients with a heart condition called aortic valve stenosis. Among these patients, blood is unable to flow freely from one of the heart’s valves to the body’s main artery, the aorta. Some patients with this condition can avoid open-heart surgery with the use of TAVR, which uses advanced imaging to help specialists guide a catheter into the heart – through a small incision in the leg, groin or chest – and insert a replacement aortic valve.

TAVR can be done without general anesthesia, and patients experience a quicker recovery than they would from a traditional open-heart valve replacement. The entire procedure takes about 90 minutes, and patients are often home within a day or two.

The Brigham performed its first TAVR in 2009 as part of a landmark, multi-institutional series of clinical trials known as the PARTNER trials. Following approval by the U.S. Food and Drug Administration, the procedure moved into clinical service at BWH in 2011.

Maximizing access to this lifesaving treatment is a major focus for the team, noted interventional cardiologist Pinak Shah, MD, who serves as the program’s medical director. The program now runs three clinics per week for patient evaluation, and TAVRs are typically done within two to three weeks of the patient’s first appointment.

“We can do this because of our ability to perform TAVR procedures five days per week, which is unusual in this field,” Shah said. “This is a testament to the dedication of everyone involved in the process – from clinic scheduling to radiology to procedure scheduling and catheterization laboratory staff.”

Pivotal to the BWH TAVR team’s success has been its focus on multidisciplinary collaboration, said cardiac surgeon Tsuyoshi Kaneko, MD.

“I am really proud of how much we’ve grown, but more than that, it’s the phenomenal teamwork,” Kaneko said. “To perform this procedure, it’s not just cardiac surgeons. It’s not just interventional cardiologists. We have an incredible team that includes anesthesiologists, nurses, non-interventional cardiologists, physician assistants, radiologists, fellows and many more. Everyone has contributed so much to the growth of this program.”

Pelletier and Shah agreed, noting that the team’s comprehensive approach and combined expertise enable them to assess referrals quickly and support faster, smoother recoveries for patients.

“It is a tremendous honor to be a part of this milestone and program, which is the ultimate example of cross-disciplinary collaboration,” Shah said. “It is very satisfying to work with such talented colleagues who have a common goal of building a successful program and providing great care for our patients.”

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

Helping Expand Access to Complex Care in Underserved Communities

Elizabeth Buzney demonstrates how phototherapy is performed at the BWH Phototherapy Center.

After topical treatments failed to heal a patient with a rare form of skin cancer, family physician John Mohs, MD, carefully evaluated the patient’s next steps.

Mohs practices at Northern Navajo Medical Center in Shiprock, N.M., a rural hospital operated by the U.S. Indian Health Services (IHS), which provides health care for American Indians living on or near their native homeland. Patients in this remote region of Navajo Nation are at higher risk for many diseases, yet specialty care is scarce. Northern Navajo Medical Center serves approximately 30 inpatients per day and approximately 600 outpatients per day, according to the IHS.

Diagnosed with cutaneous T-cell lymphoma – a form of lymphoma that affects the skin – Mohs’ patient was a good candidate for phototherapy, which exposes targeted areas of the body to ultraviolet light to reduce skin inflammation. Also known as light therapy, phototherapy has been proven to be safe, effective and affordable in treating a number of inflammatory skin conditions. 

For Mohs and his patient, the challenge was access. Until recently, Mohs had neither the training nor equipment to provide phototherapy at his small dermatology clinic in Shiprock. The nearest phototherapy center was about 200 miles away, and his patient would need to go there three days per week for several months. The combination of barriers made it infeasible for the patient to obtain the specialized care he needed. 

Ironically, the solution to their problem would be found more than 2,000 miles away – in the BWH Department of Dermatology. 

Thanks to a clinical collaboration between BWH faculty volunteers and IHS clinicians through the Brigham and Women’s Outreach Program, Mohs developed and launched a phototherapy service for his patients in Shiprock based on guidance he received from BWH experts in the field.  

He worked closely with Elizabeth Buzney, MD, director of the BWH Phototherapy Center, and Margaret Cavanaugh-Hussey, MD, MPH, director of Public Health and Community Outreach Programs in BWH Dermatology, who Mohs said both played a significant role in helping him get this new clinical service off the ground.

“I probably would not be using phototherapy without the guidance and assistance they provided. Dr. Buzney willingly shared many resources so that I wouldn’t have to reinvent the wheel,” Mohs said. “Thanks to all of this support, my patient was treated right at Northern Navajo Medical Center and is now in remission.” 

Buzney was delighted she could help to expand access to this treatment – a cause she says is close to her heart.

“I felt like I did something that was so small – I shared resources and knowledge I already had – and Dr. Mohs has since been able to care for so many people as a result,” Buzney said. “As physicians, we typically treat patients one-to-one. To play a part in assisting many patients who are so far away is immensely gratifying.” 

A Helping Hand

From left: Toby Crooks, Margaret Cavanaugh-Hussey and John Mohs

The project represents one of many collaborations established over the years between IHS clinicians and BWH faculty volunteers through the Outreach Program. Building on their latest momentum in phototherapy, Mohs and his physician assistant colleague, Toby Crooks, PA-C, visited the outpatient Dermatology clinic at 221 Longwood Ave. last month for a weeklong shadowing opportunity to observe and learn from BWH clinicians in action.

Mohs and Crooks were assigned to various specialty clinics, ranging from advanced wound care to cutaneous lymphoma – an experience that enabled them to broaden their dermatologic knowledge and strengthen relationships with experts in the field, said Cavanaugh-Hussey. In return, she added, BWH faculty had the chance to learn firsthand about the important work their IHS colleagues are doing in Shiprock. 

“The BWH Outreach Program is a model for how forming meaningful relationships with primary care providers in underserved communities can dramatically increase access to high-quality specialty care,” said Cavanaugh-Hussey. “This is particularly important in dermatology, where access to care is limited in many areas of the country.”

While the Outreach Program may be best known for sending BWH faculty volunteers to Shiprock to train IHS clinicians and help care for patients, providing shadowing and observation opportunities at the Brigham are equally important to its work and mission, said Thomas Sequist, MD, MPH, medical director of the Outreach Program, a primary care physician in the Phyllis Jen Center for Primary Care, and chief quality and safety officer at Partners HealthCare. Since 2009, the program has hosted training opportunities at the Brigham for 18 IHS clinicians.

“The delivery of highly specialized, complex care is crucially needed within the IHS. However, the number of patients that require such care on a day-to-day basis is relatively low, so if we send a BWH specialist to New Mexico, it is quite likely that there will be no training opportunity with actual patients the week they are there,” Sequist said.

Mohs agreed that observing the BWH Dermatology team in person was enormously beneficial. 

“We were able to see a large volume of more rare and complex conditions that we don’t see often enough to feel confident managing,” he said. “Being able to see these cases with BWH attendings and ask questions – and receive extensive answers from the experts – in real time was invaluable.”

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

Innovative Video-Assisted Surgery Leads to Faster Recovery, Less Pain

From left: Wallis Urmenyhazi and Scott Swanson

Wallis Urmenyhazi, PhD, was speaking with her primary care physician by phone after a recent chest X-ray when he said four words that would change her life: “You have a lesion.” 

“I didn’t know what he meant by lesion, but he told me to see a thoracic surgeon,” says Urmenyhazi, a retired professor of French literature, who had seen her physician for a persistent cough.

After meeting with a thoracic surgeon in her home state of Pennsylvania, Urmenyhazi learned that her lesion was a thymoma, a rare disease in which a tumor grows within the thymus gland, a butterfly-shaped organ that sits in front of the heart and makes immune cells. There are only 1.5 cases of thymoma for every million people each year in the United States.   

The most common treatment is to remove the tumor with surgery. Accessing a thymoma can be challenging, however. The thymus sits behind the sternum, between the lungs, and is surrounded by sensitive blood vessels. A traditional surgery opens the chest by making a large incision in the breastplate.   

Urmenyhazi had misgivings. It was a major operation with a long recovery process. Her tumor had been caught early; her only symptom was a cough. Through online research, she learned that some surgical procedures approached thymomas through small incisions and used less-invasive techniques aided by video or robotic technology.  

“I asked my surgeon at the time if he would perform a minimally invasive procedure, but he didn’t have that expertise. He recommended the more complex traditional operation, which had no guarantee of success,” she said.    

Despite her reservations, Urmenyhazi scheduled the operation – but canceled a day later. She searched online for a surgeon with experience in minimally invasive techniques for thymoma, ultimately finding Scott Swanson, MD, director of Minimally Invasive Thoracic Surgery in BWH’s Lung Center. 

A member of the surgical team for Dana-Farber/Brigham and Women’s Cancer Center, Swanson is an expert in video-assisted thoracic surgery (VATS) and teaches the technique around the world.

“After meeting Wallis, I recommended VATS, a minimally invasive procedure where we insert a tiny camera and instruments into small incisions in the chest. This allows us to access the thymus without opening the chest. Compared with traditional approaches, patients can expect less pain and a quicker recovery,” Swanson said.  

The procedure was performed without complications. After the surgery, Urmenyhazi had no pain. It was almost as if the surgery hadn’t happened, she said.   

VATS has been available for 25 years, but not enough surgeons are trained to do it, Swanson explained. That’s why he and members of the Division of Thoracic Surgery travel to hospitals across the globe to train surgeons in minimally invasive techniques and expand access to this lifesaving procedure.

Swanson applauded Urmenyhazi for being an advocate for her own care. “Sometimes, the patient needs to seek out the physicians who are trained to perform the most cutting-edge surgical techniques,” he said.   

Urmenyhazi meets yearly with Swanson for follow-up scans. “I will be forever grateful for Dr. Swanson,” she said.

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

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.

Blizzard Brings a Bundle of Joy to the Brigham

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.

1 Comment

Grateful for a ‘Priceless Gift,’ Boston Marathon Runner Gives Back to BWH

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.”

About Stepping Strong

The Gillian Reny Stepping Strong Center for Trauma Innovation was established by the Reny family to honor the BWH caregivers who saved their daughter Gillian’s life and legs in the aftermath of the 2013 Boston Marathon bombings. Five years after the tragedy, the center has raised more than $13 million to transform trauma research and care for civilians and members of the military who experience traumatic injuries and events. Funds raised by members of the 2018 Stepping Strong Marathon Team support the center’s work. To meet other members of the team or make a gift, click here. Learn more about the center at BWHSteppingStrong.org.

1 Comment

Removing Barriers to Cancer Screening for High-Risk Patients

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.”

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 colorectal cancer screening initiative is featured in the Structural Empowerment (SE) 10EO section of the submission.

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.”

Nurses See Success with Breastfeeding Education Initiative

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.

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.

New Angiography Imaging System Comes to Hybrid OR

From left: Michael Belkin, Felicity Billings and Edwin Gravereaux, beside the ARTIS Pheno imaging system in BWH’s hybrid OR.

BWH surgeons and interventionalists working in the Michael J. Davidson, MD, Hybrid Operating Room are among the first clinicians in the Northeast to use the new ARTIS Pheno angiography imaging system.

The powerful, robotically controlled device delivers high-end imaging for patients undergoing certain cardiac, endovascular or thoracic surgeries or procedures.

The Brigham has a rich history of pioneering technologies and imaging tools in the hybrid operating room (OR) to deliver the most advanced care to patients. Some interventions that once took place over several days – historically in multiple operating rooms and diagnostic labs – can now be done over the course of one visit in the hybrid OR. BWH was the first hospital in the U.S. to use the ARTIS Zeego system, the Pheno’s predecessor, in the OR.

Known as “C-arms” for their C-shaped design, the Zeego and Pheno perform real-time X-ray imaging during angiograms and therapeutic procedures. Both are designed to rotate completely around a patient’s body, making it easier to diagnose a condition in the OR and, if necessary, immediately operate.

BWH clinicians are using these imaging systems to guide increasingly complex procedures, such as aortic valve replacements and transcatheter aortic valve replacements (TAVRs). These require high-quality, granular imaging – an area in which the Pheno offers several improvements, according to Michael Belkin, MD, chief of the Division of Vascular and Endovascular Surgery.

“The Pheno algorithms will allow us to better perform these procedures,” he said. By better, Belkin means faster imaging, less radiation exposure for patients and interventional surgeons, and higher-quality images. Resolution for two-dimensional imaging in Pheno is four times higher than in the older device.

Last month, BWH clinicians began enrolling patients in a clinical trial for transcatheter mitral valve replacement, a study the Pheno will support, said cardiac surgeon Tsuyoshi Kaneko, MD, of the Division of Cardiac Surgery.

“This trial requires a thoracotomy – a surgery to open the chest wall – which we will perform in the hybrid OR. It’s a perfect example of where the Pheno will be really useful,” Kaneko explained, as the newer system will provide better visibility and resolution with less contrast load.

Improving Quality and Safety

In addition to the new system’s advanced capabilities, parts of its design are expected to improve care quality and safety for patients in the hybrid OR, providers said. Pheno’s wider-space robotic C-arm moves more easily in and out of the patient field without interrupting the sterile surgical field. And as a more closed system compared to the Zeego, the Pheno is easier to keep sterile.

“The Zeego moves like an old-generation robot, whereas Pheno will be silky smooth when the arm moves and will make our procedures much, much easier,” Kaneko said.

The new device also enables clinicians to obtain images faster. “We want to see the image in a matter of seconds, especially when working on an urgent or complex case,” said Kaneko. This isn’t only a matter of convenience; it also concerns patient safety. Because the Pheno scans up to 15 percent faster than earlier systems, images are produced with less IV contrast – an added benefit, as contrast can tax the kidneys.

While the Pheno likely won’t be used for conventional open cardiac, thoracic or endovascular procedures, Belkin is enthused about the device’s potential benefits for patients for whom its use is appropriate.

“We are already doing hundreds of cases every year in the hybrid OR now,” Belkin said. “With this newest machine, we can deliver even better care to our patients.”

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

V-Day Speakers Share Insights on Domestic Violence Screening

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.”

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.

‘My Heart Is Full of Love’: Patient Grateful for Care, Compassion

From left: Ann Washington, Cindy Washington and Darien Clark

At age 25, Cindy Washington and her heart have been through a lot: two cardiac arrests, the installation of a pacemaker and, most recently, the implantation of a left ventricular assist device (LVAD). But the Roxbury native says there’s one thing that has kept her heart going through all the hard times: love.

“From the amazing care team at the Brigham to my fiancé, mom, siblings and friends, I am so grateful for all the support I receive from them every day,” Washington said. “If it weren’t for these people in my life, I don’t know where I’d be today. Because of them, my heart is full of love.”

In 2011, Washington was diagnosed with dilated cardiomyopathy, a type of heart failure due to an enlarged heart that has an impaired ability to pump blood. Despite having an implantable defibrillator placed in her chest in 2014, her heart grew weaker. In 2016, she needed to have an LVAD implanted. The LVAD, a mechanical pump that supports heart function and blood flow in patients with heart failure, is a “bridge to transplant” as Washington awaits a donor heart.

On Valentine’s Day, Washington came back to BWH with her mom, Ann Washington, and fiancé, Darien Clark, to visit with members of her care team and thank them for all they’ve done for her and her family.

Ann, who saved her daughter’s life twice by performing CPR on Washington when she suffered the cardiac arrests, said she’s forever grateful for the incredible, compassionate care provided at BWH.

“I know Cindy might not be here today if it wasn’t for the extraordinary team of experts at the Brigham that has never given up on my daughter,” said Ann, as she wiped tears from her eyes.

‘A Special Patient’

After Washington first became sick, she had to drop out of college because she was too weak to attend classes and keep up with the workload. She became depressed and isolated from family and friends. Today, her life looks a lot different. She feels great and is taking online courses, with hopes of one day becoming a health policy lawyer. Washington said she’s gotten through the tough times because of her support system, both at the Brigham and at home, and by maintaining a positive outlook.

“Heart disease hasn’t beaten me yet,” Washington said. “I’ve always told myself that I’ve never had a broken heart; it’s just been a little sick. My will is strong, and I refuse to let anything get me down.”

Michael Givertz, MD, medical director of BWH’s Heart Transplant and Mechanical Circulatory Support Program, is a member of Washington’s care team. He described Washington as a “very special patient” who, from a young age, has remained hopeful, joyful and positive.

“Cindy is a shining example of a patient who is living life as fully as she can,” Givertz said. “She’s independent, strong and determined. She’s a true pleasure to care for, and I feel fortunate that I’ve had the opportunity to get to know Cindy and her family.”

Knowing that returning to school was important to Washington, Givertz wrote her a letter of recommendation for a college scholarship.

Another person who has been instrumental in Washington’s life is her fiancé, who has stood by her side through everything. Clark said he wouldn’t have it any other way. Although it has been difficult to see his loved one hurting, he knew they’d get through it – together.

“Cindy is my world,” Clark said. “She’s my valentine today and every day. We’ve overcome so many obstacles together, and I will never leave her side.”

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

1 Comment

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.

Warming Heads and Hearts: BWHers Knit 550 Hats for Newborns

Stephanie and Larry Harmon receive a red hat for baby Stella as part of the Little Hats, Big Hearts program.

When Labor and Delivery nurse Denise Giller, RN, asked her BWH colleagues to help knit and crochet hundreds of tiny red hats for babies born at the Brigham – in honor of American Heart Month in February – she wasn’t sure what to expect.

She set an ambitious goal of 450 hats, correlating to the approximate number of infants delivered at BWH each month. But soon enough, the collection box in the staff lounge on CWN 5 began to fill up. One NICU nurse dropped off 106 homemade hats. A nurse working the night shift texted Giller a photo of her and her colleague crocheting hats during their break. Giller also enlisted help from friends and family; many BWHers shared the message with their own loved ones, as well.

“I didn’t think we were going to have enough hats, but then they poured in,” said Giller, who ultimately collected 550 hats, which are being distributed to infants in the Connors Center for Women and Newborns throughout February. “I am so grateful for every single hat that was made and for the people who helped spread the word. This would not be possible without everyone’s help.”

The project is part of Little Hats, Big Hearts, a nationwide program sponsored by the American Heart Association (AHA) and The Children’s Heart Foundation to raise awareness about heart disease and congenital heart defects. Volunteers knit and crochet red hats for babies born in February; once cleaned, the hats are packaged by the AHA and delivered to participating hospitals for distribution to patients and families.

This was the first year BWH participated in the initiative, which Giller spearheaded after learning about it last fall and contacting the AHA to implement it at the Brigham. While the AHA typically receives hats from the general public, BWH was the first participating Massachusetts hospital whose contributions largely came from the institution’s staff.

Stephanie and Larry Harmon, who recently celebrated the birth of their second daughter, Stella, were the first family to receive one of the signature red hats. The Stoughton couple said they were deeply touched by the thoughtfulness of BWH staff.

From left: Matthew Carrow and Anna Ballard with their son, Leland, and Denise Giller. Baby Leland was the second infant to receive a red hat.

“To hear that Brigham employees themselves knit these 550 hats blew my mind,” Stephanie said. “They work around the clock here to provide incredible care, and then to know they carved out time at home to make these hats really made it clear to us how much they care for patients and families.”

That warmth and commitment to patients are what make the Brigham stand out, she added.

“We wanted to deliver at the Brigham because we knew it was going to be best care all around,” Stephanie said. “Everyone here truly cares about you and your baby. You don’t necessarily get that experience everywhere. At the Brigham, I knew we would.”

Giller agreed, adding that she was proud to work with so many dedicated professionals.

“What we accomplished speaks volumes to the dedication of our staff, who care about our patients far beyond their shifts,” Giller said. “As a Labor and Delivery nurse, I love being part of patients’ lives during the miracle of birth. When you get to deliver something else – in this case, a warm hat and additional patient education – it makes what we do even more rewarding.”

2 Comments

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.

DF/BWCC Opens New England’s First Adult Cancer Diagnostic Service

From left: Cancer Diagnostic Service team members Luke Arney and Louise Schneider

Sometimes, a routine medical examination leads to more questions than answers. But for patients with suspicious and complex symptoms that point to cancer, not receiving concrete answers right away about their diagnosis can be especially scary.

Take, for instance, a patient who met with her Partners HealthCare-affiliated primary care physician (PCP) for a routine lung cancer screening. While a chest CT scan didn’t show signs of lung cancer, it did reveal a bone lesion and pathologic rib fracture, a form of rib injury caused by disease rather than blunt trauma. Additional tests suggested cancer, but her doctor wasn’t sure.

Such a patient poses an unusual challenge. A referral to an appropriate oncologist is difficult because a cancer diagnosis has not been made, but the next steps in the diagnostic workup aren’t always clear either for PCPs. Yet the prospect of a cancer diagnosis also creates stress, so everyone wants answers as soon as possible.

The Cancer Diagnostic Service (CDS) at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) aims to alleviate that uncertainty and make the determination of a cancer diagnosis faster and simpler for patients and their providers. Initially piloted as a virtual clinic to help Partners-affiliated PCPs streamline and expedite a diagnosis for patients with suspected cancer, the CDS recently graduated from its pilot phase and began seeing patients in its new physical space on the main campus.

While the service’s biggest users at the moment are PCPs within Partners, including those at the Brigham, it is expected to grow into a regional resource for referring physicians at other health care organizations as well.

“When there is a strong suspicion of cancer without a definitive diagnosis, it can be difficult for patients and physicians,” said Lindsay Carter, MD, MBA, medical director of the Cancer Diagnostic Service. “As doctors order additional diagnostics test for their patients or seek input on the appropriate next steps, there can be significant delays and unnecessary tests. We created the Cancer Diagnostic Service to streamline the process to help doctors reach a timely diagnosis so that treatment can begin without delays.”

The patient with suspicious findings on her lung CT was referred to the CDS, where she was diagnosed with adenocarcinoma – a form of cancer – following a CT-guided biopsy. She was then seamlessly transferred to a thoracic oncologist at Dana-Farber Cancer Institute (DFCI) to begin treatment.

A More Seamless Approach

During the center’s six-month pilot, which began in October 2016, providers used Epic’s E-consult function to consult virtually with CDS staff. Of the 82 cases evaluated by the clinic’s staff – an internist, physician assistant and consulting BWH and DFCI oncology specialists – 70 percent of patients were recommended for and received a full diagnostic work-up. Among that group, nearly two-thirds were ultimately diagnosed with cancer and referred to oncologists or surgeons.

The pilot generated an overwhelmingly positive response from PCPs. “It’s scary when your patient has cancer, and it was really nice to have someone guide you as you make diagnostic decisions,” wrote one physician in a feedback survey. Others praised the rapid response and seamless process in reaching a diagnosis.

With funding from the Brigham Care Redesign Incubator Startup Program (B-CRISP) and DFCI, the CDS opened its physical space on Oct. 20 in the Brigham Medical Specialties Suite at 45 Francis St. The team sees patients on Wednesday mornings and Friday afternoons. Patients are scheduled for an appointment within five business days of the referral.

“After a referral, the CDS takes ownership of each patient’s case and coordinates the diagnostic work-up. We communicate detailed results and a suggested treatment plan to both patients and referring providers,” said Ryan Leib, MBA, administrator for the CDS and director of Ambulatory Practice Management at DFCI. “Now that we have an established physical location, we are reaching out to the referring physician community to inform them about this unique service.”

To refer a patient the Cancer Diagnostic Service, call 857-307-5775. Partners HealthCare physicians may also submit an Epic order to Ambulatory Referral to DF/BWCC Cancer Diagnostic Service.  

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.

Sculpture Celebrates BWH’s Legacy of Organ Transplantation

Kerrie Ike, whose brother Kevin Sullivan was an organ donor, places an LED candle in front of the new sculpture.

In honor of the Brigham’s legacy of leadership and innovation in organ transplantation, BWH was recently selected as one of five sites around the world to receive a candle monument commemorating organ donors and their families.

Donated by Boston’s Sister City of Belfast, Ireland, the Irish limestone sculpture was recently installed in front of Stoneman Centennial Park. On Nov. 30, BWHers celebrated the gift and spoke about the importance of organ donation during a ceremony with representatives from the City of Boston, Belfast, New England Donor Services (NEDS), an organ donor’s family, a BWH lung transplant recipient and other community members.

“This is a very proud moment for us,” said Brigham Health President Betsy Nabel, MD. “We are deeply honored to receive this sculpture of light, which represents hope and inspiration for all who receive the gift of life through organ donation.”

Boston and BWH accepted the sculpture as part of the first Irish-led project and global event expressing appreciation for organ donors. The event was sponsored by the Ireland-based organization Strange Boat Donor Foundation and Organ Donation and Transplant Ireland. Each sculpture was gifted by one of Ireland’s five major cities – Belfast, Cork, Derry, Dublin and Galway – to its corresponding sister city around the world. In addition to Boston, sculptures have been installed in Barcelona, Spain; Cape Town, South Africa; Melbourne, Australia; and New Delhi, India.

The sculpture stands more than 5 feet tall and is a replica of the stone-sculpted candle on display in the Circle of Life Irish National Organ Donor Commemorative Garden in Galway, Ireland. The BWH sculpture is accompanied by a stone tablet that is engraved with information about the project.

“Individuals and families choosing to help someone in need through organ donation reflect the best of humanity,” said Belfast City Councilor Adam Newton.

Reliving History

The Brigham is an internationally recognized leader in organ and tissue transplantation. Many transplant milestones have taken place here, including the world’s first successful human organ transplant, a kidney transplant, performed by the late Nobel Prize Laureate and transplant pioneer Dr. Joseph E. Murray in 1954.

Standing next to the glass display case in the Rotunda that holds her father’s Nobel Prize in Physiology or Medicine, Virginia “Ginny” Murray, the eldest daughter of Dr. Murray, said her father would have been thrilled to be at the celebration and so proud of the Brigham’s tremendous advances in transplantation. She encouraged more individuals to sign up to be organ donors so those in need can benefit from such advances.

“As my father once said, ‘Service to society is the rent we pay for living on this planet,’” she said.

From left: Irish Consul-General Fionnuala Quinlan chats with BWH patient and transplant recipient Eileen Sullivan.

Describing the first kidney transplant as a “defining moment in medical history,” Sayeed Malek, MD, clinical director of Transplant Surgery at the Brigham, expressed his gratitude to those who have selflessly given the gift of life and urged others to help grow the ranks of organ donors.

“It is an opportunity that has no borders and embraces the whole world, as represented here today by Belfast and Boston,” he said.

Also in attendance at the ceremony was Eileen Sullivan, a BWH double-lung transplant recipient and NEDS volunteer. Sullivan said that thanks to her organ donors and the transplant team at BWH, she could be present for all of life’s greatest milestones, including watching her children grow up and celebrating her 30th wedding anniversary.

“I’m truly very grateful,” Sullivan said. “Through my volunteer work with the New England Donor Bank, I spread the message that organ donation works and it can work very well. I’m living proof of that.”

To view a gallery of photos from the celebration, click here.

1 Comment

Town Meeting Highlights Efforts to Improve Access, Enhance Safety

Betsy Nabel addresses BWHers during Town Meeting.

Overcoming challenges through collaboration, innovation and expansion was a theme echoed throughout Town Meeting, held in Bornstein Amphitheater on Dec. 1.

Among these challenges is the unusually high patient census BWH has experienced in recent months. While high volume is a testament to the quality of care at the Brigham, it can cause undue pressure on patient flow, requiring the use of Code Help and sometimes Code Amber to reduce the number of boarders in areas such as the Emergency Department (ED) and the Post-Anesthesia Care Unit (PACU), said Brigham Health President Betsy Nabel, MD.

“We’ve been very busy this fall, and that is a real sign of confidence that patients have in the care we deliver,” Nabel said. “But that also presents a challenge for us: We must continue to deliver safe, exceptional care every day, including when we have high occupancy rates.”

While there are long-term plans to build a new inpatient tower at 45 Francis St. to accommodate a greater number of patients, that is still several years away, Nabel explained. A more immediate solution is needed to optimize our existing resources, she added.

Charles Morris, MD, MPH, associate chief medical officer, and Eric Goralnick, MD, MS, medical director of Emergency Preparedness and the Brigham Health Access Center, announced a new initiative launching in January to address these challenges. Every weekday at 9 a.m., clinical staff and members of the senior leadership team will gather for a daily safety huddle. These focused meetings will provide an opportunity to proactively identify obstacles to managing patient care in a safe, timely manner.

“It’s a chance to increase the situational awareness of where we are each day at an institutional level,” Morris said. “At the same time, we’ll be able to do near real-time problem-solving so that we can get patients the care they need.”

At the heart of these efforts is greater communication at all levels, said Ron M. Walls, MD, executive vice president and chief operating officer.

“We need to learn from providers on the front lines – and not just people at the bedside but also those registering or transporting patients. We need all of your ideas about what things we can fix, and we’re very committed to fixing them,” Walls said.

Identifying Efficiencies

In addition, a project is underway in the ED to double its size – adding 30 patient rooms, larger trauma bays, a second CT scanner and areas dedicated to oncology and behavioral health patients.

During the question-and-answer portion of Town Meeting, one BWHer asked how the ED expansion will affect wait times and boarder volume without a concurrent expansion of inpatient beds in the short term. Walls explained that a redesign of BWH’s care continuum management program – a blend of care coordination and utilization management – is underway to better support both the ED and inpatient areas as well as imaging, transport, procedural areas, operating rooms and more.

“We know that we don’t have space to accommodate additional patients in the beds that we have, nor can we ask people to work any harder because it is plain to see how hard everyone works here,” Walls said. “Our goal is to provide teams with the support they need to be more effective, efficient and empowered to identify solutions.”

Community hospitals will also play an important role in streamlining patient flow.

Goralnick explained that the Access Center, launched earlier this year, provides a centralized system to facilitate timely, safe patient transfers across Brigham Health. Part of its goal is to identify which transfer requests from referring hospitals can be safely directed to community hospitals like BWFH or Newton-Wellesley Hospital. This improves access to care for more tertiary and quaternary patients at BWH.

“The idea is to find the right bed for each patient to support the best care,” Goralnick said.

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

‘An Unbreakable Bond’: BWHers Partner with Indian Health Service Providers

From left: Hanni Stoklosa, Mardi Chadwick, Annie Lewis-O’Connor, Jacqueline Savage Borne and Jessica Loftus

For several BWHers, including Srini Mukundan, MD, PhD, of the Department of Radiology, being able to work with care providers at Northern Navajo Medical Center in Shiprock, N.M., and Gallup Indian Medical Center in Gallup, N.M., through the Brigham and Women’s Outreach Program with Indian Health Service (IHS) has been an educational and transformative experience they will always cherish.

Mukundan, who has trained IHS staff on-site in Shiprock and remotely from BWH, said his experiences with the program provide an antidote to burnout and remind him why he chose this path in medicine.

“The Outreach Program opportunities have been one of the greatest rewards of being a BWHer,” Mukundan said. “After meeting the wonderful patients and witnessing firsthand the work of our remarkable colleagues at Shiprock, it is clear how important the essence of the physician-patient relationship is, especially in light of the limited resources available in Shiprock.”

Since 2009, BWHers have collaborated with the Navajo Area IHS – the federal agency responsible for delivering medical and public health services to members of federally recognized Native American tribes in the region. Through the Brigham and Women’s Outreach Program with IHS, BWH faculty, nurses, trainees and other providers volunteer their time and expertise to provide specialized care and training – on the ground at IHS hospitals and through remote teaching – in rural New Mexico and Arizona.

Advancing Care

Over the past year, BWHers across multiple disciplines have helped establish critically needed and sustainable services that would have otherwise been unavailable in these resource-poor areas.

Earlier this year, a BWH team traveled to Shiprock to teach IHS staff about human-trafficking in addition to screening and intervention strategies for domestic violence in the health care setting. Because of that visit, a BWH/IHS Trauma-Informed Care working group has been established with the goal to implement a trauma-informed care model in Shiprock by late 2018.

“During our time there, I learned new things from my Brigham colleagues as well as from the IHS staff. The whole experience challenged me to think more broadly about my interactions here with patients in the Emergency Department,” said Hanni Stoklosa, MD, MPH, an attending physician in the Department of Emergency Medicine and a member of the Division of Women’s Health, who trained IHS staff in human-trafficking awareness.

Annie Lewis-O’Connor PhD, MPH, NP, director of the C.A.R.E. Clinic and a member of the Division of Women’s Health, provided staff with techniques for incorportating trauma-informed care into practice, emphasizing the need for self-care, patient autonomy and meeting patients where they are at.

Also on the team was Jacqueline Savage Borne, LICSW, hospital program manager for the Passageway program in the Center for Community Health and Health Equity, who said working with the program was a professional dream fulfilled.

“The providers at Shiprock are so deeply committed to holistic, trauma-informed care for their patients,” Savage Borne said. “The resiliency in this community and its network of care providers is nothing short of inspiring.”

The collaboration between BWH and IHS providers results in dramatic, lasting improvements in care. Because of the radiology training provided by Mukundan, a neuroradiologist and medical director of Magnetic Resonance Imaging at BWH, along with other faculty members and house officers from the Department of Surgery, Shiprock providers are now able to screen patients for stroke based on head CT scans. Prior to this, they had no ability to provide this service.

Also in the works is a live, interactive remote video-training program to license IHS clinicians to be able to administer buprenorphine, a medication to treat opioid use disorder. Joji Suzuki, MD, director of the Division of Addiction Psychiatry, provides the same training in Boston and will lead the new remote course. Such support is needed to help IHS clinicians combat the opioid crisis in their remote and resource-poor communities.

“I have a lot of respect for the clinicians in IHS. I have visited and taught remotely, and I’ve seen firsthand how they work under very difficult conditions due to their limited resources,” Suzuki said. “I’m pleased we’ll be able to help them have access to training that would have otherwise not been readily available.”

Thomas Sequist, MD, MPH, a primary care physician in the Phyllis Jen Center for Primary Care and medical director of the Outreach Program with IHS, said he believes the Outreach Program is a vital resource for the region.

“Access to specialty care services is particularly challenging in more rural parts of the country, often limiting the treatment options for patients in these areas,” said Sequist, who also serves as chief quality and safety officer at Partners HealthCare. “We are extremely proud of the work of our BWH clinical community – physicians, nurses and other staff working together to fill important gaps in care. This work is built on the premise of establishing long-lasting relationships that represent a sustainable approach to delivering advanced and high-quality care in these native communities.”

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

From Visits to Visas, IPC Helps International Patients Navigate Care

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 Celebrates Achievement of Comprehensive Stroke Center Certification

From left: Ali Aziz-Sultan and Steven Feske

The Stroke and Cerebrovascular Diseases Center received advanced certification as a Comprehensive Stroke Center from The Joint Commission and the American Heart Association/American Stroke Association on Nov. 15. This highly selective designation – awarded to only a small fraction of institutions in the U.S. – recognizes hospitals that meet the standards to treat the most complex stroke patients.

“This certification reflects our ability to care for these patients from the moment they come into our ED until they are discharged from our specialized unit,” said Linda Bresette, DNP, NP-C, director of the Brigham Health Stroke Program. “Our highly trained, multidisciplinary staff worked together to showcase how our stroke patients receive advanced, individualized care that’s grounded in science and delivered with compassion.”

To become certified, BWH underwent a rigorous on-site review by Joint Commission experts who evaluated all aspects of complex stroke care. This includes the initial assessment, treatment protocols, advanced imaging, and state-of-the-art facilities for urgent intervention and intensive care. The certification reflects that BWH meets advanced standards of stroke care and has provided evidence of successful performance on more than 18 quality measures. All BWH clinicians demonstrated advanced education and competency.

“This certification recognizes our multidisciplinary team of specialists who deliver the best in stroke care. It acknowledges our advanced diagnostic and treatment capabilities, and allows us to provide the most comprehensive medical, interventional and surgical therapies,” said Steven Feske, MD, chief of the Division of Stroke and Cerebrovascular Diseases and medical director of BWH’s Comprehensive Stroke Center.

Stroke is the fifth-leading cause of death and a leading cause of adult disability in the U.S., according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

To improve outcomes for stroke patients, BWH provides pre-arrival evaluation and treatment planning, accelerating treatment for patients transferred to BWH for advanced stroke care. The center also offers remote physician consultations via telemedicine. Once at the Brigham, patients receive rapid assessment by expert clinicians who have access to neuro-interventional suites and a dedicated neuroscience intensive care unit. Additionally, BWH researchers investigate groundbreaking approaches to stroke management in several national clinical trials.

“Stroke is a life-threatening emergency, and the greatest chance for recovery from stroke occurs when treatment is started immediately after the onset of symptoms,” said Ali Aziz-Sultan, MD, Neurosurgical director of BWH’s Comprehensive Stroke Center. “Newer stroke therapies offered at BWH, such as endovascular treatments, can rapidly reestablish blood flow and restore patients’ health.”

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

Magnet Matters

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