Posts from the ‘highest-quality safe care’ category

When a major flood caused by a burst pipe forced the closure of the labor and delivery and neonatal intensive care units at Boston Medical Center (BMC) temporarily last year, the Brigham and several other hospitals stepped up to ensure patient care remained the priority.

During a Quality Rounds presentation in Bornstein Amphitheater last month, BMC clinicians spoke about the flood and reflected on the disaster response and lessons learned. 

A critical piece to the emergency plan for BMC was the safe and timely transfer of patients out of the affected units to area hospitals, including the Brigham, for care. At the end of Quality Rounds, the Brigham was presented with an award from BMC in recognition of the assistance staff provided during the flood incident. 

Karen Fiumara, PharmD, BCPS, executive director of Patient Safety at Brigham Health, said the Brigham teams that responded to this challenging situation were “nothing short of remarkable.” 

“While continuing to safely care for their existing patients, they welcomed this group of BMC patients and their loved ones to the Brigham with open arms and provided them with exceptional care,” Fiumara said. “This was one of those amazing stories that makes you proud to be part of the Brigham community.” 

Katherine Gregory, PhD, RN, associate chief nursing officer for the Mary Horrigan Connors Center for Women and Newborns, echoed Fiumara’s thoughts.

“The Brigham comes together in a crisis like no other, and we care—not only about our patients but also those across the city and region,” she said. “It was our privilege to care for the women and newborns who were affected by the BMC flood last year, and we stand ready to serve if called upon by our obstetric and newborn colleagues again in the future.”

La’Lena Etheart BSN, RN, PCCN and staff

From left: Nina Jordan, La’Lena Etheart, Michelle Lafferty and Reba Dookie

I recently went back to school for my master’s degree in Nursing Administration. I had to design a brochure as part of an assignment, and I decided to make a brochure about hand hygiene and preventing the spread of infection. I thought of the idea to have real nursing staff in my visuals, and my amazing coworkers on Shapiro 9/10 were more than willing to help! This picture is the cover photo of my brochure, which was titled “The Power Is in YOUR Hands!”

La’Lena Etheart BSN, RN, PCCN
Nurse in Charge, Shapiro Cardiovascular Center 9/10

From left: Ann Cook, a patient on the frailty pathway, speaks with Lynne O’Mara on Tower 8B.

Older patients face a unique set of health challenges – including chronic fatigue, low muscle mass, cognitive impairment, bone fractures and reduced mobility – that can raise their risk of illness or injury during hospitalization.

Launched in 2016, the BWH Frailty Identification and Care Pathway is a multidisciplinary program addressing these challenges by providing clinicians with standardized guidelines for identifying and accommodating frailty – a complex, often age-related syndrome characterized by physical decline and increased vulnerability to stressors.

“Frailty and cognitive impairment are often key contributing factors in falls and accidents that lead to fractures and other injuries among older patients presenting in our Emergency Department,” said Zara Cooper, MD, MSc, FACS, of the Division of Trauma, Burn and Surgical Critical Care. “We believe that focusing on these underlying conditions is essential to optimizing the care and outcomes of these patients.”

Physician assistant Lynne O’Mara, PA-C, of the Department of Surgery, was one of many BWHers who played a key role in implementing the pathway in the Emergency Department (ED) and the Surgical, Burn and Trauma Intermediate Care Unit on Tower 8ABCD. Part of a multidisciplinary team that sought to identify and remove barriers to care for older patients, O’Mara worked closely with Cooper and Samir Tulebaev, MD, of the Division of Aging and Center for Older Adult Health, to create order sets for the pathway.

The Frail Scale

At the heart of the initiative is an assessment tool known as the “frail scale,” which is used to screen for frailty in patients over the age of 65 when they arrive at the ED. In the frail scale, “frail” also functions as an acronym, with each letter representing the constellation of symptoms and conditions that may indicate frailty. Patients are considered frail if they meet three or more of these criteria:

  • Fatigue (“Are you fatigued?”)
  • Resistance (“Can you climb one flight of stairs?”)
  • Ambulation (“Can you walk one block?”)
  • Illnesses (“Do you have more than five illnesses?”)
  • Loss of weight (“Is your weight loss greater than five percent?”)

It’s important to recognize these risk factors early because frail patients are more likely to experience negative health outcomes, including increased rates of morbidity, obesity and trauma, O’Mara explained.

In addition to the normal effects of aging, a patient’s circumstances at home may contribute to or worsen their frailty, O’Mara said. For example, a patient might have poor muscle mass because they’re not eating, and they might not be eating because they’re on a fixed income and don’t have the financial means to purchase food. While such challenges are not unique to frail patients, understanding this context is key to helping these patients recover smoothly, avoid injury, discharge safely and reduce readmissions, O’Mara said.

During hospitalization, frail patients are also at greater risk of experiencing delirium, an acute state of confusion that is separate from dementia. Patients who experience delirium may try to pull out their IV lines or attempt to get out of bed when they cannot safely do so, leading to a secondary injury, O’Mara said.

The frailty pathway includes standardized ways to prevent, assess for and treat delirium. Since implementing these measures, the rate of delirium has decreased by a remarkable 50 percent among patients over 65 on Tower 8ABCD. The mortality rate for the same population has dropped by 30 percent, and complications have decreased by 47 percent.

“Our main goals when we first started the pathway were to prevent delirium and preserve function for these patients, which we have since been able to achieve,” O’Mara said.

Standardizing Care

Once a patient is screened and meets the criteria for frailty in the ED, providers enter a set of admission orders to standardize the care for each patient on the pathway. Within 72 hours, the patient receives a comprehensive geriatric assessment, which includes an evaluation of medical conditions, cognition, function, nutrition, emotional status and risk for delirium, with a geriatrician, and a nutritional assessment with a nutrition consultant. This information is detailed in the patient’s electronic medical record to ensure a safe transition of care.

On Tower 8ABCD, care teams work closely with patients on the pathway to ensure they eat, get out of bed, have bowel movements and perform other self-care tasks on a routine basis.
O’Mara said collaborating with her colleagues to develop and implement the pathway – and ultimately achieve better outcomes for patients and their families – has been extraordinarily fulfilling.

“I really enjoy the personal interaction with the patients,” she said. “I like having that one-on-one time to talk with them on the floor, meet their families, discuss their diagnoses and create a personal care plan. You really become part of the patient’s family for a couple of days.”

Reiterating the importance of the frailty pathway’s multidisciplinary model, O’Mara has engaged both staff and trainees in the program. To date, she has trained 70 residents on the pathway, and she continues to offer ongoing training for new residents and providers.

“The pathway has brought the entire trauma floor together and has gotten me really excited about geriatrics,” O’Mara said.

Brigham Health’s Strategy in Action: Highest-Quality, Safe Care
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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
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Quality care often hinges on effective communication with patients and loved ones engaged in their care. But in a high-stress environment such as the intensive care unit (ICU), it can be a difficult and daunting task for some patients to articulate their needs and assume an active, collaborative role in their care plans.

Patricia Dykes, PhD, RN, a senior nurse scientist in the Center for Patient Safety, Research and Practice and the Center for Nursing Excellence, is lead author on a paper published in the August issue of Critical Care Medicine that describes how to improve communication in the ICU through the use of web-based tools.

Using an approach called PROSPECT (Promoting Respect and Ongoing Safety through Patient Engagement Communication and Technology), Dykes and her team implemented a safety checklist with real-time data from patients’ electronic health records (EHRs) that providers review during patient rounds. In addition to the checklist, there is also a messaging platform for patient and care team communication, as well as an online portal where patients can input feedback on their care plan. Patients who could give informed consent (or their proxy) were given access to the portal through a hospital-issued iPad by their bedside, encouraging them to engage in development of their care plan.

Clinicians involved with the intervention in two ICUs were trained in patient-centered care and engagement and learned how to use the web-based tools. The researchers compared patients’ experience and outcomes before and after the intervention. The team studied both patients and their “care partners” – family and friends involved in the patient’s care.

The results were encouraging – adverse events fell by 29 percent, driven primarily by a drop in catheter-associated urinary tract infections and pressure ulcers. Additionally, the researchers observed improvements in both patient and care partner satisfaction scores. Surveys measured each party’s overall satisfaction with care provided before and after the intervention, as well as specific elements of care, such as staff responsiveness and decision-making processes.

Participants in the study praised the initiative for empowering patients and their families with better tools for communicating with care teams and accessing information about quality and safety.

Although researchers were unable to determine which specific tools accounted for the improvements, they believe daily use of the electronic checklists (instead of paper safety checklists) played an important role.

“Using web-based technology to enhance tools such as the ICU safety checklists has a meaningful impact on improving care quality,” said Dykes. “With updated, patient-specific information pulled from patient EHRs, clinicians can make more informed decisions. As the checklists are reviewed daily, frontline providers become more focused on the patient’s care plan, routinely asking and addressing the care preferences and goals of the patients, enabling patients to better engage in their care.”

Based on their preliminary results, the team plans to expand the use of the web-based checklist to other ICUs in BWH and Brigham and Women’s Faulkner Hospital.

Brigham Health’s Strategy in Action: Highest-Quality, Safe Care
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Inside the newest wing of BWH’s neonatal intensive care unit (NICU), Emily Chang began to decorate her son Bennett’s space so it felt more like home. She taped a small poster on the wall above his crib that included photos of Bennett over the course of his almost 90-day stay in the NICU.

Chang said moving into the new NICU on April 11 felt like a “breath of fresh air.” She thanked her son’s care team for all they’ve done to care for Bennett and for making his transition a smooth one.

“Our care team in the NICU has treated Bennett like he’s one of their own children,” Chang said. “The care Bennett has received at the Brigham has been top-notch. This hospital is very invested in ensuring patients get the best care possible.”

Bennett was among the 19 infants and their families who moved into the newly expanded NICU as their beds were relocated during the second phase of the unit’s transformation earlier this month.

The NICU is being renovated and expanded in three phases to provide state-of-the-art care for premature and sick infants who are admitted to BWH. The project began in July and is expected to conclude in December.

During the second phase, two areas were expanded. Nine beds in the intensive care unit (ICU) opened, as well as 13 beds in the Growth and Development Unit (GDU), with one being an overnight room for parents. The design of the Brigham’s NICU is suited to babies’ changing developmental needs as they grow; the GDU provides the most therapeutic environment for infants who are beyond the acute medical stage.

Construction for the project’s final phase began this month; it will result in seven more GDU beds and 10 additional ICU beds.

During last week’s move, babies were transported one at a time, with teams of staffers guiding each crib or isolette to the new unit, located across the hall on the sixth floor of the Connors Center for Women and Newborns.

Carmina Erdei, MD, medical director of the GDU and a neonatologist in the Department of Pediatric Newborn Medicine, commended the multidisciplinary team involved in ensuring a smooth and efficient move-in day.

“The families and the staff were overjoyed, as this wonderful, new space offers rich opportunities for family-centered developmental care,” Erdei said. “The new GDU will help staff provide the best care not only to infants, but also to their families.”


Brigham Health’s Strategy in Action: Highest-Quality, Safe Care
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Nawal Nour shares her personal and professional reflections as a Sudanese-American physician.

Nawal Nour shares her personal and professional reflections as a Sudanese-American physician.

Mustapha Khiyaty is grateful to be part of BWH’s diverse community, knowing that everyone here – regardless of race, religion or ethnic origin – is valued for who they are as a person and for their role at the Brigham. A supervisor in Materials Management and a Muslim, Khiyaty said it hurts knowing that many colleagues and their loved ones who have been affected by the recent executive order do not feel as secure.

On Feb. 3, Khiyaty spoke at a gathering convened by hospital senior leaders and hosted by Spiritual Care Services and the Office for Multicultural Careers in Bornstein Amphitheater. The gathering reinforced the values embedded at Brigham and Women’s Hospital: BWH welcomes patients, family members, employees and visitors from all backgrounds, ethnicities and religions, regardless of age, gender, sexual orientation or country of origin.

“It does my heart good and brings me joy to see so many of you here today,” said Kathleen Gallivan, PhD, director of Spiritual Care Services. “We know this is a very difficult time for our community, for our country and for the world. We want to emphasize that the Brigham’s doors are always open to everyone.”

During the gathering, BWHers listened to brief readings from several religious traditions and heard from colleagues, including Khiyaty, who offered messages of hope and unity.

“I was born in and grew up in a Muslim country,” said Khiyaty, who is originally from Morocco. “I’m glad to be Muslim and Moroccan-American, but I’m a human first. I’m so grateful that I can sit among all of you today and know that I am not alone. Thank you for all of the support for humanity.”

Nawal Nour, MD, MPH, director of the BWH Ambulatory Obstetrics Practice, founder of the African Women’s Health Center and faculty director of the Office for Multicultural Careers, shared reflections as a Sudanese-American on what it has been like to care for immigrant women who are feeling the effects of the executive order.

Nour said many of her pregnant Muslim patients have struggled with the idea of removing their headscarves and veils, also known as the hijab, when they are out in public because they feel as though they are treated differently or at risk of violence. She encouraged her colleagues to take the time to explicitly reassure patients that the Brigham’s commitment to their health and to them, as individuals, is our top priority.

“The Brigham, and in particular the African Women’s Health Center, has worked hard to achieve the current level of culturally competent care that we offer to our patients,” Nour said. “I tell people, ‘Let’s just smile. Smile at everyone you see. Smile even more when you see a woman with a hijab; she needs it. She wants and needs to feel safe and secure.’”

At the conclusion of the gathering, Ron M. Walls, MD, executive vice president and chief operating officer of Brigham Health, emphasized how important it is to support one another and welcome everyone who walks through our doors.

“This ban may affect how we are seen as a country, but it doesn’t change how we should see our country or how we should see each other,” Walls said. “Remember in your heart that we are what we are. We have believed what we believe at the Brigham since the day of our founding. We have never wavered on that, and we will never waver. Welcome everyone. Love one another. That’s the Brigham Way.”

From left: A young patient at Southern Jamaica Plain Health Center is cared for by Regina Harvey and Erica Santiago.

From left: A young patient at Southern Jamaica Plain Health Center is cared for by Regina Harvey and Erica Santiago.

High-quality care encompasses a broad range of priorities: meeting and exceeding clinical standards, maintaining excellence, providing an exceptional patient experience and helping achieve better outcomes. To reaffirm the Brigham’s commitment to these areas, BWH is seeking Magnet designation, which honors an institution for quality patient care, clinical excellence and interprofessional collaboration.

“Magnet designation has become a trusted symbol of excellence in patient care nationally and internationally,” said Betsy Nabel, MD, president of Brigham Health. “It’s meaningful to patients and family members who are deciding where to receive care, as well as to prospective employees who are looking for a hospital that stands out among its peers.”

While the Magnet Recognition Program’s roots are in nursing – the program is run by the American Nurses Credentialing Center (ANCC) – it honors the work and culture of an entire institution. BWH’s next step in the process occurs April 1, when a team from Nursing and Patient Care Services will submit an application package consisting of 75 examples that illustrate how the hospital meets or exceeds each of the 49 standards in the Magnet model.

Examples of the evidence BWH is submitting include the development and implementation of a falls prevention toolkit, a program at the Southern Jamaica Plain Health Center designed to educate patients about diabetes self-management and improve health outcomes, and “Goals for the Day, Goals for the Stay” cards used on Tower 14 ABCD to document the patient’s goals and ensure all staff are aware of them.

“The evidence for Magnet has become increasingly powerful. The quality of patient care, nursing excellence, innovations in professional practice and interprofessional collaboration are all much stronger in Magnet-designated hospitals,” said Mary Lou Etheredge, MS, RN, PMHCNS-BC, executive director of Nursing Practice Development, interim associate chief nurse for medical nursing and BWH co-program director for Magnet.

Only 8 percent of hospitals in the U.S. are Magnet-designated, with three in Boston (Massachusetts General Hospital, Dana-Farber Cancer Institute and Boston Children’s Hospital). The Joint Commission considers Magnet as a way to provide consumers with benchmarks to measure quality of care, and U.S. News & World Report uses the designation as a primary competence indicator to rank the best medical centers.

“We’re excited about continuing the journey toward obtaining Magnet designation, as it will help us demonstrate and confirm what we know to be true here at BWH: that our care and quality are unsurpassed,” said Chief Quality Officer Allen Kachalia, MD, JD.

At the core of the Magnet model is a focus on outcomes: evidence illustrating the impact of structures and processes on patients, families, staff, the organization and the community.

“It’s not just that you have good structures and systems in place, but that you also have the outcomes to prove that you have a low fall rate or that you have a low rate of hospital-acquired pressure ulcers, for example,” said Rosemary O’Malley, MSN, MBA, RN, associate chief nurse for the Emergency Department, Neurosciences, Orthopaedics, Gynecology, Central Resources and Strategic Practice Initiatives, and BWH co-program director for Magnet.

Following submission of the evidence this spring, BWH will be notified three to six months after acceptance whether the hospital has been selected for a site visit. If selected, BWH will receive dates for a site visit. During the visit, appraisers from the ANCC will speak with employees, patients and families about the quality of care provided at the Brigham. One to two months after the site visit, the ANCC Commission on Magnet will decide whether BWH has achieved Magnet designation.

StrategyIcon_WordpressBrigham Health’s Strategy in Action: Highest-Quality, Safe Care
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bh_bwh_pms_293Brigham Health was unveiled earlier this week as the new name for the parent organization that includes Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and the Brigham and Women’s Physicians Organization. All three entities will retain their individual names and identities. Brigham Health replaces Brigham and Women’s Health Care (BWHC). 

Brigham Health President Betsy Nabel, MD, discusses with BWH Bulletin what this change means for us. 

Why did we change from BWHC to Brigham Health?

Nabel: Those who know the Brigham think of it as a top-tier New England hospital – a place to go for care when needed, especially complex procedures. But according to market research, many outside of New England assume we are solely a women’s hospital. And while we are certainly a leader in women’s health care, we want to be sure it’s clear that our excellence and expertise extend to so many other areas. Brigham Health reinforces that we are not just one point on a map, or even a single point of discovery.

The new name eliminates some of the confusion we have found among those outside of New England. Talking about the services of BWH, BWFH and the BWPO as simply Brigham Health will enable us to more effectively reach people who are seeking health information, referrals and care.

How does this change fit into our strategy?

Nabel: This change is a vital component of our institutional strategy. For example, one of our strategic priorities is to improve health. In addition to providing highly specialized care in the hospital and ambulatory settings, we also must engage people around the world as we promote health and wellness and concentrate on preventing disease in populations.

Another example is twofold. By building national and international lines of business, we reinforce our financial strength and advance our work in business development – two areas essential to guaranteeing we continue delivering on our mission.

Why was the name Brigham Health selected?

Nabel: Brigham Health reflects our role as a leader in maintaining and restoring health around the world, encompassing all that we do in delivering care, advancing scientific discovery and educating the next generation of health care professionals. It broadly defines everything we do today and provides a new platform for amplifying our commitment to what everybody desires: health.

For more Brigham Health information and resources – including an FAQ, downloadable logos and presentation templates – visit

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From left: Nurse practitioner Lara Coakley listens to patient Amy Prince’s heart during a recent appointment.

From left: Nurse practitioner Lara Coakley listens to patient Amy Prince’s heart during a recent appointment.

On an almost weekly basis, Mandeep R. Mehra, MD, medical director of BWH’s Heart and Vascular Center, can count on receiving a certain type of email in his inbox. It contains a photo shared by a smiling patient who is now enjoying life after receiving a ventricular assist device (VAD) at BWH to treat end-stage heart failure.

Celebrating the success of these patients, some of whom previously relied on support for mobility due to a weak heart, is just one example of the commitment to patient-centered care in BWH’s VAD Program. That culture, as well as excellence in safety and quality of care, earned the program a recertification of accreditation from The Joint Commission (TJC) last month – the 30th successful review since 2009.

“What I’m most proud of is the absolute diligence to patient-centered care by our team,” Mehra said.

From left: Patient Amy Prince practices hooking up a backup VAD device, with help from BWH nurse Krysten Montoya and Amy’s father, Don Prince.

From left: Patient Amy Prince practices hooking up a backup VAD device, with help from BWH nurse Krysten Montoya and Amy’s father, Don Prince.

During its most recent review, TJC surveyors referred to BWH’s VAD Program as “a poster child” in the field. Surveyors applauded the program’s comprehensive clinical and nonclinical services, supported by the highest-quality specialists for each role.

“It is obvious this is very much a vested team whose actions speak louder than words,” according to one TJC surveyor. “Your patients and families speak very highly of you all.”

While Amy Prince, 42, of Maine, was recently recovering from surgery after receiving a VAD implant, the seamless coordination among her providers and their compassionate care left a lasting impression on her and her parents, Don and Jeanne Prince. Seeing Amy’s nurses stay after their shift ended to ensure a safe handoff as the next nurse came on duty was one of many acts that made the family feel more at ease during a stressful time, Don said.

“The way they orchestrated each team was amazing to see,” Jeanne said. “There was a willingness of everyone to help no matter what the task was, and people just stepped up. I didn’t perceive it as them just doing their job.”

Amy agreed, recalling that her care providers made her feel empowered to ask questions or address concerns.

“That was huge. They were always happy, friendly and knowledgeable,” Amy said. “Everyone here genuinely cares.”

Multidisciplinary teamwork among the program’s clinical and nonclinical staff – the latter of which includes roles such as financial counselors and equipment managers – is vital to improving the lives of VAD patients, said Michael M. Givertz, MD, medical director of BWH’s Heart Transplant and Mechanical Circulatory Support Program.

“Patients with end-stage heart failure have different challenges, so their care is often highly individualized,” Givertz said. “That requires a team with the capability of providing a high level of care while also being able to focus on a patient’s specific needs – whether those are medical, surgical, psycho-social, nursing-related or nutritional.”

Taking a holistic approach to caring for VAD patients is essential, agreed Lara Coakley, FNP, an outpatient nurse practitioner. That means not only monitoring a patient’s recovery from surgery, but also providing education on self-care and checking in on their home life, sleeping habits and exercise routines.

“We look for ways we can make improvements in their total care – not just their cardiac care,” said Coakley, who sees patients at BWH’s Watkins Cardiovascular Clinic, as well as at Spaulding Rehabilitation Hospital and remotely via video conferencing.

Looking ahead, the program aims to reduce morbidity, shorten patients’ length of stay and serve more patients, Givertz said. Improved quality of life and functional capacity are also key to optimizing VAD care, he added.

“With our new surgical director, Dr. Steve Singh, there’s growing excitement about the outcomes we’ve been able to achieve and, given the size of this team, the bandwidth we have to offer this type of therapy to greater numbers of patients,” Givertz said. “In addition, the Brigham remains at the forefront of innovation in VAD technology, which will continue to drive the field forward.”


StrategyIcon_WordpressBWHC’s Strategy in Action: Highest-Quality Safe Care
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Ayesca Machado displays the flu shot sticker on her ID badge.

Surrounded by toddlers all day at the child care center where she once worked, Ayesca Machado thought she ought to get the flu shot so that she wouldn’t be sick around the children.

A week after getting the vaccine, though, she got sick. It didn’t feel like the flu, but it was a lot worse than the sniffles, she recalls. Machado, like many people, came to believe the myth that the flu vaccine caused the flu.

“I was like, ‘Nope, I’m done. I’m not doing that again,’” Machado said.

But when she started an internship with BWH’s Department of Quality of Safety this past January – and saw how important the flu vaccination program was at the Brigham – she opened her mind to revisiting her position on the flu shot. Machado sat down with a nurse practitioner in Occupational Health Services and shared why she was reluctant to get vaccinated against the influenza virus. Learning the facts about the flu vaccine compelled Machado to reconsider.

“She explained to me that a couple different scenarios could have happened. For example, I could have already had the flu virus,” said Machado, now a practice assistant at BWH’s Orthopaedic and Arthritis Center. “She just put my mind at ease.”

Machado got her flu shot in January, and she just got vaccinated again in September for this flu season. The result: “Other than a sore arm for a couple of days, I’m fine,” she said.


Mayra Guerrero de Rosario, of Environmental Services, gets ready to receive her flu shot from nurse practitioner Coleen Caster.

The flu vaccine contains no live viruses, making it impossible to transmit the flu. In fact, the Centers for Disease Control and Prevention say that getting the flu shot may make your illness milder if you do get sick.

In addition, the protective effects of the flu shot don’t kick in until about two weeks after being vaccinated. This gap means it’s possible to get the flu before the vaccine has had enough time to provide protection. For this reason, the sooner you receive a flu shot, the more likely you’ll be protected from the virus.

Still, 25 percent of BWHers who declined to get vaccinated last flu season made that decision based on their belief that the flu vaccine can cause the flu or made them sick in the past.

Flu vaccination rates at the Brigham hit their highest levels ever last year, with 90 percent of BWHC staff receiving the vaccine. BWH is aiming for an even higher rate for the 2016-2017 flu season to further improve patient safety and protect all members of the BWH community from the spread of disease.

Among those who declined to receive the vaccine for the 2015-2016 flu season, the most common reason given during the attestation process was grounded in another myth: that they didn’t need a flu shot or never get the flu (37 percent). However, no one is immune to the influenza virus. Infectious disease experts say that not having had the flu previously doesn’t mean you have an innate resistance to the virus.

Mark MacMillan, grants administrator in the Center for Excellence in Vascular Biology, acknowledged he used to be one of those people who thought he could never get the flu. Eventually, he did – and has been getting an annual flu shot ever since.

“After enduring a fever that got to 104 degrees and symptoms that had me flat out for a few days, I came to understand two things,” he said. “One, at the risk of sounding hyperbolic, I understood that people have died and still can die of influenza, and two, if possible, I never want to go through that again and will do anything to prevent it.”

Similarly, Machado decided that getting vaccinated each year was something she could do to help ensure patients receive care in the safest environment possible.

“Working in a hospital, you should be aware not only of yourself but also the patients you come in contact with. Even if you’ve never gotten the flu or if you believe that it wouldn’t be so bad if you did, it could be much worse for a patient,” Machado said.

Learn more about how you can get your flu shot and about BWH’s flu vaccination policy at

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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From left: Saima Aftab, Raghu Seethala, Rita Patnode, Michael Prendergast, Karen Griswold, Robert Fine, Janet Gorman, Peter Stone and Claire McGowan

From left: Saima Aftab, Raghu Seethala, Rita Patnode, Michael Prendergast, Karen Griswold, Robert Fine, Janet Gorman, Peter Stone and Claire McGowan

A young child has an allergic reaction while visiting a grandparent who is a patient in the Shapiro building. A new mother in the Connors Center for Women and Newborns cries for help when she sees her baby has a blocked airway. These are some of the medical emergencies that would trigger a Code Blue and, until recently, prompt several different code teams made up of physicians, nurses and other staff to respond—not all of whom specialize in pediatrics or have experience working together.

Although BWH is not a pediatric hospital, some of its visitors and patients are children and infants. And none of them are immune to experiencing a medical emergency within the hospital’s walls.

Recognizing this, the Brigham launched two new code teams on Sept. 1: one dedicated to Code Blue emergencies involving newborns, with the other specializing in children under 15 who are visitors or receiving outpatient care on the Brigham’s main campus. These teams, available 24/7, join the existing Code Blue teams that respond to adult patients and the Code Blue Obstetrics team.

“Even though the likelihood of a pediatric emergency happening is very low, we want to be prepared because we care for everyone who walks through our doors—regardless of their age or whether they are a patient or visitor,” said Saima Aftab, MD, a neonatologist in BWH’s Neonatal Intensive Care Unit (NICU), who worked on the multidisciplinary task force that helped develop the new code teams.

Prior to this, several teams would respond when a Code Blue was called: the adult code teams, a specialized Code Blue Obstetrics team and an internal NICU code team for newborn emergencies in the Connors Center’s inpatient areas.

“We worked with these existing teams to establish tailored responses for younger patients and visitors that will enhance the safety of all of our patients, visitors and staff,” said Karen Griswold, RN, MBA, CPPS, lead program manager for Patient Safety.

Code Blue Pediatrics Response

The ED Code Team and the NICU Code Team are combining their expertise to respond to medical emergencies for children under the age of 15 who are visitors or receiving outpatient care at BWH. The two teams trained together in the BWH’s Neil and Elise Wallace STRATUS Center for Medical Simulation for several months to get comfortable with responding to emergency situations together before being called to a real-life emergency involving a child.

“The teams worked through multiple scenarios that were posed to them in the simulation center, and some great learning came out of it,” said Griswold. “Everyone is focused on doing the best thing for the patient, and that really shined through as they worked through the various scenarios.”

The STRATUS Center offered a safe but realistic environment that helped the two teams identify the best roles for various members of the code teams, said Raghu Seethala, MD, of Emergency Medicine, who was also part of the task force.

“These are two teams that function well, but didn’t have any prior experience functioning together, so we wanted to avoid  having ‘too many cooks in the kitchen’ and figure out the best way to integrate everyone,” Seethala said. “We have the infrastructure to care for every event here, but we had to get the right people in the room to formulate a plan to deal with these rare events.”

Calling a Code Blue: what’s Changing?

The only change to the process of calling a Code Blue will be a question from the operator about whether the patient is an adult, child or newborn so that the correct team is paged.  Call a Code Blue from anywhere on the main campus by dialing 617-732-6555.

Code Blue Newborn

When a mother requires care in the Shapiro Center or the Tower after delivery, her baby is usually brought to her unit to be with her.

If the baby had an emergency, staff on these units would previously call a Code Blue Obstetrics, bringing three code teams to the location: the NICU team, the Obstetrics team and the adult Medical code team.  “You may have 30 people show up, which sometimes made it difficult to coordinate,” Griswold said.

When a Code Blue Newborn is now called, only the six specialized members of that code team will respond. This ensures the other two code teams are available for emergencies elsewhere in the hospital and the right expertise is brought to care for the baby.

Although medical emergencies for children and infants are an uncommon occurrence in the Brigham—only a handful of events occur over a year—having a defined protocol will greatly reduce the risk of human error or logistical issues.

“We created this very highly specialized team that has a very clear-cut protocol,” Aftab said. “Instead of having to figure it out in an emergency situation, we now know exactly what to do.”

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From left: Gloria Oppen, NP, demonstrates the Peer-to-Peer flu vaccine program with her Occupational Health Services colleague, Dennisse Rivera.

From left: Gloria Oppen, NP, demonstrates the Peer-to-Peer flu vaccination program with her Occupational Health Services colleague, Dennisse Rivera.

Flu vaccination rates at the Brigham hit their highest levels ever last year, with 90 percent of BWHC staff receiving the vaccine. And as the hospital aims for an even higher rate for the 2016–2017 flu season to further improve patient safety, a task force of clinical and administrative leadership is trying to better understand what prevented the remaining 10 percent of staff from getting their flu shot.

Among those who declined to receive the vaccine for the 2015–2016 flu season, the most common reasons given during the attestation process were “don’t want/need, never get the flu” (37 percent) and that the “influenza vaccine can cause flu/made me sick in the past” (25 percent).

But both of these beliefs are common misconceptions, notes Deborah Yokoe, MD, an infectious disease expert, medical director of BWH Infection Prevention and Control, and member of the BWHC Flu Vaccination Task Force.

“A flu shot can’t give you the flu—it doesn’t contain any live viruses,” Yokoe said. “Even if you are generally super healthy, you can become miserably sick from the flu. In addition, even before you notice that you’re sick, you can pass the flu virus on to your co-workers, friends, family and our patients. Especially for people with chronic health conditions, influenza can be life-threatening. If for no other reason, you should be getting a flu shot every year so that you’re not spreading the flu unknowingly to others.”

This season’s flu vaccination policy remains the same as last year: Staff members who do not get a flu shot by Dec. 1 for any reason, including medical and religious reasons, must wear a surgical or procedure mask in patient areas for the duration of the flu season. Patient areas include not only clinical spaces, but also waiting rooms and family rooms.

‘The Flu Can Be Devastating’

Last season, physicians led with the highest rate of flu vaccination at 97 percent, followed closely by nurses at 94 percent. The research community came in below the overall average, with one in four—amounting to 740 BWHers—declining to receive a flu shot last year. But with the upcoming opening of the Brigham’s newest building at 60 Fenwood Road, research and clinical spaces will come into closer proximity, making it even more important for all members of the BWHC research community to get vaccinated.

Tanya Laidlaw, MD, director of Translational Research in the Division of Rheumatology, Immunology and Allergy, is both a researcher and clinician. As a pediatrician and immunologist, Laidlaw treats patients whose compromised immune systems leave them vulnerable to the flu, and she knows exactly how dangerous it can be if they come in contact with a person who has the virus.

“When a non-clinician pictures someone getting the flu, they might think of a bad head cold that can last for a day or two, but for some patients I see, the flu can be devastating,” said Laidlaw.

Elena Losina, PhD, MSC, co-director of BWH’s Orthopaedics and Arthritis Center for Outcomes Research (OrACORe) and her colleagues will move in the new building this fall. She says getting the flu shot is an annual routine, and that her group’s administrator also sends helpful reminders to the team about flu clinic dates and how to attest to receiving the flu shot.

“We’ll be working in the same building where patients are being seen and will be close to the flu clinics being held on campus—there really are no excuses,” said Losina.

For more details about this year’s flu vaccination policy, as well as dates of upcoming flu clinics, visit

StrategyIcon_WordpressBWHC’s Strategy in Action: Highest-quality, Safe Care
Learn more about our strategic priorities at