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The BMC Brief

The BMC Brief, Volume 7, Issue 6

June 27, 2018

Telesitting Program Helps Keep Patients Safe

All patients who come into Boston Medical Center are given the specialized care and attention they need, but some patients need more individual attention than others. In these cases, hospital sitters are employed to watch over patients who need extra attention, keeping them safe. Patients that need sitters include those who try to pull out their IVs or get out of bed against medical advice. At BMC, sitters are certified nursing assistants (CNAs), who work on every inpatient floor. While sitters have positive impacts for patients, there are also drawbacks to the system. That’s where a new program that employs telesitters comes in.

“When you have bedside sitters, it often means CNAs have to be pulled off the floor,” says Sheila Murphy, RN, a nurse in the IMCU who helps oversee the telesitting program. “This creates more work for nurses and leads to less satisfaction for both employees and patients. BMC was spending $4 million a year on sitters before,” says Murphy. “It wasn’t sustainable and it wasn’t a good use of resources. Telesitting can help put CNAs back on the floor, which leads to better patient safety and more patients getting the attention they need on the entire unit.” ”

The telesitting program reduces the number of bedside sitters needed by putting patients who need sitters on video, so fewer CNAs can watch more patients at one time. Currently, there are six to ten patients on video at a time, although they hope to get up to 12. Since telesitting launched two months ago, 150 patients have been part of the program. This has allowed BMC to return 1,168 CNA shifts to the floor, which means that there are more people available to help with all patients.

Patients who are confused, are fall risks, and are elopement risks (at risk of walking off) are all eligible for the telesitter program. The patients must also be redirectable, which means that patients who try to pull out IV lines or who are trying to get to the bathroom are eligible for telesitting if they can be directed to stop touching their IV or to wait while the nurse is called to their room. Currently, telesitting is available on every inpatient floor except Pediatrics and Labor and Delivery. 

The sitters can see, hear, and talk to patients over the video system. They can remind patients to not get up, see if the patient has an issue that needs to be addressed and what that issue is, and call a nurse if necessary. The system also allows sitters to make common announcements – such as “please stay in bed” – in different languages. None of the video is saved.

Sitters and safety nurses round on all patients with sitters every four hours to see if they can be moved to the telesitting program or if they no longer need a sitter. In addition, they do purposeful rounding on telesitting patients in between the safety rounds and huddles to offer the nurses assistance and to check on the patients.  

Telesitters work in shifts of two at a time, 24 hours a day, in a room with all telesitting video feeds. One employee is the primary monitor of patients on video, while the other rounds and checks on patients when necessary. All telesitters participate in patient safety huddles, to ensure they have all the proper information. In addition, safety nurses are available 12 hours a day to work with the telesitters, assess patients, and help answer questions. BMC is the only hospital in the country whose telesitter program includes safety nurses.

“This has truly been a team effort,” says Murphy. “The float pool nurses did the initial policy work, and the program is driven by CNAs. The staff nurses have been very supportive and helpful in figuring out which patients are eligible and evaluating patients. We’re all committed to working together to return nurse's aides to the floor.”

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BMC Pharmacy Technician Training Program Helps Advance Employees’ Careers, Addresses the Pharm Tech Shortage


Reid

Sebastian Hamilton didn’t start his career in the pharmacy. Though he’s now the director of outpatient pharmacy at BMC, his first hospital job was transporting patients. Eventually, his education and training led to his current career, but the idea of bringing talented employees from other departments into the pharmacy stayed with him. To give others the same opportunity, Hamilton spearheaded the creation of a pharmacy technician training program at BMC, which provides employees in other departments with the necessary training to become nationally certified pharmacy technicians (CPhT).

Hamilton started planning this unique program in 2014, with the help of BMC’s Employee and Labor Relations team. When the details were finalized in 2017, Hamilton reached out to Charles Green, associate director of Food and Nutrition, to identify promising candidates. The first employee to join the training program was Karlene Reid, who was working as a hospitality representative. She recently passed her Pharmacy Technician Trainee exam, which allows her to register with the Massachusetts Board of Registration in Pharmacy as a pharmacy technician, and will soon become a CPhT at BMC. The second employee, Elino Philippe, who worked in hospitality services, joined the Shapiro pharmacy in February and is about to take the trainee exam after completion of his 500 hours of training.

“I’m looking forward to the new experience of being a full nationally certified pharmacy technician,” says Reid. “It’s a whole new world from what I was doing before.”

Pharmacy technicians provide a wide range of services to support pharmacists in the outpatient pharmacy department. They call providers for renewals or prescription clarification, and work with other pharmacies to transfer prescriptions. They also transcribe prescriptions into the computer system, and count and fill prescriptions, preparing them for the pharmacist to review before dispensing to patients. In addition, they work with patients, both over the phone and at the registers, to help ensure they get the proper medication.

“Every day I learn something new,” says Philippe. “I really like working with patients, and the pharmacists are all very nice and teach you a lot. It’s a great experience for me.”


Philippe

The BMC program is structured so that training is consistent for all pharmacy techs and addresses the skills they’ll need at the BMC outpatient pharmacy department and beyond. The first part of the program is 500 hours of training in the pharmacy, including specific training on BMC’s outpatient pharmacy system. Program participants then take a trainee exam, then receive additional training if they pass. After the further training and preparation, participants can take the national certification exam, which BMC provides study guides and tutoring for. After that, they will be nationally certified to work as a pharmacy technician and will be fully eligible to be considered for a position within the BMC outpatient pharmacy department. Participants are paid during training, and if a trainee leaves the program, they have the option to go back to their previous job at BMC.

The program not only allows BMC to provide opportunities to promising employees by retaining great talent, but also helps alleviate the effects of a pharmacy technician shortage in Massachusetts. Because the field is currently so competitive, the BMC program helps create options for  open pharmacy technician positions  with workers they know are well-trained and fit into BMC culture.

“I’m very proud of the program and the level of talent we’re getting,” says Hamilton. “We’re giving great workers more opportunities at BMC.”

If you are interested in joining the pharmacy tech training program, please speak with your manager. Managers who have interested candidates should email Julio Fred, pharmacy tech supervisor at [email protected].

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What do you do, Holly Sabo?

Name: Holly Sabo
Title: ACO Operations Manager, Greater Boston
Time at BMC: Two and a half years

Q: What do you do at BMC?
A: I am part of the Population Health Services (PHS), and we work in partnership with our colleagues at the Boston Medical Center HealthNet Plan to help manage the cost of care for Boston Accountable Care Organization (BACO), and our other ACO partners across the state.  My role is to work with the community health centers, as well as the hospital-based practices that are part of BACO, to ensure that they have the tools and resources needed in their work with our ACO patients. I travel between 13 sites, including eight community health centers and five practices at BMC.

My days are all very different and involve a variety of ACO initiatives. For example, right now I’m working on enrollment and making sure that patients who need to be get enrolled in BMCHP Community Alliance, which is the health plan product for BACO, before they’re locked out at the end of this month. Once patients are locked out, they will not be able to be part of BACO, which means that patients who had historically received primary care at BMC wouldn’t be able to get their primary care here. We are working very hard to make sure that patients who want to continue to come to BMC or their community health centers (CHCs) that are part of BACO are enrolled in the right health plan product so they can continue that continuity of care.                         

Another big initiative right now is risk coding, which is accurately documenting the social and medical complexity of our patients. It is extremely important to making sure BMC, and the other CHCs that are part of BACO, get paid properly for the work we do.  My team works with providers to help them understand the changes with risk coding as part of the MassHealth ACO reform, and give them tools to help them code, and helps identify any missed opportunities for coding.

Q: What brought you to BMC?
A: I was living in Philadelphia and my husband got a job offer in Boston. I knew I wanted to work at a hospital, and preferred to work at one of the larger hospitals because I felt like I could make more of a difference.

In my previous position in Philadelphia, I worked for a human service organization where most of our patients were Medicaid patients, so I liked BMC in particular because of the population that we serve. What I do every day is rewarding because I and my colleagues at BMC can make a difference in someone’s life who has limited resources. My efforts promote meaningful change throughout greater Boston. I can be part of the solution to underlying issues facing our population.

Q: You previously worked in Geriatrics. Why did you decide to work with the ACO? What lessons did you take from your previous experience?
A: For the most part, I’ve always worked in geriatrics. Geriatrics is my passion. I really enjoy working with older individuals. I think my heart will always be in geriatrics, but I worked in that area for a long time wanted to try something new.

Once I got a chance to learn more about the ACO, it was very intriguing to me. I really believe in what it stands for, that we can’t just help patients with their medical needs. We need to go beyond that to the root cause of why they’re in a particular situation. For example, if a patient needs help with food, why do they need help with food? Do they need education so they can get a better job and be able to afford more food? I like digging in and figuring out how exactly we can help our patients.

There are a lot of lessons I learned from my work in geriatrics. In geriatrics, you really have to be patient and listen. The senior population has a lot of great life lessons and I really enjoy listening to our patients’ stories. You can really learn a lot by just listening. I think I take that to my job now. I’m a patient person and I try to really listen to figure out what a patient needs.

Q: What’s the top thing you want people to know about the ACO program or the work you do?
A: We’re a very small team, but there’s a lot of work that needs to be done. We really want to educate employees on what the ACO is, what it means for our patients, and how important it is for our population. I invite anyone who wants to learn more about the ACO or understand it better to reach out to me or anyone on my team. The more people understand the work we are doing and its impact on our patients, the more successful we will be.

Q: How do you and you colleagues interact with clinicians at the hospital and with the health plan to support ACO patients?
A: We collaborate daily with the health plan and are currently working on several initiatives with them, including behavioral health and enrollment.

The complex care management (CCM) team also meets regularly with providers to address patients’ psychosocial and clinical needs. We have a CCM team at all of our BACO sites, as well as in the ED and inpatient units. This allows us to directly engage with patients and connect with providers. Providers also attend our weekly care meetings.

The ACO team also partners with patients, to better advocate for them.

Q: Can you share a story of how the complex care management program has helped patients?
A: One example is a patient who had frequented the ED a few times a month. Our complex care management team in the ED was able to help figure out why the patient was there so often and get them enrolled into the program, as well as get them the resources they needed from our community wellness advocate.

It turned out that this particular patient wasn’t staying in the ED until they got treatment, or staying in the hospital, because they have a cat at home that needs to be taken care of. They would leave before they got treated so they could go home and take care of the cat, which was very important to this patient. Once we found out what that barrier was, we were able to get the patient some resources to help with the cat. Then we could make sure the patient was actually treated, as well as really drill down to other types of resources they need to keep them out of the ED.

Q: What do you like most about working for BMC?
A: I really like the population that we serve and knowing that I can make a difference in people’s lives.

I like that we have a lot of diverse people working here and everyone listens to each other’s ideas. If you have an idea, you can try it, and if it doesn’t work, that’s okay. It allows you to be innovative and creative and try different things that help better the health system.

Q: What do you do for fun outside of work?
A: I like baking, and playing bingo. I also like going out with my friends and unwinding from a busy week. I also do a lot of hiking and traveling. I’m going to the Montreal Jazz Festival in July.

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New Technology Helps Providers Deliver Better Care to Frequent ED Visitors

When a patient comes into the Emergency Department at BMC, how do providers know they have all the data they need? While other notes about the patient from within the Boston Medical Center Health System are accessible, providers may not know if the patient had recently visited another hospital’s emergency department, and if so, why and how they were treated. This information can be crucial, especially for high-utilizer patients, who often use the emergency department for health care. To help manage this issue, BMC and many hospitals in Massachusetts have signed on to use PreManage, software that allows ED providers to see if a patient has visited other emergency departments.

BMC was one of the first hospitals in the state to implement the PreManage technology, and it’s now in all major health systems in Eastern Massachusetts, as well as many hospitals in the central and western parts of the state. The program puts an indicator in a patient’s electronic medical record if they’ve had six or more ED visits to any hospital within six months or three ED visits at three different hospitals within three months.

For these patients, PreManage automatically generates a page showing a patient’s ED visits, whether or not they were admitted, any diagnoses they received, and prescriptions they were given. Providers can also add more to these notes, including care plans and further reasons for a visit. There’s also a separate icon for patients who are enrolled in BMC’s complex care management program, with information on who to contact when those patients come to the ED.

Evan Berg, MD, vice chair of clinical operations in the Emergency Department, estimates that more than ten percent of ED patients fit the criteria for the indicators.

The indicators allow hospitals to understand ED utilization patterns for specific patients and help ensure consistency of care for these patients. Currently, a group at BMC is working on understanding these patterns, as well as figuring out the best ways for care teams to communicate about high-utilizing patients. The goal is to have clinical staff input care plans and their contact information for patients who meet the criteria, so the ED and other hospitals can have better access to information.

PreManage will also soon be onboarding Boston Healthcare for the Homeless and the Pine Street Inn, who serve many high-utilizing patients. This will help non-hospital care providers share information and care plans, which can help EDs better understand their patients and treat them more consistently.

“There are lots of touch points for high-utilizing patients, and we need to make sure that everyone has access to all the relevant information,” says Berg. “Our goal is to create awareness within the health system, so that patients have consistent, coordinated care. The more information different providers can exchange, the better care will be for patients.”

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Recognizing Employees that Embody Exceptional Care without Exception

The Be Exceptional Awards were conceived as a way to recognize the colleagues among us who represent BMC’s mission of exceptional care without exception day in and day out. The annual awards aim to recognize outstanding individuals and teams, while highlighting the amazing work that takes place across BMC.

Over 145 BMC individuals and nearly 50 teams were nominated for the prestigious awards this year. From this pool, a hospital-wide selection committee chose 21 exceptional individuals and six team winners. The awardees come from all over the BMC campus, hold many different jobs, and all share a deep commitment to BMC our patients and the community.

This year’s awards were once again emceed by Kate Walsh, president and CEO, and Lisa Kelly-Croswell, senior vice president of HR and Chief Human Resources Officer. The program focused on our core values - built on respect, powered by empathy; move mountains; and many faces create our greatness - as well as our 2018 priority goals: quality of care, patient experience, and growth.

“Thank you to all our winners for being living, breathing examples of what BMC is like on its best day” said Walsh.  “All of your efforts are moving us closer to realizing our Vision 2030, to make Boston the healthiest urban population in the world.”

Congratulations to the 2018 Be Exceptional Award winners!

Individual Winners
  • Carlos Arellano, Senior Director Radiology and Otolaryngology
  • Carmen Bala, HR Benefits Specialist
  • Anick Chery, Medical Assistant, Hem/Onc
  • Erica Criscuolo, Social Worker
  • Kathleen Flinton, Clinical Director Boston Center for Refugee Health and Human Rights
  • Ellen Ginman, Senior Director, Population Health
  • Raul Guzman, Transporter
  • Beth Hagan, Neurology Manager
  • Karam Housni, Transporter
  • Kristin Jeffes, Senior Manager, Support Services
  • Amanda Lai, Chinese Medical Interpreter
  • Kathleen Masters, Senior Project Manager, Ambulatory
  • Jason Mordino, Inpatient Pharmacy Clinical Specialist Lead
  • Thanh Nguyen, MD, Director, Interventional Neuroradiology and Interventional Radiology
  • Macy Reed, Volunteer Services Manager
  • Volcie Richard, Registered Nurse, Infectious Disease
  • La'Davia Sutton, Certified Application Counselor, Patient Financial Services
  • Jennifer Thurman, Specialty Care Pharmacy Liaison
  • Benita Toledo, Dietary Aide
  • Lisa Whelan, Registered Nurse
  • Evonne Yang, Population Health Manager
Team Winners
  • Inpatient and Pediatric Clinical Dietitian
  • JC Comprehensive Stroke Center Certification Team
  • Maternal - Child HIV Program
  • NICU Nursing Team
  • Social Determinants of Health Screening and Referral Program Leadership Team
  • Solomont Simulation Center

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Awards and Accolades

Colleen LaBelle Receives Innovator in Health Award

Collen LaBelle, MS, RN-BC, CARN, has been honored with an Innovator in Health Award from the Network for Excellence in Health Innovation. LaBelle is director of the Office-Based Addiction Treatment (OBAT) program at BMC and Director of the Massachusetts OBAT program. She is being recognized for her transformative impact on the field of substance use disorders, particularly through her creation and leadership of the nurse care manager model that has enabled effective opioid use disorder treatment in community health settings.

Vonzella Bryant Honored at Fenway Park

Vonzella Bryant, MD, a physician in the Emergency Department, was honored at Fenway Park for her work mentoring youth in Dorchester.  She was invited for the first pitch ceremony along with her mentee-student.

Thea James Honored by The Community Builders

Thea James, MD, VP of Mission and associate chief medical officer, was honored for her work at the Community Builder’s Power of Home Event. The Community Builders, Inc. is America's largest nonprofit developer of urban mixed-income housing.

Joseph App and Laurie Goldman Receive Spirit of Elaine Ullian Oto Helper Awards

Joseph App, charge nurse, and Laurie Goldman, staff nurse, both in the operating room, have received this year’s annual Spirit of Elaine Ullian Oto Helper Award. The award is given annually to the person(s) who has been of the most help to the Department of Otolaryngology – Head and Neck Surgery team in achieving their mission.

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News of Note

Liz Walker and Eilene Grayken Named to BMC Board of Trustees

Reverend Liz Walker, senior pastor at Roxbury Presbyterian Church, and Eilene Grayken were voted in as trustees to the Boston Medical Center Board of Trustees.

Walker was the first black woman to co-anchor a newscast in Boston. She then attended divinity school and became pastor of the Roxbury Presbyterian Church in 2014.

Grayken was instrumental in providing BMC with the $25 million gift to create the BMC Grayken Center for Addiction, the biggest private gift in the U.S. in the last decade for addiction treatment and medicine.

BMC Child and Adolescent Psychiatry Researchers Awarded $13.5 Million from PCORI

Boston Medical Center has received a $13.5 million award from the Patient-Centered Outcomes Research Institute (PCORI) to test two different methods of delivering cognitive behavioral therapy – face-to-face and online – to children with anxiety. The goal is to determine if the online format is as effective as face-to-face treatment for delivering CBT in the community and if certain characteristics about patients, families, therapists, and healthcare systems may influence each format’s effectiveness.

The multi-site study will be conducted in both urban and semirural communities that serve primarily racial and ethnic minority children. More than 1,800 children ages 3 to 17 with mild to moderate anxiety symptoms in Boston, Miami, Seattle, and Baltimore will participate.

The principal investigator of the study is Lisa Fortuna, MD, medical director for child and adolescent psychiatry services at BMC.

Kate Walsh Named Chair-Elect of the Council of Teaching Hospitals

Kate Walsh, president and CEO, was elected the next chair of the Administrative Board of the Council of Teaching Hospitals. The Council of Teaching Hospitals is a division of the Association of American Medical Colleges that provides its 400 member hospitals with advocacy resources, professional development offerings, care redesign expertise, and learning networks that exclusively support clinical teaching environments.

Providence/Boston Center for AIDS Research (CFAR) Receives $9.1 Million Grant

The Providence/Boston Center for AIDS Research (CFAR) was awarded a $9.1 million grant from the National Institutes of Health to support new and continuing initiatives. CFAR is a collaboration between Boston University/BMC, Miriam Hospital, the Lifespan Health System, and Brown University.

CFAR is currently focusing on research around the relationship between HIV and substance use disorders, as well as women, men who have sex with men, at-risk youth, and individuals in the criminal justice system. Its research is aimed at preventing and treating HIV in the United States and in highly pandemic regions around the world including.

BMC Hosts Historic Physical Therapy Course

BMC recently hosted a pelvic floor physical therapy course for the transgender population that was the first of its kind in the country. The course focused on physical therapy examination and treatment of transgender patients.

BMC was represented on the course faculty by nursing, adult, and pediatric primary care providers who are members of the Center for Transgender Medicine and Surgery. Rehab Services coordinated the event, which was attended by approximately 40 pelvic health physical therapists, including BMC’s pelvic floor physical therapists.

This course was designed to educate physical therapists on evaluation and treatment of the transgender population using evidenced-based practice, standardized protocols, hands on skills, and resources from interdisciplinary collaborations. Specific topics covered include pre-operative evaluation, treatment and education issues, intra-operative recommendations, post-operative evaluation, treatment, education and follow-up.

BMC Receives $3.2 Million Grant from The MA Executive Office of Health and Human Services

A team at BMC will receive a $3.2 million grant over five years from the Massachusetts Executive Office of Health and Human Services to help increase access to long-acting reversible contraception. The team, led by Kate White, MD, an OB/GYN at BMC, will focus on training hospital-based providers across the state and improving operations that will allow more patients to have access to LARCs.

BMC and BU Researchers Receive $899,999 from the National Science Foundation

A team of researchers from BMC and BU has received a $899,999 grant from the National Science Foundation for a project entitled “QuBBD: From Personalized Predictions to Better Control of Chronic Health Conditions.” Their research aims to utilize digital health data to predictive models that anticipate future undesirable events, such as hospitalizations, re-admissions, and transitioning to an acute stage of a disease. These predictions will be used to trigger personalized interventions, such as increased monitoring and doctor visits to optimized treatment policies adapted to each patient.  Rebecca Grochow Mishuris, MD, MS, MPH, associate chief medical information officer at BMC, is a co-principal investigator.

Elizabeth Barnett Named Division Chief of Pediatric Infectious Disease

Elizabeth Barnett, MD, Professor of Pediatrics has been named division chief of Pediatric Infectious Disease at Boston Medical Center and the Boston University School of Medicine.

For the past 25 years, Barnett has been a full time faculty member of the Department of Pediatrics at BUSM where she currently holds the rank of Professor of Pediatrics. She has been a clinical and academic leader and has achieved international prominence in travel and tropical medicine, with a particular focus on refugee health and the medical needs of new immigrant families.

For over 20 years she has served as the PI of the BMC Refugee Health Assessment Program and is also the site director of the GeoSentinel Program in partnership with the Center for Disease Control. Barnett has also studied the safety and dissemination of childhood immunizations and is a leader in the BMC Center for Immunization Safety and Assessment.

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