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The BMC Brief

The BMC Brief, Volume 7, Issue 11

November 28, 2018

Advancing Emergency Care through Simulation

ER Simulation

When an emergency code is called over the hospital intercom system, healthcare personnel spring into action. Any type of injury could be coming through the doors, and staff have to be ready to respond with precision. It’s not just the injury that needs to be considered but also the person suffering from it. Babies and children who come to the trauma bay require specialized care, equipment and medication. To provide the best outcome for these little patients there is no room for error.

“It’s a low frequency, high stakes occurrence,” explains Barbara Walsh, MD, director of In Situ and Mobile Outreach Simulation at Boston Medical Center. “Most critically injured children will be brought to a community emergency department not an urban children’s hospital. Medical staff don’t see these types of cases often and that’s why it’s important to provide on-site simulation to address gaps in care and create best practices.”

Walsh spearheads Community Outreach Mobile Education Training (COMET), a simulation-based experience offering community hospitals with acute pediatric emergency training. Simulation is just what it sounds like—a medical scenario presented in real time with medical teams responding and reacting as the situation unfolds. Often medical teams have to travel to large simulation centers to receive this type of training, but Walsh and her staff bring the simulation right into the trauma bays of community emergency departments. This gives teams the opportunity: to include more personnel; to assess their own medical equipment and supplies; and to ensure they are properly prepared for true emergencies.

Acute pediatric scenarios can comprise of serious respiratory distress like choking or anaphylaxis, seizures, accidental poisoning or trauma. The team is expanding its menu to include early term labor and birth and complications due to sickle cell disease. COMET uses special high-fidelity computer-assisted mannequins that are able to mimic the physical symptoms of these conditions. Medical teams have to communicate what they are seeing and follow through with a care plan like resuscitating the patient, administering medications and performing life-saving procedures.

“After the simulation, we meet as a group to go over what went well and what needed improvement. It is a great way to for teams to see how they can improve communication and where they can make adjustments to improve response time,” says Walsh.

Walsh recently received a $50,000 grant from the Childress Institute for Pediatric Trauma—a nonprofit dedicated to promoting innovative ideas in pediatric acute care. The funds will allow the team to build their critical pediatric simulations cases into a pilot online gaming application. The hope is to further broaden the reach of pediatric emergency education specifically for pediatric trauma care.

“We are always exploring ways to reach different types of learners. We are excited to build something engaging and educational, something nurses and doctors will want to play on their lunch break. Keeping people fresh, that is what it’s all about,” concludes Walsh.

COMET laid the foundation for and is part of a multi-institutional research collaborative called Improving Pediatric Acute Care through Simulation (ImPACTS), which is dedicated to studying advancements in the quality of pediatric emergency care through the use of simulation.

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14th Annual Raphael Miara Patient Safety Symposium includes Launch of New Book Dedicated to the Memory of Raphael Miara

Raphael Miara lecture

Providers are generally defined by their expertise, decisiveness, and altruism. But despite efforts to provide the best care possible, mistakes can still happen during the course of care. As part of BMC’s ongoing commitment to confront mistakes and learn from them, the hospital comes together as a community each year for the Annual Raphael Miara Patient Safety Symposium.

But this year’s symposium was much more than an educational opportunity, as it included a special dedication of the newly published book, OK to Proceed?, to the family of Raphael Miara who died from a medical error.

“Boston Medical Center is truly helping our family heal through the release of this book, which will undoubtedly become an essential resource for the medical community,” said Mrs. Miara.

OK to Proceed? outlines what every health care provider should know about patient safety and illustrates ways to reduce preventable harm. The book, which was edited by Keith Lewis, MD, Chair of Anesthesiology, Rutgers Biomedical And Health Sciences; Rafael Ortega, MD, Vice Chairman of Academic Affairs, Department of Anesthesiology; and Robert Canelli, MD, Assistant Professor, Department of Anesthesiology. It was fully funded by BMC and represents a collective effort, from every corner of our campus, to further prioritize patient safety so that we can save more lives. Its complementary digital toolkit further helps providers and students learn with narrated case studies that were produced in the Department of Anesthesiology’s world-class multimedia center.

Following the dedication was a panel discussion with the editors that helped attendees understand the role of human error in patient safety, see the value of using multimedia in medical education, and identify strategies to combat common precipitants of error. There were also presentations by chapter authors that showcased the innovative approach taken to develop the book and ensure that it is a relevant educational tool for students and providers everywhere.

Ravin Davidoff, MBBCh, SVP and Chief Medical Officer, provided closing remarks, underscoring that the book will not only help BMC achieve our Vision 2030 goal, but also significantly contribute to decreasing the number of preventable medical errors in the near future.

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Providing Exceptional Care in the New Integrated Procedural Platform

IPP EP room

Many changes came to BMC recently as part of our campus redesign project and the recent patient moves and decommissioning of our Newton Pavilion. One of the most exciting – and biggest benefits of the redesign – is the addition of the Integrated Procedural Platform (IPP). This platform consolidates all procedural-based specialists to one location on the second floor of Menino.

Traditionally, all procedures were performed in their silos of care. Endoscopy, interventional radiology, the Cardiac Catheterization Lab, interventional pain, MRIs, bronchoscopies, and many other procedures were spread out across campus. In addition, the BMC operating rooms were in three separate locations, with two separate surgical intensive care units. Many of these operating rooms were small and had not been renovated in a long time. This all meant that anesthesiologists and surgeons had to float between campuses, and patients had to be transferred between campuses depending on what procedure they needed performed.

The IPP eliminates many of these challenges. All procedures are now performed on one floor and primarily in one location, with only a few exceptions such as MRIs requiring anesthesia. There will be multiple 600+ square foot rooms for major procedures like cardiac, neurosurgery, and spine procedures, and a 42-bay post-anesthesia care unit to care for patients after surgery.

Read on to find out more about some of the other new IPP features.

Hybrid Operating Room

The hybrid operating room combines a conventional operating room with advanced imaging. The new, 1,000+ square-feet, hybrid OR will provide BMC with a state-of-the-art location for complex endovascular procedures to be performed. Certain traumas or OB cases requiring IR interventions to minimize blood loss will also take place in the hybrid room.

Dedicated Pharmacy

The IPP contains a satellite pharmacy, with two dedicated, full-time pharmacists to serve the needs of patients and providers. Having a dedicated staff on-site will allow pharmacists to mix medicines and get them to patients more quickly, saving valuable time. The speed and proximity of the pharmacists will also help improve patient safety and minimize the risk of adverse events.

The pharmacists will not only dispense medication, but also be a resource for providers with medication-related questions. Because both pharmacists are experts in operating room and critical care pharmacy, providers can get their questions answered more quickly. Providers and pharmacists will also be better able to work together on operational improvements.

Surgical Teams

Two and a half years ago, the Vascular Surgery team decided to try an experiment. They started a pilot program where the entire team – from surgeons to nurses to anesthesiologists to techs – met regularly to discuss issues and ideas, share best practices, and work to make their operating rooms more efficient.

The pilot was very successful. For example, the team worked on a plan to standardize patient prepping and draping, which led to a significant decrease in surgical site infections. Thanks to the success of and lessons learned from this pilot, surgical groups in the new IPP will be organized into teams to help improve efficiency and patient and staff satisfaction.

As a start, the IPP has divided staff into three teams from the Department of Surgery who will meet at least once a month to share ideas. The teams will also identify and track metrics based on the BMC priority goals of quality of care, patient satisfaction, accountability, and growth. Not only will the teams help BMC provide the best care at the greatest value, but they’ll also allow employees to get to know each other and build closer relationships in a less stressful environment than the OR.

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BMCHP Sponsors Boston Police Department-Run Program for Boston Youth

A group of teens gathered the evening of October 30 at the Schrafft’s Center in Charlestown to begin a special eight month journey through We Belong. This unique leadership program, sponsored by BMC HealthNet Plan (BMCHP) and run by the Community Police Officers Division of the Boston Police Department, empowers inner-city at-risk youth to be the voices of their communities through work on public service projects and meetings with elected officials, community leaders, and executives in the Greater Boston and Washington D.C. areas.

Last year BMCHP was pleased to sponsor the first year of the We Belong program, which was all boys; this year the program expanded to include girls. The group of 40 Boston high school students, who range in age from 16 to 19, now will move on to the Boys & Girls Club of Mattapan for their weekly meetings.

Teaming with We Belong

BMCHP’s affiliation with We Belong resulted from a chance meeting. Lisa Hatfield, BMCHP’s Director of Market & Community Development, met Jorge Dias, a Boston police officer who cofounded We Belong with Officer Jeff Lopes, through the Lead Boston program.

“When Jorge described the vision for We Belong, I recognized that this was a project BMCHP might want to support,” Hatfield said. As she discussed the program with Trina Martin, BMCHP’s VP of Sales & Marketing, it was obvious that partnering with We Belong would benefit both organizations.

“Supporting We Belong and its focus on inspiring young people closely aligns with our own community-centered mission,” Martin said.

Challenging their notions

Trina Martin was able to secure two nationally known facilitators to address the group –Lisa Markland from the Northeastern Center for the Study of Sports in Society and Monica Cost from The Core Value Company. After the initial meet-and-greet segment, the boys and girls separated so that each group could engage in gender-focused discussions and exercises. These would lay the foundation for the coming months. The boys were challenged, for example, on their perceptions of what it meant to be a man, what the role of a bystander was, and how men spoke to and treated women.

In a different conference room, the girls’ confronted their self-perceptions, behaviors, and perceptions of others. Each group experienced “a-ha moments,” and even the adults who were present realized the relevance and practicality of each theme. Lisa Hatfield reflected on the effectiveness of We Belong saying, “This is an organization we’re proud to work with. We see the results as the year progresses and these young people become more confident and develop special bonds with each other.”

On October 31, The Boston Globe reported on this first We Belong meeting.

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What do you do, Tracey Burg?

Tracey Burg

Name: Tracey Burg, RD, LDN
Title: Culinary Nutrition Manager, Teaching Kitchen
Time at BMC: 7 and a half years

Q: What do you do at BMC?
A: I manage BMC’s Teaching Kitchen, which has a mission to encourage people to make healthy food choices and help them develop the confidence to cook nutritious meals at home. As a dietitian and chef, I’m in the unique position to both educate and advise our patients and staff on ways to navigate their personal food journeys so they can ultimately achieve healthier lifestyles.

I became a chef because I love to cook and I became a dietitian because I wanted to empower people to take control of their health. This job affords me the opportunity to combine two of my biggest skills in a way that benefits not just our patients and staff, but the community as well.

Q: How were you introduced to BMC and the Teaching Kitchen?
A: In 2001, when the Teaching Kitchen was launched, I gave advice on the type of equipment that should be installed and taught the full-time dietitians how to host food demos. But for years, the kitchen was underutilized. So I was asked to step in as chef and revitalize the program by creating new classes for more patients and staff to enjoy.

Today, we host about twenty-five classes a month and have reached patients in nearly all of the departments here. I couldn’t be more proud of the success we’ve seen over the years and greatly look forward to boosting our impact in 2019 and beyond.

Q: What sets our Nourishing Our Community programs (Teaching Kitchen, Preventive Food Pantry, and Rooftop Farm) apart from others across the country?
A: No other hospital in the nation has adopted the model we created, which has become known as the “trifecta effect.” The bulk of the food used in the Teaching Kitchen comes directly from our Preventive Food Pantry and Rooftop Farm. So, we really shook up the industry by promoting “farm-to-table” nutrition, on hospital grounds, at no cost to patients.

Q: What were some of your most popular classes and recipes this year?
A: Our Bariatric Food for Life, Cancer Survivors, and Cooking Skills 101 were the most popular classes, with the Healthy Hearts and Weight Management classes ranking second place in popularity. As far as recipes go, all of them were pretty well received. If I had to pick a couple as fan favorites, I would say the lemony kale salad and the red curry butternut squash soup.

You can find a list of the recipes we’ve made in 2018 here.

Q: Is there anything new on the horizon?
A: We will be starting a prenatal cooking class called “Healthy Cooking for Mom and Baby” in December, to educate pregnant mothers about nutritious meals they can prepare at home. The class will also inform new mothers about ways to maintain healthy lifestyles post-pregnancy and how to cook nutritious foods for their babies during various early development stages.

Q: What’s something people may not know about you?
A: Believe it or not, I went to college for computer science! Everyone was doing it in the ‘80s so it felt right at the beginning. But I quickly grew to despise my courses and found myself daydreaming more and more about pursuing what I then considered my hobby – cooking! So, I decided to switch gears and enroll at the Culinary Institute of America (CIA) in New York so I could start turning my dream into reality. After working as a chef for some years, I decided to shift my focus to dietetics as a way to maximize my impact - and the rest is history.

Q: What do you do for fun outside of work?
A: I love shopping at yard sales and antique shops. I also really enjoy hiking – last summer, I successfully reached the top of Mount Wachusett!

The Teaching Kitchen is trying to ramp up participating in 2019, so if you are interested in getting your patients or departments involved with its classes, please contact Tracey Burg at [email protected]

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Awards and Accolades

BMC Wins "A" in Patient Safety

Boston Medical Center has received an "A" in patient safety from The Leapfrog Group’s Fall 2018 Hospital Safety Grade. The designation recognizes BMC’s efforts in protecting patients from harm and meeting the highest safety standards in the United States.

BMC Health System Named Top Woman-Led Business

Boston Medical Center Health System was named #1 on a list of the top 100 women-led businesses in Massachusetts by the Globe Magazine and The Commonwealth Institute. The list was created by looking at organizations’ revenue or operating budget, workplace and management diversity, and innovative projects. Last year, BMC Health System came in second on the list. Click here to see the full 2018 list.

BMC Wins Two WorkWell Massachusetts Awards

The BMC employee wellbeing program was honored with two awards at the annual WorkWell Massachusetts Award Program. The hospital was the first ever recipient of the new Innovator of the Year award, and also received a silver level achievement award. The Innovator of the Year recognition recognizes the fact that there is an employee assistance clinician onsite to support staff, which is uncommon in the workforce. This event, organized by the Worksite Wellness Council of MA, also recognized BMC for developing and implementing a successful well-being program that supports employee vitality, provides tools to avoid burnout, and reduces stressors.

BMC Doctors Honored with American Academy of Ophthalmology Awards

The American Academy of Ophthalmology (AAO) honored two BMC employees with awards at its annual meeting.

Stephen Christiansen, MD, chief of ophthalmology, received a Senior Achievement Award, while Babak Eliassi-Rad, MD, director of the Glaucoma Service at BMC, received an Achievement Award. Both awards recognize significant scholarly work, teaching and committee contributions to the Academy. The Senior Achievement Award honors those members with at least ten years of noteworthy contributions. The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons whose mission is to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education and advancing the profession of ophthalmology.

Betsy Henderson Named a Jonas Policy Scholar

Betsy Henderson, MSN, MS, RN, AFN-BC, a nurse manager in the Emergency Department, was selected by the American Academy of Nursing as one of six leaders and scholars across the nation to be honored as a Jonas Policy Scholar for the 2018-2020 cohort. The selection recognizes her clinical expertise, leadership skill set, and scholarship. Henderson will serve on the expert panel for psychiatric mental health/violence/substance abuse and opioid crisis. The expert panel will review current research and care delivery needs within these domains to write policy briefs and positions statements, as well as to contribute to shaping practice, education, and health policy relevant to these domains.

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