Study Finds Sexual Trauma Survivors Have Clear Preferences in Obstetric CareDecember 31, 1969
Researchers believe findings will inform best practices for pregnancy and labor treatment
BOSTON— One in five women in the United States will experience sexual trauma, yet no evidence-based guidelines exist to treat these women during pregnancy and childbirth. Researchers at Boston Medical Center (BMC) surveyed women with a history of sexual trauma and found that they have clear preferences regarding how they communicate their history with providers as well as certain aspects of their treatment plan. Published in Obstetrics and Gynecology, these results can help inform providers on best practices when caring for these women.
A group of resident researchers interviewed 20 women with a history of sexual trauma who had recently given birth, and 10 without such history, from 2015 to 2017 to discuss their care during pregnancy and childbirth. During one on one interviews, survivors of sexual trauma expressed unique preferences and recommendations for their care during childbirth.
After telling providers about their history of sexual trauma, women felt that they should not have to disclose that information to subsequent providers, but that it would be communicated to the entire care team. Several women reported anxiety, fear, or flashbacks during cervical examinations and wanted their providers to give clear explanations of why exams were being done and control over the start and end of the exam. Participants did not want providers to use language that served as a reminder of sexual trauma. Finally, women expressed anxiety about the exposure over their bodies, and wanted control over who was in the room during cervical exams and labor.
“Nearly every obstetrician will care for a woman who has experienced sexual trauma, which makes best practices for their care so vital,” says Lauren Sobel, DO, lead author and resident obstetrician and gynecologist at BMC. “There are clear steps we can take, like creating standard documentation systems to communicate a woman’s history, or improving communication during cervical examinations that can make a big difference in how a woman feels about her care.”
Researchers also recommend having conversations about the individuals who they want in the room during labor. Data supports the use of selective and sensitive language during examinations and labor that does not serve as a trigger or reflect their perpetrator’s language.
“Our goal is to add an obstetrics perspective to the body of trauma-informed care literature,” said Sobel. “Providers across the spectrum of care should work with our patients who have experienced sexual trauma and integrate their recommendations into our practice.”
Danielle O'Rourke-Suchoff, MD, an obstetrics and gynecology resident at BMC and Erica Holland, MD, a maternal fetal medicine fellow at Brigham and Women’s Hospital in Boston were also involved in the study.
The BMC Brief, Volume 7, Issue 11December 31, 1969
- Advancing Emergency Care through Simulation
- 14th Annual Raphael Miara Patient Safety Symposium includes Launch of New Book Dedicated to the Memory of Raphael Miara
- Providing Exceptional Care in the New Integrated Procedural Platform
- BMCHP Sponsors Boston Police Department-Run Program for Boston Youth
- What do you do, Tracey Burg?
- Awards and Accolades
When an emergency code is called over the hospital intercom system, health care 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.
14th Annual Raphael Miara Patient Safety Symposium includes Launch of New Book Dedicated to the Memory of Raphael Miara
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.
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.
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.
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.
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.
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]
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 wellbeing 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.
Targeted Hepatitis C Testing Misses Substantial Number of Cases in Correctional SettingDecember 31, 1969
Researchers recommend routine testing for all incarcerated individuals upon arrival
BOSTON— Results from a new study led by Boston Medical Center (BMC) found routine Hepatitis C testing identified a significant number of cases that would have been missed by targeted testing among a population of individuals in Washington State prisons. Published in the American Journal of Preventive Medicine, the authors recommend routine testing in correctional facilities to best identify and treat the disease as part of the national strategy to eliminate Hepatitis C transmission.
It is estimated that 30 percent of the total Hepatitis C (HCV) infected population in the United States passes through the prison system annually, yet there is no widely accepted approach to HCV testing in correctional settings. Approximately 40 percent of state prison facilities, including Washington State, routinely test for HCV. Other facilities employ the Centers for Disease Control and Prevention (CDC) recommendation of targeted or risk-based testing, which tests individuals born between 1945 and 1965 as well as those with a history of injection drug use.
Researchers looked at data from Washington State prison HCV testing results to determine whether routine or targeted testing was most effective in identifying cases of disease. From 2012 to 2016, more than 24,000 people were tested for HCV; 20 percent of those people were infected and close to 2,000 people had chronic infections. Of those with chronic infections, nearly a quarter had at least moderate liver disease, putting them at risk for complications.
Infections were more prevalent in individuals born between 1945 and 1965, however nearly 35 percent of infections would have been missed if only targeted testing was performed. With routine testing, five individuals had to be tested to identify a case of HCV, compared to three individuals with targeted testing. This remains a small number in contrast with other infectious diseases, such as HIV, that require testing a large number of incarcerated individuals to identify a single case.
“These data build upon existing evidence supporting the implementation of routine testing for all individuals when entering a correctional facility,” said Sabrina Assoumou, MD, MPH, an infectious diseases physician at BMC and lead author of the study. “Coupled with treatment, routine testing would identify and cure many cases of HCV, preventing the substantial burden of future liver disease.”
One of the current barriers to routine testing is the high cost of HCV treatment. Even without treatment, those who receive a diagnosis of HCV may make lifestyle changes that can reduce transmission.
Researchers also note that it is unclear how these findings will generalize to other U.S. prison populations, and believe more research should be done to determine the effectiveness of routine HCV testing across the country.
The study was funded by the Centers for Disease Control and Prevention and support was also provided by the National Institute of Drug Abuse and the National Institute of Allergy and Infectious Diseases.
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