The BMC Brief
January 12, 2012 Volume 1, Issue 17
It is New Year’s resolutions time, and chances are, eating better and exercising more are on your list. BMC can help. The hospital offers a variety of programs, benefits and discounts to help you achieve your 2012 goals. Take advantage of these offers as you work toward a new you in the New Year.
The mannequin, representing an 89-year-old woman, is lying on a stretcher in the preoperative area prior to surgical repair of a hip fracture. The anesthesia resident and preoperative nurse are conducting their final checks when the mannequin states, "I can't breathe." The nurse had started the patient’s Kefzol 1 gram prior to entering the operating room. The patient’s heart rate increases from 60 to 150 and her blood pressure drops to 50. When the resident listens to her breath, he hears wheezing in her chest. The resident and nurse must now determine what has happened and the appropriate course of treatment.
Over the next 10 minutes, a simulation trainer will watch through a one-way window as the nurse and resident respond to the patient’s anaphylactic drug reaction, which will include the administration of medications and intubation of the mannequin followed by cardiac arrest. For the participants, the scenario feels like a real emergency as they go through all the necessary resuscitation maneuvers.
Welcome to the world of medical simulation, where caregivers use computer-controlled equipment to develop and refine skills, and learn new procedures and treatment protocols before using them on actual patients. Soon BMC staff will be performing simulation exercises in a state-of-the-art facility.
This month BMC will complete construction on a 5,000 square foot simulation center in the home of the former Newton Pavilion Emergency Department. The new center will consolidate the various simulation areas around the hospital, including those located in Anesthesia, Nursing, Pediatrics and the Menino Pavilion Emergency Department.
BMC’s high-fidelity simulation center, to be called the Solomont Clinical Simulation and Nursing Education Center, will give staff the most realistic simulation experience possible using mannequins programmed with pre-defined scenarios. Entire teams will train while video cameras capture their actions for review in debriefing sessions following the simulations. The experience is as real as it gets, says Keith Lewis, RPh, MD, Chair, Anesthesiology.
“Simulation brings cases to life,” says Lewis, who has overseen the development of the center along with Lisa O’Connor, RN, BSN, MS, NEAA-BC, Senior Vice President for Clinical Operations and Chief Nursing Officer. “It’s not a technology, but a technique. It allows you to see the roles of various people, prevent errors and problems before they occur, and define how to get to a better outcome.”
The interdisciplinary Center will allow BMC/BUSM staff, faculty and residents to perform all simulation on site, which sets BMC apart in the Boston academic medical center community.
“Nursing, physicians and allied health professionals will routinely train as teams for high-risk scenarios as opposed to doctors and nurses training independently,” says Lewis. “We will be the only center in Boston to perform simulation this way.”
The Center’s vision was developed by BMC/BUSM leaders with the common goal to create a simulation area that trains the caregivers of today and tomorrow to provide the safest care to BMC patients. That focus, of putting the patient first, is what the simulation center is all about, says O’Connor.
“The Center is symbolic for changing the way we train and learn together,” she says. “We are working as a team focused on the patient, which is the crux of the patient safety culture. Through this continuous learning, we will continue to capitalize on BMC’s performance in quality and safety and our quest to Be Exceptional.”
“The goal is for simulation to become embedded in our system and part of our everyday culture,” adds Lewis.
The Center, which can accommodate up to 150 people, will feature three high-fidelity simulation rooms, two task training rooms, two control centers, a classroom and conference room, and office and storage space. The Center will be outfitted with a mix of current and new equipment, all of which will be on wheels to allow for flexibility within the space. It will be overseen by four departments: Anesthesia, Emergency Medicine, Nursing and Pediatrics, and staffed by a simulation coordinator. The Center’s construction began last October and will be completed this month. The Center will open for use in March.
Substantial funding for the Center was raised at the 2011 BMC Gala, where donors gave $1.7 million for its construction. Other donors include longtime BMC partners Anaesthesia Associates and the Massachusetts Memorial Hospitals Nursing Alumnae Association (MMHNAA). In addition, the BMC Medical and Dental Staff have given $400,000 toward this effort over the past four years. The Solomont Clinical Simulation and Nursing Education Center is named in honor of former vice chair of the BMC Board of Trustees Alan Solomont and his wife Susan Solomont, who were honored at the 2011 Gala. Space within the Center will named for Erwin Hirsch, MD, BMC's long-time Chief of Trauma Surgery, and in recognition of major support from the Ross Fund of the MMHNAA, and for Dr. Ellison Pierce, a colleague of the Anaesthesia Associates.
O’Connor notes that non-clinical teams will be able to use the Center to train for emergency preparedness scenarios, communication and de-escalation situations.
“It will give us a method to assess the preparedness of our institution,” she says.
O’Connor and Lewis believe that as team training and simulation grow, BMC will become a more fully integrated health care team.
“It’s what our patients deserve,” says Lewis.
The Solomont Clinical Simulation and Nursing Education Center will be open five days a week beginning in March.
Both unusual and common genetic phenomena contribute to extreme human longevity according to a new study by BMC and Boston University Schools of Public Health and Medicine.
The study, published Jan. 3 in Frontiers in Genetics, reports a comprehensive analysis of the whole genome sequences of a man and a woman, both of whom lived past the age of 114. Supercentenarians (age 110+ years) are very rare, occurring at a rate of one person per five million in developed countries, and there is growing evidence supporting a strong genetic influence in survival to such ages.
The study shows that while the two supercentenarians carried as many disease-associated genes as the general population, their longevity suggests other protective mechanisms are at work.
The male subject had 37 genetic mutations associated with increased risk for colon cancer, indicating that he was in no way immune to that age-related disease. "In fact, he had presented with an obstructing colon cancer earlier in his life that had not metastasized and was cured with surgery. He was in phenomenal cognitive and physical shape near the time of his death," says Thomas Perls, MD, MPH, director of the New England Centenarian Study and senior author of the article.
The female supercentenarian also had numerous genetic variations associated with age-related diseases, including those related to increased risks for Alzheimer’s, cancer and heart disease. She did have congestive heart failure and mild cognitive impairment, but these diseases did not become evident until after the age of 108 years.
"The presence of these disease-associated variants is consistent with our and other researchers’ findings that centenarians carry as many disease-associated genes as the general population," Perls says. "The difference may be that the centenarians likely have longevity-associated variants that cancel out the disease genes. That effect may extend to the point that the diseases don’t occur - or, if they do, are much less pathogenic or markedly delayed toward the end of life, in these individuals who are practically living to the limit of the human lifespan.”
"The study of these two supercentenarians is just the beginning, and genetic study of many more such subjects needs to be performed," adds Perls.
Data from the study will be available to researchers around the world at the National Institutes of Health (NIH) data repository.
Joe Camillus joined BMC Oct. 3 as Senior Director of Business Development. In this new position, Camillus is working to grow BMC’s patient volumes through high-value clinical opportunities, to increase new service offerings, and to develop strategies to attract new patients and ensure BMC’s operational and economic success. He previously served as Administrative Director in the Department of Emergency Medicine at Brigham and Women’s Hospital and Deputy Director at Allegheny County Department of Human Services in Pittsburgh.
BMC Brief staff recently spoke with Camillus about his goals and the work ahead.
What does your job entail?
BMC’s inpatient volume has been decreasing. Why is that and what is being done to address it?
At BMC we have shown that we can attract new patients when we focus our efforts, and we’ve had success in certain areas with a “boots on the ground” approach. Cancer Care is a great example. Our center rebranded itself more than a year ago and has worked closely with community health centers to make our services and staff known to providers. The result was a 10 percent growth in volume last year. We are accelerating our outreach efforts and will work to build this type of recognition for other core BMC services including primary care. The more physicians and patients hear about the new BMC, the more they like us.
The health care industry has been evolving in the past few years. How has this affected the Boston market?
How does this affect BMC?
What are BMC’s biggest opportunities?
Internally, we’ll need to work on two issues that are critical to our growth. The first is patient access. We want to make it easier for patients to see their providers and for physicians to refer to us. For instance, Primary Care recently changed its scheduling process so patients are scheduled for their next appointment when they check out, rather than putting the burden on the patient to call to make a follow-up appointment. The good news is that we have patients who are ringing our doorbell; we just have to keep the front door open for them.
The second issue is retaining the patients we have. We want to make sure our patients know about the high-quality services we provide and understand that there’s no better place in town to receive compassionate, culturally-sensitive, high-quality care. For example, later his month, OB/GYN will host a Meet the Midwives event where community members can learn all about having a baby at BMC and tour our beautiful, modern maternity unit.
Patients share their BMC experience
We are honored to support BMC and are very thankful for all that BMC and the doctors, nurses and staff have done for our family and friends.
When you go to BMC you feel like a person, not a number. The staff makes sure to handle all your problems. Sandy Allen is one of the best nurses and she went above and beyond helping both my wife and daughter as they underwent operations, treatments and follow-up appointments for their cancer. She became more than nurse to my family and we are lucky, as is BMC, to have her. We feel like family at BMC.
As a police officer in the city of Boston, this is where I want to go for all my health needs and I do. When I had a heart attack in 2001, I was rushed to the Cath Lab at BMC and they saved my life. So BMC has saved my life, my wife’s life and my daughter’s life. The saying in my department is "we don't forget our own." BMC is our own.
Officer Robert E. Anthony
East Boston family raises $2,000 for BMC
Winnie Suen, MD, MSc, Medicine Geriatrics, has been selected as a member of the Centers for Medicare and Medicaid Services’ (CMS) Innovation Advisors Program. The initiative, launched by the CMS Innovation Center, will help health professionals deepen or sharpen skills that drive improvements to patient care and reduce costs. Suen is one of 73 advisors who will support the Innovation Center in testing new models of care delivery, form partnerships with local organizations to drive delivery system reform and improve health systems enabling the community will have better health and better care at a lower cost.
BMC has received a Certificate of Accreditation with Commendation from the American College of Surgeons’ Commission on Cancer. BMC’s cancer program is evaluated every three years by a physician surveyor who is trained to evaluate compliance with the 36 standards that are required for accreditation. A three-year with commendation accreditation is given to programs that comply with all standards and receive a commendation rating for one or more standard.
Kathleen Walz, RN, BSN, Pediatric Emergency Department, has received a 2011 Nursing Excellence Award from the Massachusetts Emergency Nurses Association. Walz was presented with the Nurse Practice Award at the Nov. 16 state council meeting. The award honors an emergency nurse who exemplifies outstanding nursing practice as demonstrated through clinical skills, nursing care and compassion. Walz developed and implemented BMC’s Pieces of Home -The Backpack Project. The program gives every child being placed in the emergency foster care system a new backpack filled with pajamas, socks ,underwear, a blanket and an age-appropriate toy or personal item to take to his/her emergency foster home.