The BMC Brief
July 19, 2011 Volume 1, Issue 5
Boston Medical Center is nationally ranked No. 33 in geriatric care and No. 39 in pulmonology, according to a U.S. News & World Report survey. BMC is also recognized as high performing – in the top 25 percent of hospitals across the country – in cancer, diabetes and endocrinology, gynecology, nephrology and rheumatology. The rankings showcase 720 hospitals out of about 5,000 hospitals nationwide. Each is ranked among the country’s top hospitals in at least one medical specialty and/or ranked among the best hospitals in its metro area. The seven specialties reflect areas in which BMC has been ranked consistently in previous years.
The rankings, now available online, will be published in the magazine's annual America's Best Hospitals guide, which will appear in the August issue.
"We are pleased that Boston Medical Center continues to be recognized for its excellent medical care," says BMC President and CEO Kate Walsh. "This achievement reflects the commitment of our caregivers, researchers, staff and board members to our mission to provide exceptional care, without exception.”
U.S. News & World Report publishes Best Hospitals each year to help guide patients who need an especially high level of care because of a difficult surgery, a challenging condition, or added risk because of other health problems or age. “These are referral centers where other hospitals send their sickest patients,” says Avery Comarow, U.S. News Health Rankings Editor. “Hospitals like these are ones you or those close to you should consider when the stakes are high.”
Imagine you are a 19-year-old mother of two. You are unemployed and your boyfriend has just left you. You have $10 in the bank. And for the next month, you must provide food, clothing and shelter to your family. What do you do?
This was the challenge posed to 50 new pediatric residents as part of a poverty simulation held last month. Facilitated by the Medical-Legal Partnership | Boston, which partners health care providers with legal advocates to help low-income patients, physicians in the Boston Combined Residency Program in Pediatrics at Boston Medical Center and Children's Hospital Boston role-played the lives of low-income families, from single parents trying to care for their children to senior citizens trying to maintain self-sufficiency on Social Security. Armed with play money, transportation tickets and stuffed animals representing children, residents traveled from one community resource office to another – in 15-minute increments representing a week – seeking assistance to achieve their one common goal: survival.
According to the U.S. Census Bureau, 43.6 million people were living in poverty in 2009, the highest number since 1994. Currently 50 percent of BMC patients live in poverty, many whom suffer from stress, anxiety and poor health. Working to understand and address the factors that contribute to patients’ health, including poverty, is an important element of good care, says Cristina Dacchille, an attorney with BMC’s Medical-Legal Partnership | Boston.
“The simulation gives residents a sense of the chaos in our patients’ lives,” she says. “They are working minimum-wage jobs, trying to feed their children and pay rent on time. They often stand in line for hours to apply for government assistance, like food stamps, only to get to the front and be told they don’t have the paperwork they need. By walking in the shoes of those living in poverty, our hope is that residents gain a greater understanding of the positions of their patients and learn why they need to be advocates for them.”
Forty-five minutes into the simulation, it is week three, and half of the families have been evicted from their apartments. Most are unable to feed their children. And by month’s end, only three families meet the goals of providing food, clothing and shelter.
Following the simulation, the residents talked about their experiences, acknowledging how difficult it was to survive.
“By the second week, I sensed the inevitability that my family was going to be evicted,” said one participant.
“Everything took forever because I had to fill out so many forms,” said another.
“My health definitely came last because survival came first,” observed a third.
“Think about how hard patients work to make it to their appointment with you,” Dacchille tells the group. “They used valuable resources to get there and are giving up precious time.”
And when patients make it to their appointments on time, it’s important to acknowledge it, says Duncan Henry, MD, BMC pediatric chief resident.
“When I see parents of young patients doing something well, I tell them they’re doing a good job. By simply offering words of support, we can make a big difference.”
The Medical-Legal Partnership | Boston, founded at BMC, partners health care providers with legal advocates to help low-income patients meet their basic needs for food, housing and utilities, education and employment, health care, and personal and family stability and safety. This is the fifth year the Partnership has provided simulation training to residents.
Boston Medical Center researchers have found So-Cheong-Ryong-Tang (SCRT), a traditional Korean medicine widely used for the treatment of allergic diseases in Asia, alleviates asthma-like pulmonary inflammation via suppression of specific chemokines or proteins. These findings appear online in the Annals of Allergy, Asthma and Immunology.
Asthma is a unique form of chronic respiratory disease characterized by reversible airway obstruction and pulmonary inflammation. It represents one of the most common chronic inflammatory diseases affecting an estimated 300 million people worldwide with an expected increase to 400 million by 2025. The sharply rising prevalence and incidence of asthma has caused global concern both in the developed as well as in developing countries.
The researchers, led by Jiyoun Kim, PhD, Pathology and Laboratory Medicine, found SCRT treatment significantly reduced airway hyper-reactivity as measured by both whole body plethysmography and direct measurement of airway resistance. The scientists report that the immune response of pulmonary inflammation was significantly inhibited by SCRT treatment as demonstrated by reduced plasma IgE antibody levels and improved lung histology.
Coughing is often a symptom of illness. But for patients who cough post-surgery, it can be a sign of something good: the prevention of pneumonia.
Deep coughing is encouraged post-surgery to expand the lungs and help prevent pneumonia and other breathing difficulties patients may face after surgery. Last August, Boston Medical Center surgeons and nurses developed a new program, called I COUGH, which aims to reduce the number of cases of post-operative pneumonia and minimize the amount of time patients stay on ventilators after operations. The program’s goal is to decrease the number of post-operative pulmonary complications by at least 50 percent hospital-wide, and is one of several Quality and Patient Safety initiatives focused on improving the safety and quality of patient care.
I COUGH stands for:
All patients who undergo major operations, particularly those under general anesthesia, perform these activities post-surgery, and regular practice of them should improve pulmonary outcomes, says BMC surgical oncologist David McAneny, MD.
“Early results indicate steady improvement in care,” says McAneny, the Department of Surgery’s Vice Chair for Quality and Patient Safety, who is spearheading the initiative, along with nurse Karen Weinstock, BSN.
The program starts with education. Prior to admission, patients receive brochures and view a video on the importance of participating in I COUGH. They also are given instructions on how to use the incentive spirometer. Post-surgery, BMC nurses care for patients based on pulmonary care orders they receive electronically from surgeons. This helps guide the standardized care of patients.
McAneny says the program’s success is predicated upon patients and their families understanding, anticipating and appreciating high standards of care, including early post-operative mobilization.
“It is essential to educate both patients and staff to modify longstanding practices in order to reduce the incidence of pulmonary complications,” says McAneny, “and the results underscore the critical roles of surgeons and nurse managers in leading culture change.”
Results of the first year of the program are expected in early fall.
Allergy sufferers, breathe a sigh of relief.
Boston Medical Center now offers sublingual (under the tongue) immunotherapy to adults and children suffering from seasonal and year-round allergies, eliminating the fear and frequency of allergy shots. BMC is the only Boston teaching hospital that offers this treatment method.
According to the Asthma and Allergy Foundation of America, one out of every five Americans suffers from allergies. Common inhalant allergies result from exposure to grass, weed, tree pollen, dust mites and/or various molds. Dog or cat allergies also may cause symptoms such as itchy eyes, sneezing, nasal congestion and wheezing. Disorders like asthma, sinusitis, ear infections and laryngitis can be exacerbated by allergies.
Unlike traditional treatment for allergies where a patient visits her physician on a weekly basis for anywhere from two to four years to receive allergy shots, sublingual immunotherapy treatment involves the patient placing a drop of immunotherapy serum under the tongue in the comfort of home on a daily basis. This treatment typically only requires a visit to the allergist every six months, and research has found that allergy sufferers who receive sublingual therapy have few adverse reactions, such as itching under the tongue or in the mouth.
“We have found this treatment method works best for patients with single or multiple allergies whose allergic symptoms are resistant to medication,” explains BMC Otolaryngologist Elizabeth Mahoney, MD. “Patients who do not have the time to come for a weekly allergy injection at their doctor’s office or who are wary of needles are ideal candidates for sublingual immunotherapy. The treatment is a leap forward in being able to treat allergy patients.”
BMC’s Department of Otolaryngology currently has around 20 patients receiving sublingual immunotherapy. Although this treatment is not covered by insurance yet, the fact that patients no longer need to make weekly visits for their shots could result in lower out-of-pocket expenses.
“Patients who no longer need to visit their doctors weekly are saving on co-payments, transportation and parking costs as well as from taking less time off from work or school,” says Mahoney. “In the end, sublingual treatment may pay for itself as well as being more convenient and less painful.”
Patients share their BMC experience
I want to send my highest commendations to the Amyloid Treatment and Research Program and its staff, not only for working out a strict protocol for care and steps toward cure of amyloid patients, but also for so diligently training the personnel at the Newton Pavilion campus to maintain the protocol, anticipate problems, and deal with each and every step in a professional, competent manner. The people on Newton 7E know the drill and they know how to handle the idiosyncrasies and complications of amyloid patients, all the while keeping patients well informed as to what to expect and what they will be doing to counteract problems that arise.
Everyone on the staff on 7E, from top-level physicians to the cleanup crew, from the nurses and aides to the cafeteria/food service personnel to the housekeeping crew, do their jobs with courtesy, efficiency, competence and professionalism. I could not have been in better hands, and I am eternally grateful for the medical care I received and the many kindnesses that I was shown during a very difficult time in my life.
Boston Medical Center is truly a “Center of Excellence” for amyloid treatment, and the people associated with the Amyloid Treatment and Research Program are dedicated to not just treating, but curing this rare and debilitating disease.
I am a physician myself, and I can say unequivocally that the physicians and staff of the Amyloid Treatment and Research Program and the Boston Medical Center Newton 7 East ward are the most capable, caring, efficient people I have ever dealt with in a clinic or hospital setting.
Thank you and your facility for giving me outstanding medical care and a chance for a cure and a better life. Your institution and its programs are the best.
South Bend, Wash.
BMC Team Takes Steps
Twitchell named Director of Pharmacy
"I could not be more pleased to have David join the Clinical Operations leadership team,” says Lisa O’Connor, RN, BSN, MS, NEA-BC, Senior Vice President of Clinical Operations and Chief Nursing Officer. “I am confident that David will lead our Pharmacy into its very bright future."
Doran named Director of Maternal Child Health
In her new role, Doran is responsible for the pediatric emergency department, the pediatric inpatient unit, the pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), labor and delivery and mother baby areas of the hospital.
“We welcome Michelle's leadership on the nursing director team,” says Kim Perryman, MM, RN, NE-BC, Vice President for Nursing Operations. “She has a strong background in maternal child health and in promoting clinical excellence and professionalism in nursing. Throughout her career, Michelle has been a continued advocate for children and families and is committed to quality patient care."
Sorafine named Manager of Employee Relations and Employment Counsel
In her new role, Sorafine oversees the day-to-day activities of the Employee Relations team, which consists of four senior HR generalists and a coordinator. She is also involved in the day-to-day operations of Labor Relations, works closely with the Office of General Counsel and continues to support the Nursing group.
The Society for Investigative Dermatology has named Barbara Gilchrest, MD, editor of the Journal of Investigative Dermatology. Gilchrest is the former Chief and Chair of Dermatology at BMC/BUSM, where she directed a large laboratory, the joint Boston University/Tufts dermatology residency program, and a National Institutes of Health (NIH)-sponsored post-doctoral research training program. Her official term begins June 1, 2012.
Barbara Corkey, PhD, Director of BMC’s Obesity Research Center, is the recipient of the American Diabetes Association’s prestigious 2011 Banting Medal for Scientific Achievement Award, the association’s highest scientific award that honors an individual who has made significant, long-term contributions to society’s understanding of diabetes, its treatment and/or prevention. The award is named after Nobel Prize winner Sir Frederick Banting, who co-discovered insulin treatment for diabetes. Corkey has been a leader in the fields of metabolism, diabetes and obesity for more than 35 years. Her seminal work on the molecular basis of nutrient signal transduction has had a major impact on society’s current understanding of health and disease.
Jeffrey Samet, MD, Chief of the Section of General Internal Medicine, has been selected as a National Institute on Drug Abuse (NIDA) International Program 2011 Awards of Excellence winner. Samet was recognized for his commitment and investment in mentoring scientists in their pursuits in patient-focused drug abuse research and treatment. Samet has influenced the careers of innumerable young researchers both in the United States and abroad. He helped create the NIDA-supported Chief Resident Immersion Training program, a four-day immersion training for incoming chief residents and their faculty mentors on state-of-the-art methods to diagnose, manage and teach about substance use disorders.
BMC recently was honored with the Founding Hospitals Recognition Award at the National Association of Public Hospitals and Health Systems (NAPH) 30th Anniversary Conference in Chicago. BMC is one of the five founding members of the NAPH, which identified the need for an association that could advocate for improved coverage, access, and the general well-being of the most vulnerable patients in the American health system.