Communication with Referring Physicians
To continue providing highest quality patient care it is essential to continue to communicate with referring physicians. Information must be complete and timely. Referring physicians have repeatedly indicated the need to receive information about their outpatients and regular updates on their inpatients. It is particularly important that any patient discharged has necessary information transferred to the physician or facility that will be following the patient. The hospital offers several systems to contact referring physicians. Telephone, fax, and e-mail can be used depending on the clinical information and patient condition.
1. All Partners physicians phone numbers, pagers, and those with e-mail addresses are available through the Partners Applications, Partners Phone Directory.
2. Many physicians phone numbers, pagers, and e-mail are available through the BICS telephone directory system.
3. Brigham and Women's Teleservices (ext. 8288, 800-BWH-9999) is available to contact physicians and leave messages.
4. Through Partners internet site www.partners.org you can link to each of the
Partners institutions.
New federal initiatives regarding gene therapy trials
NIH and the FDA on March 7 announced a set of new initiatives to further strengthen the safeguards for individuals enrolled in clinical studies for gene therapy. These two new initiatives—the Gene Therapy Clinical Trial Monitoring Plan and the Gene Transfer Safety Symposia—complement and advance current patient protections.
To buttress the rigor of oversight, FDA will require that sponsors of gene therapy trials routinely submit their monitoring plans to the FDA. In addition, in those instances where the gene therapy trial has an independent data and safety monitoring board (or equivalent) associated with it, the board’s findings and recommendations regarding patient safety need to be shared with the IRB, FDA, and NIH. In some gene therapy trials, one or more of the investigators is also the sponsor or a member or employee of the sponsoring organization. NIH will work to develop procedures to further assure
appropriately independent oversight of the conduct of such trials.
In a second new initiative, NIH and FDA will enhance patient safety by providing
critical forums for the sharing and analysis of medical and scientific data from gene transfer research. The symposia, which are expected to take place about four times a year, will bring together leading experts in gene transfer research and give them an opportunity to publicly discuss medical and scientific data germane to their specialties. These symposia will address such gene transfer topics as monitoring of data safety; cardiovascular complications of vector administration; good clinical practice in research; cell and gene therapy guidance development for product quality control and assurance; entry criteria and informed consent for participants in gene transfer research; and use of drugs to control promoters in gene therapy vectors. Future symposia also will focus on topics such as the use of a particular vector, a specific disease for which gene transfer is an experimental therapeutic approach (such as hemophilia, Alzheimer’s disease, or sickle cell disease), and/or a specific population of patients enrolled in gene transfer studies, such as newborns, children, the elderly, or normal volunteers.
To further increase their educational outreach efforts, FDA and NIH also will provide support for professional organizations and academic centers interested in holding safety conferences focused on gene therapy.
Physicians Approve Stage I – Major Step Towards Formation of Physicians Organization
The first stage in the development of the new Brigham and Women’s Physicians Organization (BWPO) has been accomplished. During the month of February, the physician members of the Brigham Foundations for Medicine, Surgery, Anesthesia, Radiology, Pathology, Orthopedics, and Obstetrics and Gynecology voted to approve changes to their Foundation bylaws which implement Stage I, a major step towards the formation of the BWPO. The amendments to the by-laws make Brigham and Women’s/Faulkner Hospitals, Inc. (the parent corporation) the sole “Member” of each Foundation. Stage I, which allows the BWPO to perform many of its intended functions, passed by a 91 percent majority vote across the seven foundations (330:32). The necessary regulatory approvals are expected to be received by April of this year.
As soon as the regulatory process is completed, Stage I BWPO will provide the legal structure for certain cooperative business relationships between Brigham and Women’s physicians and the Massachusetts General Hospital physicians. This new structure allows BWH physicians to join the other economically integrated Partners physicians to negotiate all contracts with third-party payors. A new BWPO Board will soon start meeting and will appoint a Contracts Committee made up of physicians.
With the successful approval of Stage I complete, each foundation, along with the BWPO steering committee and the BWPO transition team, will continue to evaluate the possibilities for central legal, accounting/audit, human resources, and information systems.
New Do Not Resuscitate Form
The state of Massachusetts now requires a signed "Do Not Resuscitate" form be on file for each patient who has elected this status. The presence of this Comfort Care/ DNR Verification form and/or bracelet will be the only acceptable verification order followed by emergency medical technicians. This applies to all patients who leave the hospital who are transferring to their home or extended care facilities. Care coordinators or nurses provide the form, and it is the responsibility of the attending physician to sign the form and also obtain the signature of the patient or family member. The form should be signed prior to the expected time of discharge to prevent delays. The care coordinators are happy to assist physicians, patients, and families.
Partners Principles of Patient Care
Partners HealthCare System has committed to providing the highest quality of care to our patients throughout the system. George Thibault, MD, and Sheridan Kassirer of Partners lead the effort to formalize a set of principles of care for our patients. The development team included leaders from North Shore Medical Center, Massachusetts General, Partners Community Health Care Inc., Partners Community Health Care Inc., Vicki Amalfitano, Brigham and Women's Vice President of Marketing, and Drs. Robert Goldszer, Troy Brennan, and David Brooks. The principles can be used as a guide for standards of care. All clinicians should expect patients to be cared for according to these principles. The leadership of Partners HealthCare and the each institution has approved the principles.
The principles affirm Partners’ commitment to quality and measuring success by clinical outcomes, patient satisfaction, personal satisfaction, and optimal resource utilization. Partners will provide information to patients and families and respect the relationships of patients with their physicians. When a patient is admitted to a hospital a single physician will assume responsibility and be available to the patient, family, and referring physician. The full principles can be seen at www.bwh.partners.org internal medicine, physician training.
Presently a team of physician leaders from Brigham and Women's, Massachusetts General, Partners Community Health Care Inc., North Shore Medical Center, Newton Wellesley Hospital, and Partners HealthCare System are working on the dissemination of the principles, implementation, and monitoring. If you would like to assist with this process please contact Dr. Goldszer, Vicki Amalfitano, or Dr. Michael Belkin.
Faculty Examiners Needed for Comprehensive Exam
Harvard Medical School has recently adopted a comprehensive method of evaluating its fourth-year students, an OSCE (Objective Structured Clinical Examination) designed to evaluate students’ ability to integrate the knowledge, skills, and attitudes they have acquired over their three years of medical education, as well as offer insight into the design of the curriculum itself. Within the next few years the NBME (the Board exams) will include an OSCE format, so one of HMS’s aims is to familiarize the students with this mode of examination.
You are invited to participate as a faculty preceptor, offering students direct feedback on physical exam, clinical reasoning, communication, and other skills. Students last year reported that this immediate feedback from faculty was by far the most valuable part of the exercise.
The fourth-year OSCE will take place from July 24 to August 3, 2000. CME credit is available for participants. For more information, please contact Julia Graham at 432-1808 or oscecoordinator@hms.harvard.edu.
BWH Moves Forward with Revenue Management Plan
Hoping to enhance patient satisfaction while improving revenue collections by as much as $8 to $10 million, the hospital is moving forward with a management initiative designed to reduce the number of ambulatory claims denied for payment by third-party payors, and to shorten the time it takes to bill for and collect patient care revenue. The initiative will strengthen the registration process across all sites of service by hiring a new director of Ambulatory Registration and expand the scope of services offered by the department. In addition, we will create an Ambulatory Business Office to oversee process improvement, quality management, and staff training for all hospital ambulatory services. The comprehensive plan will ultimately address all aspects of the revenue cycle (such as charge capture, coding, EDI techology, etc.) to improve overall performance. More information is available by contacting
Dan Gross at ext. 7899.
Million-dollar gifts announced in Palm Beach
Nearly 250 guests joined BWH administrators and physicians for the fourth annual dinner celebration in Palm Beach at The Breakers on March 3. Among the highlights of this event were announcements of two $1 million gifts from benefactors Ruth and Carl Shapiro and Michele and Howard Kessler, event co-chairs.
“Leading the Pursuit of Discovery” was the theme for the evening, emceed by President Jeffrey Otten. Speakers included Samuel O. Thier, MD, president and chief executive officer of Partners HealthCare System; Michael Bell, BWH board chairman; Michael Zinner, MD, chair of Surgery; and Victor Dzau, MD, director of Research and chairman of Medicine. Dzau described revolutionary advances in medicine on the horizon. He also introduced Sally Mettler Joyce, a BWH stroke patient saved from debilitation by tPA, a clot-busting drug developed through trials at BWH.
Many BWH physicians shared their expertise at planned-giving and health seminars on topics ranging from Alzheimer’s research to innovations in breast cancer treatment. Next year’s event on March 2 will be co-chaired by BWH Trustee Gerald Schuster and his wife, Elaine.
New PICC Line Program Launched
A new PICC (Percutaneously Inserted Central Catheter) Line Placement service was launched at BWH on April 10th. This program was developed in response to both a tremendous growth over the last year in requests for PICC line placements by
the IV Team and Interventional Radiology (IR), as well as resulting delays in discharge and patient care. Under the current restructuring, PICC line placements will now be coordinated by the existing Metabolic Support and Line Placement Service, while preserving the expertise and involvement of the IV nursing and IR teams. Additional physician assistant resources have also been allocated to the team for triaging of requests and performance of bedside ultrasound-guided line placements.
The following abbreviated guidelines for appropriate PICC line use were recently approved by the hospital and Medical Staff Executive Committee:
• A PICC line may be placed if it anticipated that it would be needed for more than
10 days but less than eight weeks.
• A PICC line may be preferable to placement of a subclavian or jugular catheter in patients who are coagulopathic, have anatomic abnormalities of the chest region, or have open wounds of the chest region.
PICC line insertion is generally not appropriate under the following circumstances:
• In patients who are bacteremic or systemically infected, or who have a history of
bacteremia or systemic infection within 48 hours of the anticipated PICC insertion.
• In patients who are in an ICU in whom central venous monitoring needs, delivery of blood products, and frequent line changes may make other central venous access devices more appropriate.
• In patients for whom the sole indication for PICC insertion is parenteral nutrition administration, but who are candidates for enteral nutrition.
All PICC requests must now be made through the computer order entry system. This can be done in the following manner. First, select the patient for whom the PICC is being requested within the BICS CI system. Then type:
“O” for order entry,
“E” for enter new orders
“S” for sets/templates,
“M” for protocols,
“3” for PICC consult.
Then follow the instructions, and your request will automatically be forwarded to the Metabolic Support Service for processing. New PICC requests will be reviewed and processed Monday through Friday 8:30 a.m. to 3:30 p.m. New requests made after 3:30 p.m., Monday through Thursday, will not be reviewed until the following morning. Requests made after 3:30 p.m. on Friday will not be reviewed until the following Monday. PICC requests will not be reviewed on weekends or holidays at this point.
Please plan your PICC line needs accordingly.
For assistance or questions regarding PICC lines, or any central venous or enteral access device placed by the MSS, please call the MSS Parenteral and Enteral Access Coordinator, Patti Rizzo, RN, at ext. 8880.
William Randolph Hearst Fund
The William Randolph Hearst Fund has been established at Harvard Medical School in honor of Isabelle and Leonard Goldenson and Ethel and Jack Hausman on behalf of disabled children. The income from the fund is to be used by a member or members of the Faculty of Medicine to support research in the area of pre- and peri-natal medicine, with particular emphasis on those factors important for the prevention of neuromotor disabilities. Among other uses, funds may be used to supplement support for ongoing research from other sources. Preference will be given to junior and/or new investigators. An award amount of $25,000 will be available for an award period of July 1, 2000, to June 30, 2001. For more information contact Kemith LeBlanc 432-2663 or kemith_leblanc@hms.harvard.edu. Application guidelines are available at www.hms.harvard.edu/spa/funding/ fundmain.htm. Applications are due on May 1.
Research Council Retreat
“The Research Enterprise, 2001-2010: A Decade of Opportunity” was the theme of an annual daylong retreat sponsored by the BWH Research Council on March 7. More than 180 investigators took stock of past successes and debated ways to strengthen population studies, clinical medicine, basic science, and translational research.
In open discussions and breakout sessions, participants debated ways of attacking challenges that will face them in the decade ahead. How should they manage explosive growth in a research enterprise that has grown 1,000 percent since 1980? How might they foster greater collaboration between disciplines? How should they set priorities for growth and expand involvement in promising new arenas—genomics, imaging, informatics, and innovative therapeutics, for example—while also ensuring that there will be adequate space and funding in an era of declining clinical revenues? In addition, attendees outlined needs for additional space, core facilities, stronger academic and industry alliances, and additional philanthropic support. They also reaffirmed their commitment to nurturing the careers of outstanding young men and women who will usher medicine into the new millennium.
Protect patient confidentiality—
Do not discuss patient information in public places.
Ethics Service
BWH’s Ethics Service offers services to both caregivers and patients to help them deal with ethical questions surrounding patient care. A wide range of consultations are available under the direction of Lynn Peterson, MD, and Martha Jurchak, RN, PhD, and are discussed in a new brochure, “Ethics Service: Providing Assistance with Difficult & Complex Patient Care Decisions.” Call the service at ext. 8590 for more information.