News for and about Faulkner Hospital Employees

FOCUS ON

FAULKNER
Health Care Unseen
By Joe ODay, Director or Faulkner Hospitals Pharmacy A friend of mine from college, knowing I had decided to transfer to pharmacy school, would goad me, saying I heard pharmacists take pills from big bottles and put them into little bottles, and start laughing. Hed been admitted to dental school. I may have to count pills, Id respond, but youll be staring down throats the rest of your life. Dispensing medications counting pills is a fundamental activity in pharmacy. Patients need correct medications, need them promptly, and require appropriate education. But there are other parts to the job, just as important.

IN

THIS ISSUE
creates welcoming environment

P3: Bariatric Improvement Team P6: Physician group expands to meet growing needs P9: Dear Faulkner Hospital P11: Professionalism and the Culture of Safety P12: Citizenship classes offered at Faulkner P15: Faulkner Hospital receives stroke award

C .A.R.E. STANDA RDS

C. Communicate your commitment to providing high quality service A. Appear and act as a professional R. Respect all individuals E. Extend yourself Remember to plan for language needs (interpretation, translation and assistive devices) for all patients that may require this extra service.

Pharmacists help patients every day by intervening in their medication orders, discovering and correcting drug interactions and therapeutic duplications, educating other health care workers and patients, and helping to ensure the best outcomes. From an outsiders perspective, most of these actions are under the radar. A few years ago I received an urgent phone call from a medical resident covering the intensive care unit at my community teaching hospital in the Boston area. His patient had attempted suicide by drinking an extremely poisonous substance. The conventional treatment for such a poison was to administer intravenous ethyl alcohol in amounts to keep the patient intoxicated. By competing with the substances metabolism, the alcohol prevents toxic metabolites from forming, avoiding renal failure and metabolic I had encountered an identical situation years earlier at a different hospital. At that time, Poison Control helped us determine the concentration of the ethyl alcohol needed and how to prepare and lter these infusions. That patient survived with no permanent adverse effects, and when the physician on the case called days later to thank us, it felt great. Ten years later, the same poisoning had occurred, but there was a new antidote with fewer side effects than alcohol. Working with two other pharmacists, we acquired enough of the antidote to get the patient through this crisis, conferred with
continued on P4 Focus on Faulkner 1

abnormalities and allowing time for it to be removed by dialysis.

Partners HealthCare Strategic Initiative: What Happens Next?

Over the course of the past few months, we hope you have heard about the Case for Change across the Partners system and the strategic efforts underway to redesign the delivery of health care while making it more affordable for our patients. In the coming weeks, some of the best ideas from experts at Partners hospitals will be introduced at Faulkner Hospital. On the Care Redesign front, teams have been focused on specic disease conditions including stroke, diabetes, colon cancer and coronary disease (including heart attack care and coronary bypass). A separate group examining Patient Affordability has examined ways to reduce overall costs across the system. Both teams have assembled a list of preliminary recommendations as well as risks and challenges that need to be considered. Senior leaders from hospitals across the system are now in the process of reviewing and organizing these recommendations. Liaisons from all Partners institutions will begin to consider these ideas and how they will work at their hospitals. At Faulkner Hospital, senior physicians and our leadership team will lead this process. They will collaborate with clinical and administrative leadership from across the hospital to start tailoring these efforts to meet the needs of our patients. During this phase being dubbed the Test In the next few weeks, there will be additional updates and a report on how the Test Fit process unfolded here at Faulkner Hospital. This is an opportunity for you to get involved too by thinking of new and better ways to deliver care. If you see a process that can be done more effectively and efciently, please let your manager/ supervisor know. Also during this phase of the strategic initiative, you may have noticed that the Reputation/Communications Group has unveiled a public education campaign, consisting of several newspaper ads and a television commercial with a message that underscores the quality of care delivered across our Partners hospitals. If you have not yet seen the TV ad, you can view it on the Partners website. It is being aired on local stations, CNN, ESPN, and MSNBC. You can even nd the Partners ad during shows like 60 Minutes and 30 Rock. Tied to the advertising campaign is a website: www. connectwithpartners.org. This platform provides Partners with an external voice in the ongoing conversation about todays health care issues. We invite you to connect with the site. Fit phase hospitals across the Partners system will really begin to determine how change will work best at their individual institutions.

IMPLEMENTATION OF HIPAA 5010/ICD-10

As you may have heard, the Federal government has mandated changes to the 4010 HIPAA transaction standards (claims and eligibility) and the International Classication of Diseases (ICD) coding system. All covered entities, including health care providers, must convert from ICD-9 to ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) codes by the compliance date of October 1, 2013.

How will this change impact Faulkner Hospital, Partners HealthCare, the health care industry and you? Working with Partners, Faulkner Hospital has a project plan in place for this mandated change. In the weeks and months ahead, you will be receiving more formal communication about this project as it relates to your department, including an initial training survey that you will receive by the end of March. If you have any questions, please contact Debra Torosian at 617-983-7458.

Published by Marketing and Public Affairs (617) 983-7588 / djgoldberg@partners.org We welcome your feedback and suggestions for future issues.

2 Focus on Faulkner

Bariatric Improvement Team: creating a welcoming environment

By Carol Shea, RN, Quality Improvement Department

Faulkner Hospital has played a leadership role in caring for bariatric patients for many years. Bariatrics is the eld of medicine that deals with the causes, prevention and treatment of obesity. Obesity is dened as a body mass index (BMI) of 30 or greater. During the past 20 years there has been a dramatic increase in obesity in the United States and is a major risk factor for cardiovascular disease, certain types of cancer and Type 2 diabetes. Faulkner Hospital has been designated as a Bariatric Center of Excellence by the American College of Surgeons, which ensures we abide by certain standards of care. As part of Faulkners commitment to best practices in the care of this population, the hospital has established a Bariatric Improvement Team (BIT). Who we are: The Faulkner Hospital has successfully recruited a new surgeon for Bariatrics who is scheduled to arrive later this year. While waiting for the new surgeons arrival the BIT has been created and meets monthly. The group consists of members from various disciplines of the hospital including Nutrition, Psychiatry, Nursing, Social Work, Education, Quality, PACU, Perioperative, OR and Physical Therapy. This interdisciplinary approach assures care of the total patient. What we have done: The Team has been working on hospitalwide improvements to address the needs of bariatric patients, their families and staff. For example, modied furniture, including beds, wheelchairs and toilet seats have been purchased for patient comfort and safety.

an environment that offers privacy and support. It is hoped that bariatric patients will feel more comfortable in developing an exercise regime to enhance their weight loss program.

the bariatric patients. Based on the growing number of statistics about obesity in the United States, and the health problems associated with it, we will continue to work with our patients who may have weight

Perhaps the most important work of the BIT is its sensitivity to the emotional difculties that many patients experience due to their size. Our team initiated a campaign to raise public awareness of attitudes about bariatric patients during the last years Safety Fair. A poster was presented that explained the difculties that patients experience on a daily basis due to their size. The awareness campaign is now focused on developing Faulkner Hospital as a leader in providing exceptional care to our bariatric patients in a sensitive and encouraging environment. Where we are going:

concerns, as well as family members visiting that need some consideration or resources due to their weight. What can you do? We appreciate staff input as we move forward and take the next steps. Be on the lookout this spring for a survey where you can tell us what improvements you think would further develop Faulkner Hospital as an exceptional center of care for the bariatric patient. To read more about what is available in bariatrics go to Faulkner411.org under Departments and Services. If you have information that you would like added to this section you can contact Carol Shea at 617-983-7980.

An important added component of care developed by this committee is the establishment of a specialized bariatric exercise program which can be used pre- and post-operatively by creating

The BIT intends to educate the hospital community and to gain its support in creating a welcoming environment for everyone. We believe our efforts will benet all our patients and family members, not just

Focus on Faulkner 3

Health Care Unseen, continued from P1

the resident to ensure correct dosing and appropriate duration of treatment, and prepared and delivered it to the patients nurse, describing its mechanism of action and side effects. Over the next few days, we delighted in the fact that our patient survived with no permanent physical injury.

cardiologist who ordered it looked up from the patients chart and smiled, a silent thank you crossing his lips. I remember an anesthesiologist once asking me to mix a new type of preparation, an infusion to be administered into the epidural space. He wanted to use it on an inpatient

mixture of a local anesthetic and a narcotic. We gured out the amounts of each drug in the mix, ensuring compatibility, stability, and correct dose. It was administered to the patient with great pain-relieving results. Our epidural analgesia program had begun and quickly spread to include many other patients. Epidural analgesia would become an important tool in the world of pain relief. Several months later, while checking medication stock on the intensive care unit, the chief of anesthesia pulled me into a patients room and introduced me as the guy responsible for relieving your pain. I thought it a kind and overstated gesture by a nice guy, but Ive remembered it through the years. A few years ago there was a patient admit-

. . . After handing it over, I relaxed and caught my breath, then walked past the nurses station towards the elevator. The cardiologist who ordered it looked up from the patients chart and smiled, a silent thank you crossing his lips.

I once sprinted up four ights of stairs carrying gingerly the life-saving clot buster Alteplase (TPA) in order to get it into the nurses hands so she could administer it to a patient suffering a heart attack. The sooner it gets infused, the greater the amount of heart muscle saved, and the better the chances are of a successful outcome. After handing it over, I relaxed and caught my breath, then walked past the nurses station towards the elevator. The

with terminal cancer who, despite receiving high doses of narcotics intravenously, had intractable pain. Epidural analgesia is a technique where the tissue space around the spinal cord is injected or infused with an analgesic. Benets include enhanced pain relief (the drug is administered directly to the central nervous system), and fewer side effects (the amount needed is small so less drug gets into the systemic circulation). The preparation in this case would be a

ted to a surgical oor with an exceptionally confusing drug regimen. She claimed to have allergies to the excipients (inactive ingredients) in medications, was on more than ten different drugs, took them throughout the day, and had set up a nicky system of self-medication. This patient requested to take her own medications. Hospitals have a policy requiring that only those medications purchased and stocked by that hospital can be used while the patient is under its care.

FAULKNER PHYSICIAN DONATES ORIGINAL ARTWORK

Dr. Raymond Murphy, former Chief of Faulkner Hospitals Division of Pulmonary Care, recently donated ve original pieces of his artwork to Faulkner Hospitals Patient/Family Resource Center. Dr. Murphys donated artwork is of birds, owers and other things found in nature, which he has recreated using pastels and watercolors. The paintings were done over the last ve years and donated to the hospital in 2010. It is Dr. Murphys hope that viewers of his artwork are able to see the beauty in the world despite the many problems life throws at them. I donated them as an expression of my thanks to the wonderful people Ive worked with, as well as to the patients and their families who have beneted from the excellent care they received at Faulkner Hospital, says Dr. Murphy.

4 Focus on Faulkner

This makes certain the drugs have been obtained from a reputable supplier, have been stored properly, and are still in date. However, sometimes an exception is made, and only if the patients medications are properly labeled, can be identied by the pharmacy, and will be administered by the patients nurse. This patients physician said that her certainty of reacting badly to the hospitals drugs (many identical to the ones she had brought in) was causing her great angst. We acquiesced and picked up the patients Tupperware container with her medications inside. They were a mess, mixed together in various prescription bottles. Another pharmacist and I spent hours sorting through, organizing, and identifying as many as we could. As we nished up, I noted the time: 6 pm. I hoped to make my hospitals medical book club meeting that night. We were to discuss Anne Fadimans book The Spirit Catches You and You Fall Down. It tells a harrowing story of a Hmong family in California, how a lack of cultural understanding contributes to the tragic death of a child to seizures, and highlights the importance of understanding the patients side of an interaction, of the role of empathy in the healing process. The group was to meet at 6:30 pm.

My assistant had to leave, so I brought the patients reorganized medications to the nursing unit to review them with the nurse and physician. I needed something claried and asked the medical resident if I could see the patient. As we entered the room and the resident introduced me as The Pharmacist, the patient became agitated, pointed at me and shrieked, thats the guy whos screwing me up! I had the impulse to say I just wasted three hours guring out the meds just to make her happy. But there was nothing to ght against. My job was to help. When I gently reassured her that she could take her own medications and that I only needed one question answered, she settled down. Arriving at the book club at 7:30 pm, I mentioned the irony of having read a book about the dangers of miscommunication between patients and caregivers and what I had just experienced. I was upset, but had respected her fear about someone tampering with her system. The book had done its job. One evening I got a call that a patient had refractory thrombocytopenia (abnormally low platelet level), a potentially life-threatening condition, and that the physician wanted to try a seldom used medication. We worked out the dose with the patients resident and

consulting hematologist, and prepared it and educated the nursing staff about its administration. This, of course, occurred at the end of the day, making a long day longer. Finishing up afterwards, I thought of the stressful hours the process took, how the pharmacy had reacted quickly and successfully, and as I threw on my coat and walked outside into the damp, cold, winter night toward my car, I clenched my st and punched the air in victory. The drug was administered with good results: the patients platelets rose to safe levels. Days later, I asked our two pharmacy students, who rounded with the residents, about the patient. Shes a professional singer, they said. She sang O Danny Boy for St. Patricks Day, to thank everyone. I felt a wave of resentment. Surely we also deserved to receive this gift of thanks. No one knew that three of us had stayed hours after our shift to ensure her treatment went perfectly. Then I caught myself: We dont work for accolades; we work to get our patients well.

RESOURCE CENTER OFFERS NEW DIGITAL BOOK PLAYER

Faulkner Hospitals Patient/Family Resource Center (PFRC) recently received a digital talking book player on permanent loan from the Perkins Braille and Talking Book Library. The player utilizes book cartridges and downloads from the Library of Congress digital book collection. Each month, the With this player, we are now able to expand our offerings to patients who cant see or have difculties reading print, says Cara Marcus, Director of the P/FRC. Perkins Library will send the PFRC a new cartridge for their collection.

Focus on Faulkner 5

Faulkner Community Physicians group expands to meet growing needs

Patients granddaughter donates artwork

From left: Dr. Naureen Raja-Shaq, Dr. Glenn Allison and Dr. Khang Vinh Nguyen

Inspired by her grandmothers survival from breast cancer, 12 yearold Hanna Serena Kaye donated 11 inspirational drawings to Faulkner
Hannah Kaye

Faulkner Community Physicians recently added three new primary care physicians to their ofces in Hyde Park, Roslindale and West Roxbury to meet the growing need for PCPs in the area. Dr. Naureen Raja-Shaq has joined the staff of the Hyde Park ofce. Dr. Glenn Allison has joined the staff of the Roslindale ofce and Dr. Khang Vinh Nguyen has joined the staff of the West Roxbury ofce. All three are currently accepting new patients. I enjoy working with diverse patient populations in terms of different medical issues, ethnicities, ages and socioeconomic backgrounds, says Dr. Nguyen. Its a great privilege to be able to practice in an area Im so familiar with, states Dr. Allison. What I enjoy about primary care is getting to know patients and striving to form a trusting relationship that will allow me to accurately diagnose any health problems they encounter.

With the training theyve received and the collective experiences they bring to our medical group all three of these new primary care physicians will be an asset to this community for years to come, states Dr. John Lewis, Medical Director of the Faulkner Community Physicians practice in West Roxbury. While access to primary care physicians has continued to decline in recent years, were proud to be able to expand our services to meet the needs of our surrounding communities. Faulkner Community Physicians is a group of 10 physicians with ofces in 3 communities. Being involved in primary care allows me to get to know patients and their families on a long-term basis, says Dr. Raja-Shaq. For me, helping people from all walks of life is what makes primary care medicine so fascinating. For more information or to make an appointment, please call 617-983-7500.

Hospitals Sagoff Breast Imaging and Diagnostic Centre.

Each drawing has a different theme which offers words of encouragement to patients currently undergoing various types of treatments. One of the drawings is of a mermaid with the message just keep swimming, shown below. Others include animals and stars. When asked why she decided to make the donation, Kaye said I wanted to bring joy to the people and help them take their minds off of getting breast cancer treatment. She began drawing at age two and continues to create artwork as a student at the Carroll School in Lincoln, MA.

6 Focus on Faulkner

Community Corner
Walk for Life Faulkner Hospitals community walking program, Walk for Life, will resume after a long winter. The program is free and open to everyone in the community. Start walking to reduce your risk of heart disease. We will meet every Wednesday starting April 6 - November 16 at 2pm at the Arnold Arboretums Hunnewell Building. Everyone is encouraged to check with their physician before starting any new tness routine and you are always instructed to walk at your own pace. Note: We will not meet if there is rain or extreme heat. Powerful Tools for Caregivers Faulkner Hospital recently hosted a program, Powerful Tools for Caregivers which is sponsored by AgeWell West Roxbury. The program is a six-week event that incorporates learning the skills to cope with caring for someone with a chronic illness or for an elderly relative or friend which can be stressful physically, emotionally and nancially. For more information contact: Tracy Sylven in the Community Health Department tsylven@partners.org 617-983-7451 Fall Prevention and Fitness for Seniors Faulkner Hospital sponsors two exciting programs for seniors. The programs are in conjunction with the West Roxbury YMCA and AgeWell West Roxbury. The classes provide opportunities for seniors to explore various modalities of exercise, balance, exibility, and relaxation. They are designed to increase strength, balance, exibility and endurance. Balancing Mind, Body and More and Tai Chi are free of charge and offered several times a year. For more information on next sessions contact: Tracy Sylven in the Community Health Department tsylven@partners.org 617-983-7451 For more information contact: Tracy Sylven in the Community Health Department tsylven@partners.org 617-983-7451 Manning Elementary School Stacey Miller and Ania Fusiek from the Community Health Department taught a lesson with the K0 and K1 class on the spread of germs and germ prevention. The children participated in activities that taught them how to sneeze into their sleeves and they also learned a song on the proper way of hand washing. Healthy Conversations Tracy Sylven and Ania Fusiek from the Community Health Department held a Coconut Tasting offering coconuts and coconut water. Whole fresh coconuts were cracked open and the kids got to sample the fruit along with various avors of coconut water. Brooke Staats, RD from the Food and Nutrition Department worked with the 1st and 2nd grade Manning School classes on lessons for healthy foods and nutrition. Each grade had both a visit from Brooke to the school, as well as to the hospital, where during their lesson, they made healthy snacks. Faulkner Hospitals Healthy Conversations program is organized through the Community Health Department, which connects clinical staff with local community groups, to offer free educational presentations. For more information about how to participate contact: Stacey Miller in the Community Health Department sbmiller@partners.org 617-983-7907 In November, Dr. Derrick Todd presented on the topic of Arthritis to a local community group, comprised of retired senior citizens. Flu Vaccine Clinics The following staff contributed to the successful community inuenza vaccine clinics: Ninon Bastien Anne Marie Birmingham Sheila Delamere Candy Eggers Dow Helen Driscoll Karen Fuller Carol Garcia Lillian Go Nancy Harrington Judy Hayes Stacey Miller Amanda Nasson Paula OBrien Digi Rojas Rosemarie Shortt Paula Whalen Curley Middle School Job Shadow In February, the following staff hosted 8th grade students from Faulkner Hospitals newly established school partnership with the Curley Middle School, in Jamaica Plain: Mike Cacioppo Madeline Gervasey Ellen McKenna Shannon Vukosa

Focus on Faulkner 7

Process improvement helps discharge process

Dr. Stephen Wright, Chief of Medicine and Dr. Nina Chaln, MRCP, Hospitalist, recently attended the Clinical Process Improvement Program (CPIP) which is a part of the High Performance Medicine Initiatives at Partners Healthcare. The program, adapted from Intermountain Healthcare in Salt Lake City, UT, focused on educating doctors and other health care providers to identify and improve their clinical processes. The program also took them through completing an original project from start to implementation. The course met on six days over a four month period. We are always looking to improve and this program gave us the tools necessary to help facilitate improvements at Faulkner Hospital, says Dr. Wright. Their group, along with other clinical leaders, looked at various data collected by the High Performance 2.4 group at Partners in order to identify a subject for their project. This data looks at quality measures and the hospitals adherence to those standards. For the group project, they decided to take a closer look at hospital discharge documentation. In order to facilitate change, the group had to rst determine which missing data elements were causing lower than expected scores. The elds that they found were being left off the discharge documents were: 1. the hospitals contact phone number 2. condition of admission diagnosis at discharge (what happened after treatment) and 3. complete information about the prescription of Coumadin With the errors identied, the group began searching for strategies to eliminate them. One solution they came up with was to modify the template physicians were using to ll out the summaries in the hospitals clinical system, Meditech. By changing the way we create discharge documents at Faulkner, we are able to give patients and their physicians/caregivers a detailed explanation of what happened during their stay, says Dr. Chaln. By doing this, we ensure that both patients and their physician/caregivers understand their medical issues as they move out of the hospital to their next care environment. With input from residents, PA/NPs, and Information Systems, the group developed additional elds for this information that were either automatically populated or required before they could move on. The hospital contact number was set to auto populate like the patients name and other identifying information. The condition of admission diagnosis at discharge and Coumadin prescription elds were marked as required, and prompts were put in to alert the document preparer what needed to be done in order to move on.
Dr. Stephen Wright and Dr. Nina Chaln show off their certicates of completion for the Clinical Process Improvement Program.

GET THE LATEST PROGRAM INFORMATION, HEALTH TIPS AND EVENTS IN ONE OF THREE EASY WAYS:

1
Become a fan of Faulkner Hospital: http://www.facebook. com/faulknerhospital

2
Follow Faulkner Hospital on Twitter: http://twitter.com/ faulknerhosp

3
Sign up for online news delivered right to your inbox: http://www.faulknerhospital.org/ enews.html

8 Focus on Faulkner

Dear Faulkner Hospital,

My father suffered a horrible fall and I immediately brought him to Faulkner Hospitals Emergency Room for evaluation and treatment. From the moment we entered the hospital to the time we left every staff member we encountered treated us with genuine kindness and compassion. Beth Gangemi greeted us as we walked in and she immediately took our information and called for someone to get ice for his injuries. Lorraine Traft, RN immediately assessed my fathers condition and was very kind and warm to him while treating him. My father was immediately brought into an exam room and Anthony Paglia, PA was very thoughtful and caring while treating my father and made him feel very comfortable. There was a sweet nurse named Karen White that came in and sat next to my father on the It was a difcult situation to be in with my father and the treatment that he received at Faulkner Hospital made a bad situation more endurable. We are very grateful that we can count on Faulkner Hospital to treat our valued family members with respect, kindness and compassion. I am happy to tell you that my father is recovering very quickly and feeling much better. Thank you all for being there when we really needed you. stretcher and talked to him and made him feel cared for. Our nal encounter was with Kelly Mastroianni, RN who cleaned and treated my fathers wounds. Kelly communicated with my father before she treated him just so he was aware of what was going to be done and she was very gentle and sweet with him.

Dear Faulkner Hospital,

I am writing to thank you for the wonderful care of my mother while she was hospitalized at Faulkner Hospital. Most of the staff was helpful and measured up to expectations of a world class hospital, however, there were certain staff members on 6 south who were exceptional. Dr. Chaln was quite impressive not only as a skilled physician, but also as a leader and teacher. She advocated for her patient, managed the care team and listened to the concerns of the family and responded as quickly as possible. Her competence and awareness of cultural differences was outstanding. Not My family and I are truly grateful for the treatment received at your hospital. There was also a nurse whose name I do not recall. She attempted to meet my mothers every need, making her feel as if she was her only patient. The nursing supervisor whom I had the opportunity to meet was also a superb employee. She was competent, caring and very professional. only was she respectful and kind to all involved, she did this with ease.

Dear Faulkner Hospital,

My father was recently hospitalized at Faulkner Hospital and I am writing to commend the staff on the expert, compassionate care that they provided. From the nurse in the ED to the nursing staff and PCSs on 6 South, the care provided was outstanding. I would also be remiss if I did not mention the high level of customer service provided by transport, dietary and phlebotomy staff. Your staff exceeded my expectations in the high quality and safe patient care provided and, as such, should be recognized for their efforts. Staff was respectful and welcomed the input of family members in my fathers care. Two residents, Katherine Rose and Michelle Morse, exemplied the essence of patient- and family-centered care in their interactions with my father and his family.

Focus on Faulkner 9

Turn around time for robotic cases decreases

Faulkner Hospitals Process Improvement Department, led by Senior Consultant Sherman Zemler Wu has been working with staff members from multiple departments to help reduce the turn around time on robotic surgery cases. When the process rst began, it took staff 44 minutes from the time one robotic surgery patient was taken out of the OR to the time the next patient entered. With a goal of getting the turn around time to consistently be 20 minutes, the hospital is not only aiming to increase patient satisfaction but also looking to add more cases.

NEW TECHNOLOGY ALLOWS RADIOLOGISTS TO OPTIMIZE IMAGES

Faulkner Hospitals Radiology Department recently began using an eight-channel wrist coil in their MRI service to optimize both the patient experience and the images produced. The wrist coil utilizes eight channels, or frequencies, to provide more specic, high resolution images of the wrist and its components, as well as to maximize the comfort of the patient throughout the imaging process. These optimized images provide physicians with a more detailed view of the wrist, allowing them to better diagnose and treat the symptoms more accurately. The noise, or motion some images show, is also greatly reduced. Since we have implemented the coil we have seen a reduction in test time and patient satisfaction, says Catherine Brockington, RTRMR, Staff Technologist.

If we can cut down on the time it takes between cases then theres the potential to have more surgeons utilizing our robot, states Zemler Wu. Not only will this enhance our ability to start and end on time, but it will facilitate the ability to grow Brigham and Womens Center for Robotic Surgery at Faulkner Hospital by enhancing our reputation of having the most efcient Robotic Surgery team in Boston. In the rst quarter of scal year 2011, the OR team has been able to take the turn around time from 44 minutes down to 33 minutes. They were able to do this by developing new OR supply packs and implementing new parallel processes where nurses, OR scrub techs, and anesthesia are working in parallel to speed up the turn over time. Patients are now brought into the room while it is nishing being set up, which has already proven to cut valuable minutes off of the turn around time. On a regular basis, patients relay to me the wonderful care that they receive at Faulkner, and I am grateful to nursing, anesthesia, housekeeping, administration and my team for their signicant contributions, says Dr. Jim Hu. Patients whove been treated here in the past are loyal to continued treatment here and those new to Faulkner marvel at the world class care they receive. Im delighted at the 25 percent reduction in turnover time, and look forward to working with Sherman and others to improve the quality of care that we deliver.

10 Focus on Faulkner

Professionalism and the Culture of Safety

Maureen Fischer, RN, MSN

Professional behavior is a central component for a successful patient safety program and is necessary to truly establish a Culture of Safety. A Culture of Safety is one in which an organizations beliefs, attitudes, values and actions are evident through its strong teamwork, clear communication, and transparency about reporting errors and adverse events. An effective Culture of Safety assumes an institutional commitment to learn from mistakes in a non-blaming way. There must be recognition by the institution that while human error is inevitable, secure systems can be implemented to safeguard patients from harm. As part of Faulkner Hospitals commitment to patient safety, it has convened a multidisciplinary steering committee to promote professional behavior throughout the Faulkner community. While there is universal agreement that our hospital endorses the principles of professionalism and respectful communication, this is not enough. Faulkner Hospital is also committed to creating an infrastructure that sets clear expectations about behaviors and consequences for non-compliance. According to the Joint Commission, positive collaborative behaviors can be embedded in hospital culture, but clear policies, including sanctions, must be developed that address these behaviors. The Joint Commissions Sentinel Event Alert in July 2008 acknowledged a history of tolerance to unprofessional and disruptive behavior in health care. The Sentinel Alert required hospitals to combat this history by creating a Code of Professional Conduct that specically denes acceptable, unacceptable, and disruptive behavior, and to develop a fair and equitable process for addressing these behaviors. With this mandate, the hospitals steering committee has begun the process of establishing such a program at Faulkner Hospital. Disruptive behavior is known to pose a clear threat to patient safety and has been reported widely in several studies in medical literature,

including a 2005 study, entitled, Silence Kills. This study found that more than 20 percent of respondents reported actual harm to a patient as a result of disruptive behavior by members of the health care team. Faulkner Hospital began its efforts to respond to this serious issue by examining baseline perceptions of our own clinical staff about the prevalence of unprofessional and disruptive behavior within this hospital. The departments of Patient Safety, Risk Management and Quality Improvement distributed an anonymous and condential survey to the hospital community in August 2010. The response rate was greater than 40 percent, representing more than a dozen disciplines from a wide variety of departments. Seventy six percent of the respondents reported having witnessed disruptive behavior, which was higher than expected but in keeping with other published surveys. Unfortunately, of those respondents who had either witnessed or experienced disruptive behavior, only 52 percent had reported this to their supervisor, director or department head. After establishing our baseline, which will be used to gauge the effect of the new initiative and policies on expected improvements, the group drafted a code of professional conduct that meets Joint Commission requirements, and the steering committee is now considering how the institution will address non-compliant behaviors. When completed, there will be a hospital-wide educational roll-out of the code and related policies. The hospital encourages all staff to report unprofessional and disruptive behavior directly to appropriate individuals, or by utilizing the rL Safety Reporting system which now contains a specic eld for unprofessional behavior. It is hoped that the hospitals commitment to this important element of patient safety will continue to improve the high quality of care provided at Faulkner.

Faulkner Hospital offers two options to pre-register:

Please have your insurance card available when pre-registering. If you have pre-registered for your visit, please report directly to your appointment location. If you are not pre-registered or unsure if you are, please stop at the Information Desk upon arrival. They will direct you to your appointment or to registration as needed.

Online:
www.FaulknerHospital.org (24 hours a day)

Telephone:
BREAST IMAGING 617-983-7068 Monday - Thursday, 7 am - 8 pm Friday from 7 am - 3:30 pm Saturday from 8 am - 3 pm ALL OTHER SERVICES 617-983-7010 Monday - Friday from 6 am - 8 pm

Focus on Faulkner 11

Volunteer Coordinator wins YMCA award

Faulkner Hospitals Volunteer Coordinator, Alphonso Westley, has been named a YMCA Achiever for 2011. He is one of only three recipients throughout Brigham and Womens/Faulkner Hospital to receive this years award. The criteria for the award looked at a candidates contribution to Partners and their willingness to impact the lives of minority youths in the Greater Boston area. Westley was nominated by Rosemarie Shortt, Director of Patient/Family Relations and Volunteer Services. Throughout Alphonsos recruitment and retention work, our diverse volunteer workforce now more closely resembles the communities we serve and reects the multiplicity of ages, cultures and other demographics of our patient population, Shortt writes in her nomination letter. Many of these volunteers are students and their volunteer work at Faulkner provides them an opportunity Along with this award, Westley must also complete 40 hours of community service the program sets forth. In April, he, along with other winners across the city, will be formally recognized at the YMCAs Annual Recognition Gala.
Alphonso Westley

to view the healthcare environment rst hand, often inuencing them in their educational and career choices. Outside of his work at Faulkner Hospital, Westley is a youth mentor at the Greater Boston Vineyard R.E.A.C.H. program and is also pursuing a Masters of Healthcare Management from Cambridge College. Westley was quick to point out that this award isnt just about recognizing him. This award recognizes my department and the work we do to improve the overall patient experience by providing them with resources and other requests they may have.

Citizenship classes come to Faulkner

Faulkner Hospital is now offering free citizenship classes to its employees and their immediate families who wish to become US citizens.
Through a grant from Jewish Vocational Services (JVS), participants will be provided with the following services: History and civics lessons Assistance completing the N400 application Interview preparation for the meeting with a USCIS ofcial Follow- up sessions and tutorials In addition to these services, participants will also have access to referrals for additional support services, including nancial assistance with the application fee if needed. Classes will be run in eight week blocks that consist of meeting one day per week for two hours at the hospital. To inquire about participating in the class or for more information, contact Mary Duggan at 617-983-4634 or mduggan5@partners.org. Prior to taking the class, a prospective participant will be administered a pre-class assessment by a JVS representative. a green card or equivalent be a permanent resident for at least ve years be moderately procient in English In order to participate in this class, employees must have: Mary Duggan, Education Coordinator here at the hospital, is excited to see this program become part of the long line of classes offered to hospital employees. When we found out about this class being offered and knowing we had employees interested in something like this, we jumped at the chance to bring these classes to the hospital.

12 Focus on Faulkner

Medicare cost report submission indirect impact on Medicare rate setting

With the adoptions of prospective payment methodologies under various types of Medicare facilities, the submission of cost report data has taken on a compliance focus instead of a direct reimbursement concentration. There are still categories of Medicare reimbursement that are impacted by various components of the Medicare cost report, such as, Nursing and Allied Health programs, Medicare DSH and direct and indirect Graduate Medical Education. Outside the areas of direct Medicare reimbursement, the remaining portion of the cost report is completed accurately in order to comply with Federal regulations and statutes from a compliance perspective only. The link of the cost report to Medicare reimbursement goes beyond the direct reimbursement areas previously mentioned. The Centers for Medicare and Medicaid Services (CMS) has been steadily increasing the use of the Medicare Cost Report for Medicare rate setting purposes by adding Inpatient Prospective Payment System (IPPS) to the list of PPS methodologies which rely upon submitted cost report data to estimate and set rates for Medicare. Therefore, the submission of each Medicare Cost Report contributes indirectly to the Medicare rates which a facility receives. Given the fact that the cost report data will impact the IPPS rates (and Outpatient Prospective Payment System as well), concern has been raised by the hospital industry as to whether or not the cost report data is compatible for use in estimating rates at the DRG level. The hospital industry has communicated this concern to CMS The hospital industry must ensure that the gross revenue on Worksheet C of the cost report is linked to revenue codes: 275 (Pacemaker), 278 (Intraocular lens), 278 (Other Implants) and 624 (Investigational devices). In turn, the expenses on Worksheet A of the cost report for Implantable Devices Charged to Patients cost center must only include those related to the aforementioned revenue codes. The assumption will be that all hospitals Questions or comments regarding this article can be address to Patrick V. Cerce, Director of Compliance at (617) 983-7470. It is extremely important for hospitals to properly submit cost report data for this new cost center as it could increase or decrease reimbursement for devices depending on the collective data submitted by all of the hospitals. Currently, there are approximately 3,400 IPPS acute care hospitals included in the IPPS rate setting methodology. Although, our facility is one of 3,400, it is the collective nature of the cost report data that all hospitals should focus on. If all 3,400 hospitals have the mindset that their cost report data alone will not impact the rate setting process, the approach may have an impact on the rate setting approach adopted by CMS. Hospitals must make a concerted effort to assure that data submitted for the new Implantable Devices Charged to Patients cost center is accurate based on the fact that each hospitals cost report data will indirectly impact hospital Medicare rate setting. Hospitals must not only focus on the direct areas of Medicare reimbursement that the cost report impacts, but also realize the indirect impact for which the cost report has. in numerous Federal Register comment periods. CMS has acknowledged the need to modify the cost report to improve the data used in calculating the cost-based weights. One of the rst components of the cost report to be changed is Medical Supplies. CMS intends to correct for charge compression for devices and implants. CMS implemented a new cost center titled Implantable Devices Charged to Patients, which is effective for cost reports beginning on or after May 1, 2009. CMS has made it clear in the IPPS nal rules that hospitals are responsible for submitting accurate cost report data and that reliance should not be placed on a Medicare Administrative Contractor (MAC) to determine if the amounts are reported correctly. Therefore, it does not appear that there will be much oversight by CMS or their contacted agents to oversee the submission of this data. are coding the supplies correctly in their respective revenue codes. If facilities are not properly coding the supplies then the reported data could be skewed. The respective expenses related to the implantable devices must be separately identied in order to accurately reect the expenses in this cost center.

Focus on Faulkner 13

WALK FOR LIFE

Lace up your sneakers and join us! Walking group open to all those interested
Wednesdays at 2 pm April 6 - November 16 (weather permitting) Meet at the Arnold Arboretums Hunnewell Building.

Heart disease is the number one killer in the United States and physical inactivity doubles the risk. Start walking and reduce your risk. For questions or more information, please call Tracy in Faulkner Hospitals Community Health Department at 617-983-7451 or email tsylven@partners.org.
This program is a collaboration of Faulkner Hospital, the West Roxbury/Roslindale YMCA and AgeWell West Roxbury.

Pre-college classes offered at Faulkner Hospital

Faulkner Hospital has begun offering pre-college classes to employees to assist them with the college admissions process. The classes are part of a grant the hospital received from the Massachusetts Department of Elementary and Secondary Education, Executive ofces of Labor and Workforce Development, Commonwealth and Jewish Vocational Services. For four hours a week, participants study English, math and reading to prepare for the required entrance exam all colleges require before a student is admitted to their program. The classes run until all participants have passed their exams or up to 47 weeks. Class size ranges from seven to nine participants per session. Along with academic preparation, participants meet with an academic coach one-on-one throughout the session. The advisor makes sure the students understand the materials and are on the right track that will help them succeed. The coach also assists them with the overall admissions process. This program gave me the opportunity to explore my education further which then allows me to be successful in life, says student Norbely Bustillo of the Sagoff Centre.
14 Focus on Faulkner

From left: pre-college class participants Lillian Riley, Ava Peeples, Rosalyn Gonzalez, Margaret McPartland, Debra Gladden and Norbelly Bustillo.

The rst class of the program ran from May 25 December 20, 2010. The class had nine participants and out of the nine, seven enrolled in college and the remaining two plan to enroll this fall.

Faulkner Hospital receives Get With The Guidelines Gold Plus Performance Achievement Award
Award demonstrates Faulkner Hospitals commitment to quality care for stroke patients
Faulkner Hospital has received the 2010 American Heart Association/ American Stroke Associations Get With The Guidelines Stroke Gold Plus Performance Achievement Award. The award recognizes Faulkner Hospitals commitment and success in implementing excellent care for stroke patients, according to evidence-based guidelines. To receive the award, Faulkner achieved of 85 percent or higher adherence to all Get With The GuidelinesStroke Performance Achievement indicators for two or more consecutive 12-month intervals and achieved 75 percent or higher compliance with six of 10 Get With The Guidelines-Stroke Quality Measures, which are reporting initiatives to measure quality of care. These measures include aggressive use of medications, such as tPA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol reducing drugs and smoking cessation, all aimed at reducing death and disability and improving the lives of stroke patients. With a stroke, time lost is brain lost, and the Get With The GuidelinesStroke Gold Plus Performance Achievement Award demonstrates Faulkner Hospitals commitment to being one of the top hospitals in the country for providing aggressive, proven stroke care, said Linda Bresette, NP, Stroke Program Manager. We will continue with our focus on providing care that has been shown in the scientic literature to quickly and efciently treat stroke patients with evidencebased protocols. Faulkner is to be commended for its commitment to implementing standards of care and protocols for treating stroke patients, said Lee H. Schwamm, MD, chair of the Get With The Guidelines National Steering Committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston. The full implementation of acute care and According to the American Heart Association/ American Stroke Association, stroke is the third leading cause of death in the United States and a leading cause of serious, long-term disability. On average, someone suffers a stroke every 45 seconds; someone dies of a stroke every three minutes; and 795,000 people suffer a new or recurrent stroke each year. This level of care requires an amazing collaboration between physicians, nurses, CT staff, and rehab professionals. We have a great team dedicated to providing the best stroke care possible, stated Bresette. The time is right for Faulkner Hospital to be focused on improving the quality of stroke care by implementing Get With The GuidelinesStroke. The number of acute ischemic stroke patients eligible for treatment is expected to grow over the next decade due to increasing stroke incidence and a large aging population, said Bresette. Through Get With The GuidelinesStroke, customized patient education materials are made available at the point of discharge, based on patients individual risk proles. The take-away materials are written in an easy-to-understand format and are available in English and Spanish. In addition, the Get With The Guidelines Patient Management Tool gives healthcare providers access to up-to-date cardiovascular and stroke science at the point of care. Get With The GuidelinesStroke uses the teachable moment, the time soon after a patient has had a stroke, when they are most likely to listen to and follow their healthcare professionals guidance. Studies demonstrate that patients who are taught how to manage their risk factors while still in the hospital reduce their risk of a second heart attack or stroke. secondary prevention recommendations and guidelines is a critical step in saving the lives and improving outcomes of stroke patients.

Focus on Faulkner 15