What Sets Us Apart
Not surprisingly, BIDMC has been selected one of America's "Most Wired Hospitals" by U.S. News and World Report. Housestaff utilize the online medical record each day. Technological tools like those highlighted below and those currently employed at BIDMC streamline work by residents and interns.
Online Medical Record (OMR):
BIDMC's comprehensive online medical record (Web OMR) includes outpatient notes (from BI primary care physicians and subspecialists), lists of medications, radiology and pathology reports, lab results, and hospital discharge summaries. The online medical record is user-friendly and used in both the inpatient and outpatient settings. With the recent implementation of scanning inpatient progress notes, medical administration records, emergency department records, and vitals flow sheets from inpatient stays, you truly have all the necessary information at your fingertips!
Housestaff commonly cite the following benefits of Web OMR:
- The depth and breadth of information contained in one place assists with timely medical decision making;
- From Web OMR, physicians can directly access both inpatient and outpatient electronic provider order entry systems;
- Electronic prescribing allows the provider to send prescriptions directly to the patient's pharmacy;
- For outpatient care, a reminder system allows housestaff to create both public and private "to do" lists in a central location; and
- Management sheets, such as a diabetes management tool, contain core quality markers which allow easy tracking of what needs to be done for the patient.
Electronic Provider Order Entry (POE) Systems
BIDMC has both inpatient and outpatient POE systems which are easy to use and access. Through the inpatient POE system, housestaff order medications, inpatient consults (such as wound care and nutrition assessment), general nursing instructions, radiologic studies, laboratory tests, and respiratory care. Inpatient medication ordering has been designed with the goal of eliminating prescribing error and includes automatic reminders of patient's allergies, medication contraindications, a link to online Micromedex, and an estimation of dosing based on creatinine clearance.
The outpatient POE is used mainly for radiologic studies (i.e., mammograms and chest x-rays), labs, physical therapy evaluation, and gastroenterology procedures (i.e., screening colonoscopies). Medications frequently can be electronically submitted to the patient's pharmacy.
BIDMC has computers at specific physician workstations on every floor. There are also several portable computers on every ward and intensive care unit allowing teams to enter orders as they walk round on each patient.
Each year a group of junior and senior residents travel to the beautiful Maine coastline for a 1-week basic science immersion experience in comparative physiology. The goals of the course are to increase appreciation for physiology and enhance residents' routine incorporation of pathophysiology into their teaching and clinical roles on the general medical ward and ICU rotations. The course, held at Mount Desert Island Biologic Laboratories, is comprised of multiple modules (for example, water metabolism, NaCl excretion, hematology/coagulation, cardiovascular physiology), each with basic science experiments utilizing aquatic species, and accompanied by clinical correlation discussions. After each module, residents present their findings to one another, with specific aims for subsequent groups to investigate. Beyond the laboratory experience, residents are encouraged to enjoy all the Maine coastline has to offer including, hiking, kayaking, rock climbing, and fishing. Although exact numbers are not collected, reports suggest that copious lobsters and microbrews are consumed during off hours thanks to our gracious internal medicine training program.
Stoneman & Quality Improvement
All residents are required to do the Stoneman Quality Improvement elective; most residents do this in their JAR year. The elective allows residents to participate in ongoing quality improvement activities within BIDMC. Residents work with a preceptor as well as Patient Safety Core Faculty members to learn basics of quality improvement and how quality improvement is achieved in our own hospital.
Over the two-week elective, residents complete a didactic series on adverse event investigation, performance improvement, and an introduction to quality at BIDMC. There are opportunities to attend meetings regarding patient safety and quality throughout the hospital. The residents work together on a project aimed at quality improvement; recent projects have addressed Emergency Department to Medicine sign out and correct application of previously accepted criteria for admission of patients to the Orthopedics service. Residents work with a Patient Safety Core Faculty member to learn the basics of patient safety and the process of quality improvement at our medical center.
The Housestaff Wiki is an internal website created and managed by BIDMC residents for educational, organizational, and social purposes. The major goal is to create one website for learning, and the site features an online curriculum for each rotation, a library of seminal papers, and wiki topics which organize handouts, PowerPoint slides, and links to online textbooks for major topics in medicine. The wiki also hosts an intern survival guide, and quick links to phone directories and references organized by residents. All PowerPoint presentations and handouts from noon conferences and resident reports are posted on the wiki, along with a calendar of conferences for housestaff. Faculty have paired up with resident editors to expand the content.
The Beth Israel Deaconess Medical Center has been a leader in the healthcare quality movement, which strives not only to provide excellent care, but reliably excellent care. Part of this has been a new program called BIDMC SPIRIT (Solutions Promoting Improvement, Respect, Integrity and Teamwork)--named by a contest and vote among BIDMC staff--which emphasizes the process of identifying problems and working on solutions. Our commitment to quality is broad, and starts at the top.
Our CEO, Paul Levy, has been a leader in this aspect of hospital management and has become well-known for
Running A Hospital, a personal blog that explains some of these issues at more length (as well as occasional diversions to other things Paul does, like coaching girls' soccer or going to art exhibits). We want a patient with cancer at BIDMC to be able to receive cutting-edge treatment as appropriate, but we also want to ensure that the line that delivers that treatment doesn't get infected. Simple interventions like good oral care in the ICU or a structured protocol for placing central lines have made dramatic differences in our rates of ventilator-associated pneumonia and central line infections. And, unlike many hospitals, BIDMC has made a commitment to public disclosure of data about complications of hospital care, as a way of holding ourselves accountable for our work.
In poorly-functioning hospitals, much of doctors' time is spent in things that have nothing to do with patient care, like trying to find a stretcher to get someone down to a CT scan when the stretcher (and the person who's supposed to bring it) is nowhere to be found. While we've already made significant progress in processes like central lines and ventilator care, the goal is to achieve excellence in everything that we do. The BIDMC SPIRIT program was inspired by industrial companies like Toyota, that encourage any person working on a production line to stop the line at any time to point out a problem and improve the production process. Even as a new program, it has already led to process improvements in matters large and small--from improving lab specimen handling to making sure that patient belongings don't get lost.
In medical school, you may have noticed that systems are constantly going wrong in the hospitals in which you've worked; that interns and residents are constantly designing "work-arounds" to try to get around the ways that these systems fail; and that these problems in how things work are a frequent source of frustration. Our systems aren't perfect. And we sometimes get frustrated when they break down. But we're not asked to simply accept the imperfections. We're asked--even expected--to help change the system. The goal is to make our days more and more about delivering care and less and less about frustrations like a stretcher that can't be found or a lab specimen that keeps getting lost. We don't just want to be excellent interns and residents. We want to be excellent interns and residents, in an excellent hospital.
The Department offers categorical residents an intensive 2-week course in Research Methods in October of the second year of residency. The course gives residents important early training as they format applications for up to three months of dedicated research time in their second or third years. Drs. Mukamal and Strewler meet with each resident beforehand to identify an ideal research mentor based on each individual's career goals and interests. The course itself includes 50 hours of didactic and interactive sessions on all aspects of research, including study design, data management and analysis, the ethics of research, publication, and career guidance from expert investiga¬tors within the Department. In the course of two weeks, residents interact with IRB staff, biostatisticians, core facility directors, General Clinical Research Center staff, and others who can act as resources for research projects.
Residents bring to the course a research propos¬al developed with their mentors and during the course, work collaboratively to refine their own protocols in a series of workshops. Each resi¬dent presents a summary of the proposal on the final day of the course. In this way, principles of research design and tools are put into practice and residents have well-elaborated projects by the end of the course. Roughly half of junior resi¬dents elect to take the course each year.
Area of Concentration
Area of Concentration, or AOC time, is available to junior and senior residents interested in pursuing an independent project in basic science or clinical research, medical education, health policy, quality improvement, or hospitalist or primary care medicine. Interested residents apply for AOC time in the preceding academic year and can request up to 9 weeks of dedicated time for their project. During an AOC experience, residents continue to see patients in their continuity clinics but time is otherwise dedicated to their AOC project. International Health experiences can also be pursued during AOC time (link the International Health section). Residents typically work closely with a mentor from Beth Israel Deaconess Medical Center, the Dana Farber Cancer Institute, the Harvard Clinical Research Institute, or the Boston VA Healthcare System, depending on their area of interest. In the past, residents have had great success transitioning their AOC work into subsequent publications. At the end of the year, all residents participating in AOC present their work at a resident research night, which is open to all Beth Israel Deaconess housestaff and faculty. A list of titles of resident research projects for the 2008-2010 academic years can be found