The following are excerpts from the question-and-answer session that followed the Citation presentation at the October 23 BWH Town Meeting. Gary Gottlieb, MD, MBA, president; Andy Whittemore, MD, chief medical officer; and Matt Van Vranken, chief operating officer responded to questions from the audience.

Q: What happens to the information recorded during patient safety WalkRounds and how is it used as data to change the way that we practice at BWH?

A: (Gandhi) WalkRounds take place once a week in various places in the hospital. We invite all staff - nurses, physicians, pharmacists, etc. - to join us for a few minutes and to share any issues that they feel impede their ability to take care of patients safely. We record all information obtained and enter it into a database, looking for themes across all Walk-Rounds. We then prioritize the themes in terms of importance and assign accountability to the appropriate person, group or committee to pull together an action plan and evoke change. Most importantly, we email all staff that participated in the Walk-Rounds that identified this theme to ensure that staff are aware that their issue was taken seriously and action took place.

Q: Are there WalkRounds in the ambulatory setting?
A: (Gandhi) We have conducted WalkRounds in BIMA. We would like to expand them to other sections within the hospital and off-site as well. I think the ambulatory setting is ripe for study and improvement in terms of patient safety issues.

Q: Can you comment on external factors that impact patient safety that are sometimes beyond our control, like emergency room diversions. Can we work on those factors?
A: (Gottlieb) There are ramifications to closing down beds over time and underpaying hospitals undercapitalized the hospital system overall. We are trying to re-engineer our systems to increase efficiencies, improve the hand-offs in certain areas and enhance our relationship with Faulkner and Partners and other hospitals in Boston.

Q: Can you provide an overview of the bar-code process in terms of what will happen to all of the drugs that are ordered at BWH?
A: (Gottlieb) I’m not sure everyone knows what we are doing on the bar-coding side. It’s very exciting. We are developing a process that will allow us to track the bar-codes and detect errors.
A: (Whittemore) As many of you have heard me say before, you go to the grocery store and buy a product, which is bar-coded, so why not translate that technology to the health care industry? A big challenge is that the pharmaceutical industry does not put bar-codes on their own products, whereas manufacturers of other products place bar-codes directly on the packaging themselves. Therefore, we have to put the bar-codes on each drug. Bar-coding should further decrease errors in the administration of medicine. It is a major investment, but it is slowly coming online with a great deal of help from pharmacy, operations and IS.
A: (Van Vranken) To replicate bar-coding nationwide, we are looking at a major infrastructure change in health care. While the hospital environment will be safer overall, it will require a significant investment. Such an investment is appropriate as a hospital’s budget should articulate its values as an institution. To the extent that we value patient safety, BWH will continue to make the investment to be an industry leader in this area.

Q: What are some of the issues that have come up during patient safety WalkRounds?
A: (Erin Graydon-Baker, manager, Patient Safety Team) There are three overriding themes that have come up during Walk-Rounds. The first is the issue of space in terms of trying to get our work done in limited space. Another is materials management in terms of having the right supplies in the right place every time you need them. Finally, there is the issue of communication between caregivers. For example, how do nurses and residents know who the attending physician is? Also, how do members of the patient care team communicate care plans effectively? These three themes are indicative of the issues we have seen thus far.

Look for more articles on patient safety in future issues of Bulletin.