What You Need To Know
To keep the entire Pulmonology Department informed of our work to solve clinical challenges and standardize care, here is a brief update on the key initiatives and decisions from our July Pulmonology Specialty Collaborative meeting. The goal of this collaborative is to bring physicians together to improve patient care by aligning on best practices and partnering with other specialty collaboratives, diagnostic councils, and key clinical groups across the network.
Key Decisions & Policy Updates
1. Improving Safety and Clarity for the Network NIV Policy The collaborative endorsed several key revisions to the Adult Non-Invasive Ventilation (NIV) policy, designed to create safer and more accountable workflows.
- Clarifying Responsibility for Transfers: The policy now clearly assigns the responsibility for placing a pulmonology consult to the receiving physician when a patient on NIV is transferred from a higher level of care. The associated OPA alert will be updated to fire for the receiving physician, ensuring the system supports this workflow.
- Enhancing Safety for PRN Orders: To remove ambiguity, the policy now explicitly states that clinical staff must notify the ordering provider upon each activation of a PRN NIV order.
- Ensuring Oversight for Home Devices: The policy now requires provider notification if a patient wishes to modify their home device settings and establishes a clear workflow (including a new consult) if a patient's personal device fails and a hospital machine is needed.
2. Guidance on New, Standardized Network Bioethics Policies With the Code Status and Forgoing Life-Sustaining Treatment policies going live on September 15th, the group held a robust discussion on their clinical application.
- The "DNI & Full Code" Dilemma: The group explored the ethically charged challenge of managing patients with these conflicting orders. The discussion affirmed that this scenario is often clinically unworkable in a crisis and can stem from family fears and misunderstandings about end-of-life care.
- Policy & System Safeguards: It was clarified that the policy provides a key protection for clinicians by granting the code team clinical discretion to act in the patient's best interest, rather than mandating a clinically inappropriate action. The system's role is to alert clinicians to the conflict via an OPA when the orders are placed, not to block them. The group recommended exploring a requirement to document a reason for overriding this alert.
Clinical Resource: Palliative Care
The meeting included a discussion on the process for accessing Palliative Care services to help navigate complex goals-of-care conversations.
- For Physicians, APNs, and PAs: The new preferred method is to place referrals directly in Epic using the order: "Ambulatory referral to Palliative Care."
- For Other Clinicians (Nurses, Social Workers, Case Managers, etc.): For the time being, please continue to make referrals by emailing the team at palliativeintake@hmhn.org.
- For Questions: The team can be reached via the intake email or through the Epic secure chat group titled "palliative nurses."
Other Initiatives in Progress
- Thoracentesis Order Set: The development and refinement of a new, standardized thoracentesis order set will be a primary agenda item for the August collaborative meeting.
- Brainomix e-Lung Technology: Following the collaborative's recommendation in June, next steps are now underway to explore the potential use of this AI tool for assessing Interstitial Lung Disease (ILD) within the HMH network.
- Alpha-1 Antitrypsin (AAT) Screening: Work continues on exploring an Epic prompt for screening at-risk patients and creating a more consistent location within the patient's chart to document test results.
Who to Contact
Do you have a clinical challenge, a workflow issue, or an idea for standardization? Please reach out to any of the Collaborative Chairs or the Network Patient Safety & Quality (PS&Q) Team: Jillian Stevens (jillian.stevens@hmhn.org) and Diveena Davis (diveena.davis@hmhn.org).
For any questions, please feel free to contact the Pulmonology Collaborative Chairs:
- Dr. Keith Brenner (keith.brenner@hmhn.org)
- Dr. Lisa Casale (lisa.casale@hmhn.org)
- Dr. Eric Costanzo (eric.costanzo@hmhn.org)
Thank you for your continued partnership in improving patient care