BHB updates COVID guidelines

Monday 5 December 2022: Following the end of the public health emergency laws, BHB updated its COVID-19 guidance for patients and visitors from 1 December. BHB has also returned to alert level 1 (the lowest level), for the first time since 2020.

Chief of Staff Dr Wesley Miller comments: “Although public health emergency laws ended on 30 November, COVID-19 and other respiratory diseases, such as flu and respiratory syncytial virus (RSV), are still dangerous, especially to vulnerable people who are older, immunocompromised or unwell.

“The winter months have long been challenging for BHB, even prior to the pandemic, with increased emergency visits and admissions. This means, while we have returned to alert level 1, we remain cautious. We are, for example, maintaining precautions for staff during patient interactions, so people will find that BHB staff are masked when they have their treatments or tests, or if someone enters their inpatient room.

“There is certainly a balance between protecting our vulnerable patients, while accepting that the community is returning to normal practices throughout Bermuda. The public health emergency is over, but if you are visiting a loved one in hospital they may be more vulnerable to an infection due to age or illness. We are asking you to help protect them by wearing a mask in their room as you are in close contact for longer periods of time.

“People should also feel comfortable remaining masked throughout any other areas as a precaution. Masking in communal areas is recommended, though not mandatory, and we will continue testing patients before admissions and surgery, and regular surveillance testing in long-term care areas.”

Overview of precautions for visitors and patients from 1 December:

General masking at BHB:

• Masking is recommended but not mandatory in most communal areas of the hospital outside of patient rooms.
  There will no longer be mask and temperature checks at the door.

When masks should be worn:

• BHB staff will continue to mask for patient interactions, including outpatient consults, testing and in inpatient/resident rooms.
• Patients and visitors who are vulnerable themselves should wear a mask in all areas of BHB.
• For parents and visitors, masks must be worn in the Special Baby Care Unit (SCBU), and masking is strongly recommended in all of Maternity.
• Patients who have cold- or flu-like symptoms must wear masks if they need a service that cannot be rescheduled, for example, a dialysis treatment or emergency visit.
• People visiting patients or long-term care residents who are on isolation must wear the appropriate protection as advised by BHB staff before entering an isolation room.
• People visiting patients or long-term care residents are strongly recommended to wear a mask while in patient rooms as patients and residents are more vulnerable to serious complications of a respiratory infection.

Other protections that will remain:

• Symptom checking surveys will continue for people attending BHB outpatient services.
• Patients who have symptoms or have tested positive for COVID-19 should reschedule hospital appointments if possible. If it is urgent for someone with symptoms to attend BHB (eg a dialysis treatment or emergency visit), they should advise staff and wear a mask.
• All patients admitted to BHB inpatient units and people undergoing a surgical procedure will be tested for COVID-19.
• Surveillance testing for residents in long-term care units across BHB will continue every two weeks.
• Staff, patients and residents in any area of BHB who exhibit symptoms will be tested for COVID-19.

BHB visiting guidelines remain as follows:

Emergency Department and Lamb Foggo Urgent Care Centre:

• Patients will be allowed one support person while in the Emergency Department or Lamb Foggo Urgent Care Centre.
• Vulnerable adults and all children will be allowed up to two support people.
• For patients near the end of life, up to two support people can attend.
• If someone dies in Emergency or is brought to the hospital after passing away, only one person and one support person for that individual can attend. Up to three people can be in the family room. Other family and friends should not attend, as there is not adequate space to gather safely and the ability to offer viewings is very limited.

Acute care patients in the Acute Care Wing units (Ace Barber, Ascendant Partner Re, Catlin Lindo):

• Patients who are not on isolation can have up to two visitors in their room at any one time between noon and 8pm.

Mid-Atlantic Wellness Institute acute inpatient care units (adult, child and adolescent services):

• Pre-identified support people can visit for one hour each day between noon and 6pm.
• Support people must check in at the front desk.
• One person can visit a patient at any one time, and visitation will be in a public space, such as a family conference room.

Long-term care units (KEMH and MWI, including group homes):

• Up to two people (one at a time) can visit each resident for two hours each day between noon and 7pm.
• No more than two visitors are allowed in rooms with more than one resident at any given time.

Isolation patients in all areas of BHB:

• Two designated support people pre-identified by the patient can visit for up to two hours per day, wearing required protection as advised by BHB staff.

Intensive Care Unit:

• Designated support people may visit for two hours between 10am and 2pm, or 4pm and 8pm. Visitors must be on the ICU visitors list.

Maternity Unit:

• Symptom screening is required for support people and visitors. If they have symptoms, they will not be allowed to attend.
• One designated support person may stay as long as needed after the birth.
• If the mother is not discharged within 24 hours, visitors will be allowed to visit between noon and 8pm.

Gosling Unit:

• Up to two parents may visit minor patients.
• Adult patients can have up to two designated visitors (one at a time), between noon and 8pm.

PEARL Implementation Update

Sunday 13 November 2022: Bermuda Hospitals Board today provided an update on its progress with the implementation of its first BHB-wide electronic medical record system, called PEARL (Patient Electronic & Administrative Records Log).

Chief Executive Officer & President Dr Michael Richmond noted that the first two weeks had not been without their challenges, but that activity was beginning to return to normal.

He said: “The success of the implementation has been carried by our staff, external physicians and our partners, who prepared all they could, then have worked through the early expected issues that a major system implementation experiences. It has been a true team effort, as PEARL connects all parts of the hospital from pharmacy, diagnostics, finance and support areas to emergency, acute and critical care at all campuses.

“The good news is that we are on track and, after two weeks of having a slow down in our planned and outpatient activity, services will be running at normal capacity from Monday, including the number of elective surgeries. These are still early days, but issues have been managed, staff are mastering the new system, and we wanted the community to be fully informed about our progress.”

Despite a planned slow down in planned and outpatient activity, over the first two weeks after go-live there were still 3,267 encounters in ambulatory care (outpatient clinics and diagnostics), 150 surgeries (elective and emergency) and 20 babies born. In areas where activity could not be controlled, the normal activity levels were experienced. There were 1,011 people who attended the Emergency Department and Lamb Foggo Urgent Care Centre, and 142 admissions to an inpatient ward. This reflects KEMH and MWI wards.

In the Emergency Department, the average length of time between arrival and discharge did increase in line with expectations in the first week, but has gradually decreased since then (see data below).

Dr Richmond added: “I would like to extend my appreciation to the community for their understanding. We know it has been a challenge at times for patients in Emergency with longer average stays than normal, and elective procedures were reduced in the first two weeks. But the great promise of PEARL is to that as we work through this period we will be able to improve our care, smooth transitions, and use the system to help us deliver a better, safer care experience.”

PEARL went live in the early hours of Saturday 29 October, when information was transferred and then validated. Staff in different departments started using the system from the early afternoon.

The following is the ED length of stay (from arrival to discharge) for each day following go-live. The average length of stay up to 29 October in ED was 198 minutes (3 hours and 18 minutes).

Emergency average length of stay per day (midnight to midnight) in minutes

• Saturday 29 October (partial day): 294
• Sunday 30 October: 405
• Monday 31 October: 442
• Tuesday 1 November: 358
• Wednesday 2 November: 485
• Thursday 3 November: 366
• Friday 4 November: 285
• Saturday 5 November: 289
• Sunday 6 November: 239
• Monday 7 November: 289
• Tuesday 8 November: 190
• Wednesday 9 November: 160

BHB prepares for PEARL’s implementation

Thursday 27 October 2022: Bermuda Hospitals Board (BHB) today provided an update to the community about its first BHB-wide electronic medical record system, which goes live in the early morning of Saturday 29 October. The system has been called PEARL (Patient Electronic & Administrative Records Log) by staff.

Nurse on an acute care ward with a ‘workstation on wheels’ that can be used in patient rooms

PEARL is an electronic medical record system that makes patient information, from medical history to the latest physician notes and test results, immediately available to those who are involved in a patient’s care. This information will no longer be on paper or limited to fragmented systems. This means BHB staff caring for patients won’t have to wait for paper records to be delivered, check multiple systems for key information and results, or wait for information that might not have been filed yet. PEARL makes it easier to avoid duplications and delays because everything a clinician needs is immediately available in one place, and always up to date.

CEO & President Michael Richmond notes: “We are preparing for an exciting and significant transition in how we work. A big thank you must go to our staff across BHB for their hard work. PEARL’s implementation rests on the shoulders of hundreds of staff involved in designing, building and testing the system since the project started in April 2021, and over 1,400 staff who
are attending training, even as they meet their duties as care providers.

Staff involved in integrated testing earlier this year

“Our focus now is ensuring BHB maintains services safely throughout the go-live. There will likely be a couple of weeks where staff will be getting used to new processes, and we will run slightly slower than normal, but our ability to use PEARL will quickly become more sure and faster each day. Once we are used to using the system, the opportunities for improvements are going to help us soar.

“Going live with PEARL is just the beginning. PEARL is a tool our staff will use to deliver what they strive to do each day – the best possible levels of care and the best patient outcomes, something of which Bermuda can be truly proud.”

Key information about how BHB is managing PEARL’s go-live:

• PEARL will be used across all BHB services – at King Edward VII Memorial Hospital, Mid-Atlantic Wellness Institute, Lamb Foggo Urgent Care Centre, and across all BHB group homes
• All BHB services will continue throughout the go-live process, but it will initially take staff a bit longer to complete tasks as they put their training into practice
• Elective activity (for example, non-urgent surgeries and outpatient appointments) will continue throughout, but there will be a phased reduction in work – at 50% of normal level in the first week after go-live and 75% of normal level in the second week after go-live. This will give staff some breathing room as they get used to using PEARL, minimising any potential patient safety or care risks. This is a best practice for implementing this kind of system, and follows advice from other hospitals and Cerner on how to successfully manage the transition
• Emergency services will be open, but patients with minor conditions may experience longer waits. People are advised to see their GP if they have minor issues or need help managing their chronic illnesses
• Additional Cerner employees and BHB staff who are PEARL super users will be positioned in departments, supporting staff ‘at the elbow’ in the first two weeks after go-live
• A multi-level command centre structure is in place for the first two weeks in case there are issues that can’t be resolved at the department level, but need quick and effective resolution
• After 10 November, we anticipate normal levels of elective activity will be restored, including surgeries

Chief of Staff Wesley Miller explains: “I am very proud to work with our staff as we prepare for this implementation. PEARL is going to transform what is possible in delivering the very best in safe, quality care across BHB. A system implementation of this size and complexity isn’t easy, but the reward of working through it will be in the enhanced ability to improve patient care and outcomes, which is at the heart of all we do.”

Chief Hospital Information Officer Keltie Jamieson adds: “Our focus over the next few weeks is on maintaining safe services as staff adjust. There will be a lot of on-the-ground support in departments as well as escalation processes for issues as our hard-working staff get used to something new. Patients and visitors in the first two weeks will see additional people in bright t-shirts who are the in-department support. We have done all we can to test and test PEARL again, but issues are normal in any major system implementation. The key is having robust structures to escalate and resolve them, which we have.

“There is so much to look forward to once we are through this implementation period, but step one is a successful implementation. That will give us the strong foundation we need to use PEARL as a tool of constant improvement in our pursuit of excellence.”

Click here for more information about PEARL

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Editor’s Notes – PEARL’s development to date:

• PEARL will replace multiple BHB systems, and was necessary as BHB’s main clinical system was old and no longer going to be supported by the vendor
• Cerner was selected via a competitive process involving about 100 BHB staff starting in 2018, with final approval in 2019 from the Board
• The project was due to start early in 2020, but was postponed for a year due to the pandemic
• The electronic medical record project started on 1 April 2021
• The system was designed and built by the vendor, Cerner, in partnership with over 350 BHB staff
• There have been two extensive rounds of integrated testing, involving BHB staff who ran patient scenarios to test all parts of the system
• Although the project was undertaken because BHB’s main clinical system is being retired by the vendor, electronic medical records are the international standard of care. With all information in one place and clinicians across BHB able to share real-time orders and notes, care processes – such as a patient visiting emergency and being triaged, tested, diagnosed and admitted to an inpatient ward – can take place more efficiently