Discipline & Goal
Domains of Practice
Case Managers are registered nurses who possess a broad knowledge of clinical care and resource management which allows them to efficiently and expeditiously enhance the delivery of patient care along the continuum. While collaborating with the patient, family and the health care team, they promote the use of the most appropriate setting in meeting each patient’s needs to maximize quality of care, utilization of resources and insurance benefits. The goal of Case Management is to empower the patient and their families to manage the impact of illness on the individual’s functioning and family dynamics and to achieve maximum benefits from healthcare services throughout the continuum.
- Simultaneously address the clinical, financial and compliance aspects of patient care.
- Evaluate, predict and facilitate the trajectory of the patient’s care throughout the continuum utilizing departmental high risk screening criteria.
- Identify patients who are at high risk for a complex discharge and/or readmission by interviewing patient and family to gather relevant baseline data, identify their understanding and expectations of the treatment plan and identify any potential issues/barriers to arranging post acute care.
- Strategize with the interdisciplinary team (IDT) to ensure patient and family’s goals are utilized in developing a timely treatment plan and a safe and appropriate discharge plan.
- Continuously assess the efficacy of the plan, and provide input to the IDT to revise the plan as necessary.
- Identify appropriate resources to provide post acute care for patients with complex home care needs or those requiring post acute placements in Rehab/LTAC/SNF/Partial Hospitalization Programs/Residential Treatment programs.
- Identify funding source for post acute care and intercede with appropriate resources if funding is not available.
- Collaborate with the IDT on arrangements for post discharge follow up and hand-offs.
- Serve as a patient advocate and form collaborative relationships to maximize the patient’s and family’s ability to make informed decisions.
- Provide advice and guidance to patients and their families on managing their specific needs and support lifelong learning and skills to promote good health.
- Support the institution’s Mission and Credo in achieving clinical, quality, financial and compliance goals.
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Staff Chaplains are professionally trained to assess spiritual needs and provide spiritual support for people of diverse cultures, traditions and beliefs. They give faith-sensitive, culturally-competent patient- and family-centered care in the most efficient and effective way possible.
- Cope with illness, hospitalization and treatment
- Anticipate and prepare for surgery
- Offer support in times of crisis, grief and bereavement
- Counsel regarding personal values and clinical decision-making
- Work through spiritual struggle
- Engage in the search for hope or meaning
- Provide prayer and ritual
- Listen to concerns about relationships
- Support those without family, fiends or congregation within visiting range
- Support clinical staff through challenging cases, a series or personal distress.
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Child Life Specialists provide consultation and intervention service regarding
the impact of illness, injury and hospitalization on children and families. Our goal is to
optimize a patient’s growth and development, decrease anxiety and form positive coping
Child Life Specialists are available to assist patients and families by providing:
Preparation: helping patients and families understand their health care experience
including developmentally appropriate preparation for medical procedures.
Procedural Support: offering distraction and relaxation techniques to minimize pain
and enhance coping skills and comfort level.
Play: Guiding developmental and therapeutic play to promote socialization, normalization
and expression of feelings.
Medical Play: Using medical equipment and teaching dolls that encourage children to
voice questions and misconceptions about their experience.
Advocacy for Family-Centered Care: Supporting the unique needs of children and families
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Information Desk Associates
Information Desk Associates proactively provide high quality reception services to patients, visitors, and employees as part of an integrated team including security, patient transport, volunteers, and medical interpreter services.
Components of the role include:
- Utilize computerized information systems to access patient and employee information while respecting patient and employee confidentiality.
- Provide clear and concise directions to patients and visitors going to medical and business appointments.
- Recommend area hotels, restaurants, and attractions to patients and their families using a broad general knowledge of the Boston area.
- Recommend MGH shuttle service and provide schedules to employees and patients for access to MGH off site locations.
- Educate employees and patients about the availability of the MGH Beacon transport system for discharge and out-patient transport by wheelchair.
- Enhance communication with the public by giving directions over the telephone as to the best practice for getting to or from the MGH.
- Identify and solve problems in the Partners Telephone Directory by communicating to the Volunteer Department leadership.
- Escort patients and visitors to difficult to find locations.
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Medical interpreters are professionals who are trained to facilitate direct communication between clinicians and patients and families who have limited English proficiency; or who are Deaf or Hard of Hearing, to ensure the delivery of quality and safe care. This is accomplished by interpreting everything spoken by provider, patient, family or anyone else present in the room, without omitting, adding or changing information, regardless of the relevance of such information.
Medical interpreters are available in person, by telephone and by video inboth inpatient and outpatient settings, to:
- Facilitate communication between clinicians, patients and families, including but not limited to:
- Informed consent process
- Medical appointments
- Nursing assessments
- Specialty consultations
- Medication instructions
- Explanation of tests and procedures
- Telephone calls to patients and families at home
- Provide cultural clarification, when needed
- Assist patients in accessing appropriate resources within the hospital
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Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA).
- Creation of a caring, individualized therapeutic relationship with patients and families that promotes health and healing
- Assessment, diagnosis, plan, implementation and evaluation of interventions to promote the best possible outcome; this process is done in partnership with patients, families and the health care team
- Health teaching and promotion
- Delivery of safe, quality and evidence based practice
- Collaboration and communication with all members of the health care team
- Clinical inquiry and ongoing professional development
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Dietetics is defined as “the integration and application of principles derived from the sciences of food, nutrition, communication, and biological, physiological, behavioral, and social sciences to achieve and maintain optimal human health.” - Academy of Nutrition and Dietetics (AND)
- Assess patients’ current nutrition status. Identify nutrition issues. Plan and provide evidence-based interventions to meet the patients’ nutritional needs and promote healing and recovery. Communicate the inpatient nutrition plan to the patient and family members. Contribute to the discharge summary to facilitate continuity of care. Assist in coordinating patients’ discharge needs.
- Monitor and evaluate interventions and modify as needed.
- Communicate and collaborate with other health care providers to optimize patient care.
- Communicate and collaborate with patient food service to meet established nutrition goals.
- Provide education to patients and families for discharge. Recommend outpatient nutrition services to patients needing additional education after discharge.
- Educate dietetic interns and other health care providers.
- Promote professional development through ongoing continuing education.
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Occupational therapy has a unique focus on addressing deficits and barriers that limit the patient’s ability to perform activities that they need or want to do related to independence in their everyday routine. These activities include dressing, bathing, eating, work and leisure tasks, etc. Occupational therapy evaluation & treatment play a key role in the patient’s successful transition to home, the community, or the next level of care.
Examples of common occupational therapy practice include:
- Speak with patients & their families to learn about pre-hospital roles in order to understand what is meaningful to the patient and work towards the their ability to return to these activities in the future.
- Train patients in self-care activities with compensatory strategies or adaptive equipment if needed to increase the patient’s ability to participate in their own care.
- Evaluate and treat changes in the patient’s thinking or vision that may affect their ability to safely complete everyday activities such as cooking, medication management, driving, etc.
- Treat hand or arm injuries with splints or exercises to ensure the patient is able to use their hand for everyday activities like opening containers, buttoning shirts, etc.
- Teach coping strategies and life skills to aid patients with behavioral or psychiatric health changes in working towards community reentry.
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Promoting patient-and family-centered care, Patient Advocates work to resolve concerns related to one’s inpatient or outpatient health care experience. On behalf of patients, the advocates also share compliments with staff and hospital leadership.
The Office of Patient Advocacy services include:
- Listening to concerns and acting as a liaison between patients and the care team
- Facilitating communication between patients and providers
- Educating patients about rights and responsibilities
- Helping patients to navigate services and connect with appropriate resources
- Coordinating clinical reviews with various departments and providing information to patients based on those findings
- Working collaboratively with staff to promote safe, quality care
- Ensuring equitable and accessible care for all patients
- Providing notary services to patients for health related issues
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The mission of the Department of Pharmacy is to:
- Be essential to patient care by providing comprehensive care by reviewing medication orders
- Provide accurate and timely delivery of medications
- Be effective managers or resources
- Be responsive to the needs of patients, staff and leadership
- Be world class
Patients’ medication orders are evaluated on admission by the pharmacists covering the patient care units. Evaluation takes into account dosage, indication, patient demographics (e.g. weight, height, genetic factors, etc.), allergies, past medical history, clinical status, medication interactions, relevant laboratory test values and hospital guidelines, policies and procedures. Additionally, the cost-effectiveness of the chosen therapy is considered. Therapy is reassessed when new orders are written or as issues arise.
Pharmacists collaborate with other medical professionals to:
- determine the presence of medication therapy problems
- collect and organize patient-specific information
- summarize patients’ medication needs
- specify pharmacotherapeutic goals
- design and initiate pharmacotherapeutic regimens and monitoring plans
- conduct discharge patient counseling
- participate in pharmaceutical research
- educate healthcare professionals, students, patients, and the community regarding best medication practices
- provide cost-effective, efficient drug therapy
- ensure the appropriate use of medications in patients of all ages (neonatal to geriatric), in all practice settings, across all sites, for a wide variety of diagnoses requiring pharmacologic intervention
Technicians and other support staff:
- are responsible for medication distribution
- are under the direct supervision of a pharmacist
- are licensed with the state and many are nationally certified
- are responsible to service and supply the Omnicell automated dispensing machines utilizing a cartless medication distribution model
- are responsible to provide decentralized service to the inpatient units, emergency department and operating rooms
- prepare IV and unit dose patient specific medications
- provide support in the Clinical Trials Pharmacy
- have completed, based on area, competencies in:
- chemotherapy preparation
- central pharmacy operations
- automated dispensing machines
- sterile preparation
- customer service
- controlled substances inventory/management
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Physical therapists provide physical therapy examination, evaluation and intervention to patients with a wide variety of diagnoses and diseases. Physical therapy services provides consultation regarding the need for intervention, patient examination and direct intervention, as well as patient/family/caregiver education.
- Examining patients with impairments, functional limitations, and disability or other health-related conditions in order to determine a diagnosis, prognosis, and intervention; examinations may include, but are not limited to the following:
- Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that may include, but are not limited to the following areas:
- The patient-care process includes, but is not limited to: examination, diagnosis, prognosis, intervention, discharge planning, coordination of care, patient and family education, and staff and patient consultation.
- A comprehensive plan, including the anticipated frequency and duration of intervention is established to restore patients to their highest levels of function in activities of daily living, community mobility, occupational requirements, and recreation, and provide appropriate patient and family education, which is a cornerstone of all our programs. The established plan is subject to change based on changes in the patients acuity, change in the patients symptom/pathology.
- The physical therapist collaborates with other medical disciplines to establish comprehensive care plans for the patients. In performing the diagnostic process, physical therapists may need to obtain additional information (including diagnostic labels) from other providers. In addition, as the diagnostic process continues, physical therapists may identify findings that should be shared with other providers, including referring practitioners, to ensure optimal patient care. If the diagnostic process reveals findings that are outside the scope of the physical therapist’s knowledge, experience or expertise, the physical therapist shall refer the patient to an appropriate practitioner.
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Respiratory therapists focus on improving and maintaining the cardiopulmonary health of patients.
- Set-up management and discontinuation of mechanical ventilation (both via artificial airway and face mask).
- Administration and evaluation of the efficacy of aerosolized pharmacological agents.
- Set-up management and discontinuation of extracorporeal life-support to patients in the ICUs.
- Obtaining and analysis of arterial blood for gas exchange, pH and electrolytes.
- Assessment, maintenance, replacement, reposition and discontinuation of artificial airways.
- Education of patients and families on all aspects of respiratory care.
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Clinical social workers are licensed mental health professionals. Social workers conduct culturally sensitive psychosocial assessments and provide therapeutic interventions to promote patient/family well-being and to decrease barriers to optimal care. This is accomplished through counseling and directly connecting patients and families to hospital and community resources.
Clinical social workers are available to both Inpatients and Outpatients and their families to:
- Cope with illness, hospitalization, grief and other life stressors
- Deal with crisis
- Evaluate abuse/neglect/domestic violence
- Identify and solve problems with relationships
- Make decisions about their treatment goals and plan of care
- Enhance communication with the medical team
- Access hospital and community services
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The professional roles and activities in speech-language pathology include clinical services (diagnosis, assessment, planning, and treatment), prevention and advocacy, and education, administration, and research. Speech-language pathologists provide clinical services that include the following:
- prevention and pre-referral
- treatment, intervention, management
Speech-language pathologists serve individuals, families, and groups from diverse linguistic and cultural backgrounds. Services are provided based on applying the best available research evidence, using expert clinical judgments, and considering patients' individual preferences and values. Speech-language pathologists address typical and atypical communication and swallowing in the following areas:
- speech sound production
- apraxia of speech
- cul-de-sac resonance
- mixed resonance
- phonation quality
- language (comprehension and expression)
- pragmatics (language use, social aspects of communication)
- literacy (reading, writing, spelling)
- prelinguistic communication (e.g., joint attention, intentionality, communicative signaling)
- paralinguistic communication
- problem solving
- executive functioning
- feeding and swallowing
- oral, pharyngeal, laryngeal, esophageal
- orofacial myology (including tongue thrust)
- oral-motor functions
Potential etiologies of communication and swallowing disorders include:
- neonatal problems (e.g., prematurity, low birth weight, substance exposure);
- developmental disabilities (e.g., specific language impairment, autism spectrum disorder, dyslexia, learning disabilities, attention deficit disorder);
- auditory problems (e.g., hearing loss or deafness);
- oral anomalies (e.g., cleft lip/palate, dental malocclusion, macroglossia, oral-motor dysfunction);
- respiratory compromise (e.g., bronchopulmonary dysplasia, chronic obstructive pulmonary disease);
- pharyngeal anomalies (e.g., upper airway obstruction, velopharyngeal insufficiency/incompetence);
- laryngeal anomalies (e.g., vocal fold pathology, tracheal stenosis, tracheostomy);
- neurological disease/dysfunction (e.g., traumatic brain injury, cerebral palsy, cerebral vascular accident, dementia, Parkinson's disease, amyotrophic lateral sclerosis);
- psychiatric disorder (e.g., psychosis, schizophrenia);
- genetic disorders (e.g., Down syndrome, fragile X syndrome, Rett syndrome, velocardiofacial syndrome).
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The Tobacco Treatment Service is a multi-disciplinary team of health professionals who are specially trained to help manage and treat those patients dependent on nicotine. The in-patient service advises patients and/or staff on pharmacotherapy to manage withdrawal while in the hospital. They also provide bedside counseling to those who are interested in staying quit after discharge. Tobacco Treatment counselors are trained to provide patient-centered support and education in the most compassionate and nonjudgmental way possible.
- Assess patient’s current tobacco use status, level of nicotine dependence and severity of withdrawal.
- Recommend evidence-based medications to reduce withdrawal symptoms based on patient’s medical status and preference. Discuss appropriate dose and use of medications.
- Assess patient’s readiness to quit, and when appropriate, develop a post-discharge quit plan, including referral to community quit smoking resources.
- Educate and assist family members in supporting the patient’s efforts to remain smoke free after discharge.
- Assess exposure to second hand smoke. Educate and advise family members about the importance of creating and maintaining a smoke free home and environment.
- For those who have quit within the past year, assess current level of confidence to stay quit long term and explore specific relapse prevention strategies.
- Provide training and in-service education to health care providers on current guidelines for evidence-based tobacco treatment.
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MGH volunteers support the mission of the MGH Vol
unteer Department: To provide support and compassionate service to patients, families, visitors and staff in a caring and respectful manner.
MGH volunteers provide service under the direct supervision of the designated staff liaison in their area of service. Supervisors are listed on service descriptions for the benefit of volunteers.
Examples of programs that are supported by volunteers include:
- Inpatient Discharge and Outpatient Escort—“BEACON” system
- Book Cart
- Gray Family Waiting Area
- Volunteer Department
- Information Desk
- Pet Therapy
- Patient and Family Learning Center
- Baby Cuddler Program
- Bulfinch Medical Group Library
- Support in clinical areas including but not limited to: emergency department, chemotherapy infusion units, radiation oncology, obstetrics and pediatrics.
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