Operating Room Team Training With Simulation Program

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Presentation transcript:

Operating Room Team Training With Simulation Program Patient Safety Forum March 30, 2017 - Keep your title simple. - Use the first subtitle for the subtitle of your presentation - Use the “2nd subtitle” for your name, job, title, etc.  This is optional! Bill Berry, MD, MPA, MPH Associate Medical Director in Surgery, CRICO Chief Medical Officer, Ariadne Labs Kathy Dwyer, MS, RN Senior Program Director, Patient Safety, CRICO

Overview of Surgical-related Malpractice Data Between 2011-2016, surgical-related cases account for nearly 25% of CRICO’s total incurred loss Most common contributing factors were technical performance (50%) and ineffective communication (23%) Deeper analysis of surgical cases revealed Preventable adverse outcomes often related to poor communication and teamwork Response or lack of response to technical error because of inadequate communication often contributed significantly to patient’s injury Total incurred includes reserves on open and payments on closed cases.

Harvard Surgical Chiefs Safety Collaborative CRICO’s long role in harmonizing safety standards - e.g., Harvard Anesthesia Standards; team training in Anesthesia and Obstetrics with premium reduction Goal: Joint effort to identify areas to work together to improve patient safety in surgery and decrease malpractice risk; projects include Fundamentals in Laparoscopy Skills Resident to attending communication triggers Grant to adopt sponge tracking technology Harvard Surgery Code of Excellence 360 reviews for surgeons OPERATING ROOM TEAM TRAINING WITH SIMULATION

Program Requirements Include A simple team training curriculum Debriefer training course Multidisciplinary team training sessions 4-6 hours in length challenging surgical scenarios facilitated debriefing engage realism Three components safety checklist speaking up practicing close loop communication techniques

Program Requirements Included Three case scenarios hemorrhage cardiac arrest outside OR case based on institution’s choice

CRICO Board Support and Participation Educational grant Premium rebate for surgeons Eleven institutions participating Seven surgical specialties Over 425 surgeons and their teams Three approaches High fidelity simulation Low fidelity simulation In situ

Results and Sustainability Over 97 percent of participants rated the overall course as above average or excellent Over 80 percent of participants rated improved communication skills post training Improved safety culture in the operating room Moved simulation-based team training into the fabric of the institutions Shorter duration, more frequently reinforced training opportunities in teamwork

Lessons Learned Engage key stakeholders early Collaborations can be powerful Keep programs simple Provide some structure Allow individual creativity and ownership Pilot learnings informed the scale-up Malpractice premium rebate an important lever Support from Harvard Surgical Chiefs Safety Collaborative

What would you do differently Cultivate support at the highest levels Consider engaging chief financial officers early in the process Explore during the project ways to make the training more efficient and less costly Perform an ongoing assessment of recommended resources to inform the broader implementation Obtain baseline information/data around existing safety cultures in operating rooms and safety event data

Video

Contact Information Kathy Dwyer kdwyer@rmf.harvard.edu 617-450-6806

Dedicated to creating the safest health care system in the world.