Five Month Check-In Call

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Today’s Topics New WHO Checklist Evidence JCAHO Site Visit Update Surgical Safety Checklist Observation Tool Preliminary Results Where Do We Go From Here? Upcoming Events and Announcements

New Checklist Evidence Annals of Surgery van Klei WA et al. Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality. Annals of Surgery. 2012 Jan 1; 255(1):44-9.

University Medical Center Utrecht, The Netherlands 25,513 adult patients undergoing non-day surgery. Used hospital administrative data and patient medical records. Crude mortality decreased from 3.13% to 2.85%. Measured checklist compliance and found that mortality was significantly lower in patients with completed checklists. van Klei WA et al. Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality. Annals of Surgery. 2012 Jan 1; 255(1):44-9.

“When the checklist was not performed in its entirety the mortality rate remained unchanged.” van Klei WA et al. Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality. Annals of Surgery. 2012 Jan 1; 255(1):44-9.

Joint Commission Update “One of the focuses of the Joint Commission this year is active participation from all surgical team members in the room”

Surgical Safety Checklist Observation Tool Preliminary Results

These results include 44 Observation Tools from Five South Carolina Hospitals

Using the Checklist Helps Our Patients “7 Errors or Omissions Were Prevented by Using the Checklist”

Number of Times They Did Not Actively Participate in the Time Out The Following Team Members Did NOT Actively Participate in the JCAHO Time Out Team Member Number of Times They Did Not Actively Participate in the Time Out Percentage Anesthesiologist/CRNA 7 16% Circulating Nurse 1 2% Surgeon Surgical Tech 10 23% N=44

We Are NOT Performing All of the SCIP Measures Number of Patients that Did Not Receive Care Percentage of Patients that Did Not Receive Care Patients that did not receive one of the following SCIP Measures, when indicated: antibiotics within 60 minutes of incision, DVT Prophylaxis, and ensuring that a warmer is in place. 6 16% Patients that did not receive antibiotics within 60 minutes of incision when indicated. 1 2% N=43

We Are NOT Performing All Elements in the Briefing Section Briefing Item Number of Times the Item Was NOT Performed Percentage of Time the Item Was NOT Performed Did the surgeon discuss the operative plan? 11 25% Did the surgeon state the expected duration of the procedure? 22 50% Did the surgeon communicate the expected blood loss? 27 61% Did the nurse discuss sterility, equipment, or any other concerns? 6 14% Did the anesthesia provider discuss the anesthesia plan (including airway or other concerns)? 10 23% Were all of the checklist items read aloud, without reliance on memory? 18 41% N=43

We Are NOT Performing All of the Elements in the Debriefing Debriefing Item Number of Times the Item Was NOT Performed Percentage of Time the Item Was NOT Performed Did the team discuss specimen labeling? 8 22% (N=37) Did the team discuss equipment or other problems? 12 35% (N=34) Did the team discuss key concerns for patient recovery and post-op management? 32% (N=37)

What Do These Results Mean? We are good, but we can do even better. The checklist is helping our patients.

What Can We Do To Improve Coaching Team Training

Show Me/Teach Me C O A H I N G Watch Me Give Me Feedback

Coaching Review Pick the “right” people to be coaches in the OR. Train coaches to give constructive feedback: Ask questions Think about: What they observed Who you are coaching and if that coaching should take place in the OR or after the case

Your Hospital Reports Thank you for sending us your data. We will be sending your individual hospital results to you shortly. Please consider performing more than five observations in the next couple of months. Performing more observations will help you better understand how teams are using the checklist.

A Few Things To Keep In Mind When Completing the Observation Tools Consider training a couple of observers/coaches and use them to complete all of your observations. When completing the observations, please fill out every item. If the item was not performed by the team indicate “No” instead of leaving the item blank.

Poll 1: How Well Do You Think the Checklist Is Currently Being Performed in Your ORs? Very Well – All team members participate in the checklist and items are read off of a hard copy of our checklist. Neither Good nor Poor - Team members generally stop other activities or conversation and participate, but do not appear interested, while it is being performed. Teams read off a hard copy of the checklist, but tend to skip items. Poor - Team members continue other activities or conversation and do not actively participate. Many times the checklist is not read from a hard copy.

Poll 2: Has Checklist Performance Improved Since Our Last Call in November? Stayed the same Deteriorated

Checklist Implementation End of Checklist Implementation Checklist Rebound Checklist Implementation End of Checklist Implementation

How Do We Know When We Are Done? Have members of your surgical teams complete a document that we call, “Are we a Safe Surgery 2015 Hospital”. (Questions on the next two slides) Ask people from all disciplines to complete this form. If anybody answers “no” you are not done with this work.

Are We a Checklist Hospital? 1. Does your surgical checklist have three phases, before induction of anesthesia, before skin incision, and before the patient leaves the room? 2. Are the items on the checklist read aloud, without reliance on memory, so all members of the team can hear them? 3. Are all three phases of the checklist performed for every patient undergoing a surgical procedure in your hospital’s operating rooms? 4. Does every person that is present in the operating room say something before skin incision, at a minimum they introduce themselves by name and role or state that they are ready to proceed? (This includes perfusionists, surgical assistants, PAs, residents, observers, manufacturer representatives, and other observers)

Are We A Checklist Hospital Continued 5. Does the surgeon share an operative plan and discuss: anticipated blood loss, expected duration of the procedure, possible difficulties, and implants or special equipment needed for the case with the entire team before skin incision? 6. Do nurses and surgical techs discuss with the entire team their concerns about the patient? 7. Do the anesthesia providers discuss with the entire team the anesthetic plan and airway or other concerns? 8. Does the surgeon ask the entire team to speak up if they have any concerns during the case? 9. Before the patient leaves the OR do ALL members of the surgical team discuss equipment problems that need to be addressed, key concerns for recovery and management, and anything that could have been done better to make the case safer or more efficient?

Surgeon Webinar Thursday, January 12th, 2012 7:00 am – 7:30 am Please get your surgeon champions to participate in the surgeon webinar this week. Surgeons will be eligible to receive .5 CME Credits.

Team Training We have a team training date scheduled in early February for hospitals in the Pee Dee Region or anybody else that would like to attend. We will be conducting a team training in Columbia on Tuesday, April 24th at the Patient Safety Symposium Contact Mary Stargel for more information at: mstargel@scha.org.

April Patient Safety Symposium We will also be holding a breakout session dedicated to the Safe Surgery work on the 25th. We want you and your implementation team to participate. This will be an interactive session where hospital implementation teams can learn from each other. Atul Gawande will be giving a keynote. Invite your board to join us.

Poll 3: How Do We Support You Going Forward? Continue holding check-in calls. We will call into the existing office hours calls. We want to set-up one-on-one check-in calls with the HSPH Team.

Poll 4: Would You Be Willing To Visit a Hospital that is Participating in Wave 2 or Wave 3 of the Call Series? Yes No

? Questions

Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu