CUSP for Safe Surgery: The Surgical Unit-Based Safety Program March 3 & 5, 2014 Sean Berenholtz, MD, MHS, FCCM

Some quick administrative announcements 2 You need to dial into the conference line to hear audio –Dial in Number: –Passcode: A copy of these slides can be found on our SUSP recruitment website SUSP recruitment website A recording of this webinar will be available on the recruitment website by March 6, 2014.

Learning Objectives Identify SUSP program –Project goals and interventions –Participation requirements and timeline Describe steps to enroll in SUSP

Why is Your SUSP Work Important? 4http:// enge/safe.surgery/en/ 1 in 25 people will undergo surgery 7 million (25%) in-patient surgeries followed by complication 1 million (0.5 – 5%) deaths following surgery 50% of all hospital adverse events are linked to surgery AND are avoidable

How is SUSP different than SCIP (Surgical Care Improvement Project

Your Team Addresses Local Needs 6 No single SSI prevention bundle –Frontline staff identifies local defects –Fix defects with executive support Measure local safety culture using Hospital Survey of Patient Safety (HSOPS) Questions? the SUSP help desk!

SUSP Project Overview

8 AHRQ funding project –Individual hospitals participate for 18 months years Leveraging leaders in field –Armstrong Institute, ACS NSQIP, AHRQ, University of Pennsylvania, WHO All hospitals in any state, as well as hospitals in the District of Columbia and Puerto Rico are encouraged to participate.

Who can join SUSP? 9 Participation in the program is available to any hospital in any state, as well as hospitals in the District of Columbia and Puerto Rico. Hospitals may participate through their state hospital association, state patient safety agency, hospital engagement network (HEN) or other convening group. Questions? the SUSP help desk!

10 SUSP Enrollment by Coordinating Entity Armstrong Institute for Patient Safety & Quality Hawaii Safer Care SUSP Collaborative Arkansas Hospital Association Iowa Healthcare Collaborative (HEN) Colorado Hospital Association Maryland Hospital Association Connecticut Hospital Association Michigan Health & Hospital Association (HEN) Florida Hospital Association Nevada Health Insight (HEN) Georgia Hospital Association (HEN) Tennessee Hospital Association (HEN) Premier Healthcare Alliance (HEN) Massachusetts Hospital Association

Click to edit Master text styles –Second level Third level –Fourth level »Fifth level 11 Coordinating EntityNumber of Hospitals Enrolled Arkansas Hospital Association11 Armstrong Institute31 Colorado Hospital Association8 Connecticut Hospital Association5 Florida Hospital Association11 Georgia Hospital Association14 Hawaii Safer Care SUSP Collaborative14 HealthInsight Nevada4 Iowa Healthcare Collaborative13 Maryland Hospital Association18 Massachusetts Hospital Association8 Michigan Health & Hospital Association46 Premier Healthcare Alliance8 Tennessee Hospital Association10 Total Enrollment Cohort 110 Cohort 2102 Cohort 347 Cohort 442 Total201 SUSP Enrollment by Coordinating Entity and Cohort

Our Shared Project Goals 12 To achieve significant reductions in surgical site infection and surgical complication rates To achieve significant improvements in safety culture Questions? the SUSP help desk!

13 ong_institute How Are We Achieving Our Goals? Comprehensive Unit based Safety Program (CUSP) 1.Educate staff on science of safety 2.Identify defects 3.Assign executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools Translating Evidence Into Practice (TRiP) 1.Summarize the evidence 2.Identify local barriers to implementation 3.Measure performance 4.Ensure all patients get the evidence Engage Educate Execute Evaluate Reducing Surgical Site Infections Emerging Evidence Local Opportunities to Improve Collaborative learning Technical WorkAdaptive Work

We’re Building on Previous Successes N Engl J Med 2006;355: BMJ 2010;340:c Infect Control Hosp Epidemiol. 2011;32(4): Michigan Keystone ICU program –Reductions in central line-associated blood stream infections (CLABSI) 1,2 –Reductions in ventilator-associated pneumonias (VAP) 3 National On the CUSP: Stop BSI program 4

15 Percent of Units with Zero CLABSIs and Achieving Project Goal (<1/1000 CL days) *Data drawn from Interim Project Report – Figure 5 – Cohorts 1 through 3

We Focus on Systems, Not Individuals 16 Harm is preventable –Many healthcare acquired infection and complications are preventable; should be viewed as defect Technical and adaptive work –Engaging frontline staff to identify and fix local opportunities to improve Framing as social problem that can be solved –Clinical communities Questions? the SUSP help desk!

17 The Joint Commission, Sentinel Event Data; vent_Type_Year_ pdf;29. Wrong-patient, Wrong-site, Wrong-procedure Events Reviewed by The Joint Commission

How is SUSP Different? 18 Informed by science Led by clinicians and supported by management Guided by measures –local and national Questions? the SUSP help desk!

SUSP Interventions

No single SSI prevention bundle 20 Deeper dive into SCIP measures to identify local defects Emerging evidence –Abx redosing and weight based dosing –Maintenance of normogylcemia –Mechanical bowel preparation with oral abx –Standardization of skin preparation Capitalize on frontline wisdom –CUSP/Staff Safety Assessment

Auditing tools 21 Antibiotic –Selection, dosing, redosing Normothermia Glucose Control Skin Prep SSI investigation Others Questions? the SUSP help desk!

Comprehensive Unit-based Safety Program (CUSP) 1.Educate staff on science of safety 2.Identify defects 3.Assign executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools Questions? the SUSP help desk!

Briefings and Debriefings 23 1 Arch Surg. 2008;143(11): J Am Coll Surg. 2009;208: Jt Comm J Qual Saf. 2009;35(8): N Engl J Med. 2009;360: Reductions in communication breakdowns and OR delays 1 Reductions in procedure and miscommunication- related disruptions and nursing time spent in core 2 Improved communication and teamwork, feasible given current workload 3 Reductions in rate of any complications, SSI and mortality 4

What data will teams need to collect?* 24 Monthly NHSN and/or NSQIP SSI data by surgical specialty area –Numerator and denominator Annual teamwork/culture data using the AHRQ Hospital Survey of Patient Safety (HSOPS) Will work with CEs to ensure data reporting meets their needs *If data is already collected/available (ie: ACS NSQIP or NHSN), we will work with your team to import if you desire Questions? the SUSP help desk!

Surgical Site Infection Data Entry: NSQIP 25 Target audience: Coordinating Entities and hospital administrators Data transferred directly from NSQIP Unadjusted data transferred on a monthly basis Adjusted data (Odds) transferred every 6 months Questions? the SUSP help desk!

Surgical Site Infection Data Entry: NHSN & Manual Entry 26 Data transfer process – done by the coordinating entities or hospital administrator Unadjusted data transferred on a monthly basis Adjusted data (SIR) transferred every 6 months Questions? the SUSP help desk!

What do teams need to do? 27 –Attend the Cohort 5 kickoff webinar (~2 hours) Monday, April 10AM (EST) OR Wednesday, April 2PM (EST) –Assemble a multidisciplinary team Including Preop, OR and Postop staff –Participate in monthly project webinars All webinars recorded and archived online –Participate in monthly coaching calls –Regularly meet as a team to implement interventions and monitor performance Questions? the SUSP help desk!

Once enrolled, the SUSP website is your go to place for everything! 28 Previously recorded cohort project call webinars Manuals Toolkits Data portal –Who uses the portal? SUSP project leads HSOPS coordinators SSI data coordinators Coordinating Entities –What’s the portal used for? Data viewing, summation, sharing Hospital Survey of Patient Safety (HSOPS) Sharing of information Talk with other SUSP hospitals on our social network! armstrongresearch.hopkinsmedicine.org

29 Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2). CUSP Works in the OR Colorectal NSQIP SSI Rate at Hopkins (Wick 2012)

Why should you be a part of SUSP? 30 Improve patient outcomes –ACS NSQIP comparative feedback Platform that links data collection, reporting, and training with social networking to improve communication and sharing Finding ‘value’ in our work Teams own their own data for publication Questions? the SUSP help desk!

31 What are current SUSP hospitals saying?

Join us on our journey to improve the safety of our patients! 32 How to enroll or recruit hospitals into SUSP Everything you need is online! –Download ALL enrollment documents online! –Complete the team registration form online!  Visit the SUSP recruitment websiteSUSP recruitment website Have questions? the SUSP help desk!

State hospital associations: Important due dates and deadlines 33 By March 21: Complete the Coordinating Entity Participating Agreement and to or fax to Coordinating Entity Participating Agreement Download the Coordinating Entity Project Manual for guidance on kick-starting your recruiting effortsCoordinating Entity Project Manual  Everything you need is here: SUSP recruitment websiteSUSP recruitment website Have questions? the SUSP help desk!

Hospitals: Important due dates and deadlines 34 By April 9: Have your hospital leadership complete the Hospital CEO Participating AgreementHospital CEO Participating Agreement By April 16: Complete three additional forms –Online Project Team Registration FormOnline Project Team Registration Form –Data Use AgreementData Use Agreement –Clinical Team Participating AgreementClinical Team Participating Agreement Upload copies of these forms when submitting the Online Project Team Registration Form. You can also return the forms to the SUSP help desk at or by fax: Online Project Team Registration  Everything you need is here: SUSP recruitment websiteSUSP recruitment website Have questions? the SUSP help desk!

Next steps 35 Visit our recruitment websiterecruitment website –CEs: begin recruiting hospitals –Independent hospitals: Return all enrollment forms to no later than April Have questions? the SUSP help desk! Questions? the SUSP help desk!

SUSP from the CE perspective 36 Dana Bonistalli Project Manager, Quality Policy & Advocacy Maryland Hospital Association 18 hospitals enrolled and engaged in SUSP!