A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association September 20, 2015 Executive Briefing Drawn from the Agency for Healthcare Research and Quality AHRQ TeamSTEPPS

NYS PARTNERSHIP FOR PATIENTS September 20, o An evidence-based teamwork system o Designed to improve: o Quality o Safety o Efficiency of health care o Practical and adaptable o Provides ready-to-use materials for training and ongoing teamwork What is TeamSTEPPS?

NYS PARTNERSHIP FOR PATIENTS September 20, o Goal: Produce highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes o Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error o Team skills are not innate; people must be trained Why Use TeamSTEPPS?

NYS PARTNERSHIP FOR PATIENTS September 20, o Communication failure has been identified as the leading root cause of sentinel events over the past 10 years (The Joint Commission) o Communication failure is a primary contributing factor in almost 80% of more than 6,000 root cause analyses of adverse events and close calls (VA Center for Patient Safety) Importance of Communication

NYS PARTNERSHIP FOR PATIENTS September 20, Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project. Health Serv Res. 37: , Haig, K., Sutton S, Whittington, J. SBAR: A shared mental model for improving communication between clinicians. JL Comm J Qual Patient Saf 32(3):167-75, March What can TeamSTEPPS Do for Us? Emergency Department 1 After implementation of multiple medical team training programs: Improved observed team behaviors. Enhanced staff attitudes toward teamwork. Reduced observed clinical errors. Clinical Units in a Medical Center 2 After implementation of SBAR to improve communication among clinical caregivers: Reduced rate of adverse drug events (from 30 to 18 per 1,000 patient days). Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89%.

NYS PARTNERSHIP FOR PATIENTS September 20, Mann, S, Marcus, R, Sachs, B. Lessons from the cockpit: How team training can reduce errors on L&D (Grand Rounds) Contemporary OB/Gyn v51 i1:34(8), January Pronovost, P, Berenholtz, S, Dorman, T, Lipsett, PA., Simmonds, T, Haraden, C. Improving communication in the ICU using daily goals. J Cri Care 18(2):71-5, Jun Labor and Delivery Units 1 After implementation of multiple teamwork strategies and tools: A 50% reduction in the Weighted Adverse Outcome Score (WAOS). The WAOS describes the adverse event score per delivery. A 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse event. Intensive Care Units (ICU) 2 After implementation of a “Patient Daily Goals” form to facilitate staff communication: A 50% decrease in mean ICU length of stay from 2.2 days to 1.1 days. What can TeamSTEPPS Do for Us? Cont.

NYS PARTNERSHIP FOR PATIENTS September 20, Awad, SS, Fagan, SP, Bellows, C., Albo, D, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 190(5): 770-4, Nov Leonard, M,, Graham, S, Bonacum, D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 13 Suppl 1:i85-90, Oct Operating Rooms (OR) After implementation of a “pre-op” brief: Increased OR communication. 1,2 Increased administration of properly timed prophylactic antibiotics prior to incision from 84% to 95%. 1 Increased pre-op deep vein thrombosis prophylaxis prior to induction from 92% to 100%. 1 Error avoidance: Pre-op brief revealed seven patients (3.3%) with previously unidentified severe surgical risks — surgery cancelled. 1 A 16% reduction in nursing turnover rate.2 A 19% increase in OR employee satisfaction. 2 What More Can TeamSTEPPS Do?

NYS PARTNERSHIP FOR PATIENTS September 20, o Evidence-based and field-tested o Comprehensive o Customizable o Easy-to-use teamwork tools and strategies o Publicly available What Makes TeamSTEPPS Different?

NYS PARTNERSHIP FOR PATIENTS September 20, What Will Our Teams Learn?

NYS PARTNERSHIP FOR PATIENTS September 20, o I. Assessment o Clearly define the need o II. Planning, Training, and Implementation o Plan to sustain the effort o Train individuals o Implement and test the strategies o III. Sustainment o Integrate into daily practice o Monitor and measure programs How Does TeamSTEPPS Work?

NYS PARTNERSHIP FOR PATIENTS September 20, o Clearly define the need o Focus on enhancing teamwork and establishing a teamwork and safety culture o Support from senior leadership o Allocate sufficient resources o Personnel o Time o Resources o Measure success o Reward and reinforce teamwork What Do We Need to Make This Work?

NYS PARTNERSHIP FOR PATIENTS September 20, Create a sense of urgency 2. Pull together the guiding team 3. Formulate a change vision and strategy 4. Communicate your vision for understanding and buy-in 5. Attend a NYSPFP training 6. Contact your NYSPFP Project Manager with questions 7. More resources on TeamSTEPPS available at: How Do We Start?

NYS PARTNERSHIP FOR PATIENTS September 20, TeamSTEPPS resources include: o Three teamwork training curricula o Course Management Guide o Multimedia course materials o TeamSTEPPS Implementation Guide o Measurement tools o More resources on TeamSTEPPS available at: Resources Available