1. Implementation of TeamSTEPPS in a High Acuity Environment: A Multifaceted Approach in MetroHealth's Emergency Department August 12, 2015

2. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 TeamSTEPPS ® TeamSTEPPS in the ED Slide 2 Rules of Engagement Audio for the webinar can be accessed in two ways: 1.Through the phone (*Please mute your computer speakers) 2.Through your computer A Q&A session will be held at the end of the presentation Written questions are encouraged throughout the presentation and will be answered during the Q&A session To submit a question, type it into the Chat Area and send it at any time during the presentation The lines may open for call-in questions during the Q&A session

3. T EAM STEPPS 05.2 Mod 1 05.2 Page 3 TeamSTEPPS ® TeamSTEPPS in the ED Slide 3 Acknowledgements Project Sponsors Jim Battles, PhD (AHRQ) Heidi King, MS (DoD) Project Team Health Research & Educational Trust (HRET) Barb Edson (Project Director) Chris Hund (Project Manager) IMPAQ International David Baker (Team Lead)

4. T EAM STEPPS 05.2 Mod 1 05.2 Page 4 TeamSTEPPS ® TeamSTEPPS in the ED Slide 4 TeamSTEPPS Master Training Two-day training course Train-the-trainer approach Prepares you to serve as a TeamSTEPPS Master Trainer by Providing instruction on TeamSTEPPS tools and strategies Providing an opportunity to develop and plan your TeamSTEPPS implementation Prepares you to serve as a leader for implementing TeamSTEPPS within your organization

5. T EAM STEPPS 05.2 Mod 1 05.2 Page 5 TeamSTEPPS ® TeamSTEPPS in the ED Slide 5 Upcoming TeamSTEPPS Events Monthly Webinars Scheduled through September 2015 Topics, speakers, and registration information will be posted on the portal Register now for the September webinar: Addressing Behaviors that Undermine a Culture of Safety, Reliability, and Accountability, presented by Gerald Hickson, MD, Vanderbilt Center for Patient and Professional Advocacy Online Course Availability Not able to travel? TeamSTEPPS 2.0 Online Master Trainer Course now available. Register at: https://tslms.org https://tslms.org Learn more and register for all events at www.TeamSTEPPSportal.org www.TeamSTEPPSportal.org

6. T EAM STEPPS 05.2 Mod 1 05.2 Page 6 TeamSTEPPS ® TeamSTEPPS in the ED Slide 6 Help Line (312) 422-2609 Or email: AHRQTeamSTEPPS@aha.orgAHRQTeamSTEPPS@aha.org

7. T EAM STEPPS 05.2 Mod 1 05.2 Page 7 TeamSTEPPS ® TeamSTEPPS in the ED Slide 7 Today’s Presenters Thomas P. Noeller, MD, FAAEM, FACEP Associate Professor, Case Western Reserve University School of Medicine Director of the MetroHealth Simulation Center Attending Physician in the Department of Emergency Medicine at MetroHealth Medical Center Robert L. Smith, PhD Director of Medical Staff Assistance Program, MetroHealth Medical Center Director, MetroHealth TeamSTEPPS Regional Training Center

8. T EAM STEPPS 05.2 Mod 1 05.2 Page 8 TeamSTEPPS ® TeamSTEPPS in the ED Slide 8 Objectives Identify teamwork intervention targets in a high acuity environment Apply TeamSTEPPS principles to address identified needs Describe a multifaceted program that includes practical and sustainable applications of TeamSTEPPS principles

9. T EAM STEPPS 05.2 Mod 1 05.2 Page 9 TeamSTEPPS ® TeamSTEPPS in the ED Slide 9 Who is MetroHealth?

10. T EAM STEPPS 05.2 Mod 1 05.2 Page 10 TeamSTEPPS ® TeamSTEPPS in the ED Slide 10 Serving Cuyahoga County in Cleveland since 1837 One of the largest healthcare organizations in Northeast Ohio 700-bed medical center 17 community health centers MetroHealth

11. T EAM STEPPS 05.2 Mod 1 05.2 Page 11 TeamSTEPPS ® TeamSTEPPS in the ED Slide 11 Over 476 Primary Care/ Specialty Physicians 1,230 Registered Nurses 145 Advanced Practice Nurses

12. T EAM STEPPS 05.2 Mod 1 05.2 Page 12 TeamSTEPPS ® TeamSTEPPS in the ED Slide 12 Patient Care at MetroHealth Care provided in 2014 28,000 inpatients 2,900 newborns delivered Over 1,000,000 visits in outpatient centers Over 106,000 visits to the Emergency Department

13. T EAM STEPPS 05.2 Mod 1 05.2 Page 13 TeamSTEPPS ® TeamSTEPPS in the ED Slide 13 Twenty-four Residency Programs 374 Interns/Residents Fifteen Fellowship Programs 55 Fellows 1 st and 2 nd Year Medical Students, Nursing Students, etc. 1035 “students”

14. T EAM STEPPS 05.2 Mod 1 05.2 Page 14 TeamSTEPPS ® TeamSTEPPS in the ED Slide 14 TeamSTEPPS and MetroHealth 2013 Established Steering Committee and Change Team Buy-In from Administration and Medical Executive Committee Decision to Implement System-wide Developed MetroHealth Master Trainers

15. T EAM STEPPS 05.2 Mod 1 05.2 Page 15 TeamSTEPPS ® TeamSTEPPS in the ED Slide 15 Quality Department OB/GYN Emergency Medicine Surgery Trauma / Burn Units Medicine Pediatrics Geriatrics PM&R Organizational Change Team Ambulatory Care Medical ICU Organizational Develop Simulation Center Communication Diversity and Inclusion Marketing MetroHealth Union

16. T EAM STEPPS 05.2 Mod 1 05.2 Page 16 TeamSTEPPS ® TeamSTEPPS in the ED Slide 16 MetroHealth Mission “Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork.”

17. T EAM STEPPS 05.2 Mod 1 05.2 Page 17 TeamSTEPPS ® TeamSTEPPS in the ED Slide 17 New MetroHealth Values Service to Others Teamwork Teamwork Accountability Respect Inclusion and Diversity Quest for Excellence

18. T EAM STEPPS 05.2 Mod 1 05.2 Page 18 TeamSTEPPS ® TeamSTEPPS in the ED Slide 18 TeamSTEPPS and MetroHealth 2014 Began Implementation Emergency Department Critical Care/ Trauma/ Burn Units Operating Room and PACU Labor & Delivery, NICU and Post-Partum Administration, Strategic Planning, Foundation Middleburg Hts. Ambulatory Care Ambulatory Surgery on Main Campus

19. T EAM STEPPS 05.2 Mod 1 05.2 Page 19 TeamSTEPPS ® TeamSTEPPS in the ED Slide 19 TeamSTEPPS and MetroHealth 2015 Trained in 2015: Pediatrics Physical Medicine and Rehabilitation Neurology Approximately 40% of staff trained

20. T EAM STEPPS 05.2 Mod 1 05.2 Page 20 TeamSTEPPS ® TeamSTEPPS in the ED Slide 20 TeamSTEPPS and MetroHealth 2015 On Deck: Cardiology Pulmonology MICU / Internal Medicine Floors Finance / Information Systems Ambulatory Network Environmental Services / Dietary / Textiles

21. T EAM STEPPS 05.2 Mod 1 05.2 Page 21 TeamSTEPPS ® TeamSTEPPS in the ED Slide 21 MetroHealth Emergency Department Urban Academic / Community >106,000 visits annually 350 Staff Residency Program 39 residents Affiliated with Case Western Reserve University and Cleveland Clinic MAGNET Nursing Designation Metro Life Flight Level 1 Trauma and Burn Centers

22. T EAM STEPPS 05.2 Mod 1 05.2 Page 22 TeamSTEPPS ® TeamSTEPPS in the ED Slide 22 ED Team Patients Physicians / Providers Nurses Paramedics Police / Security Metro Life Flight EMS Environmental Services Behavioral Observers Financial Counselors EMR / Registration Radiology Stat Lab Other departments Other hospitals Entire MH System

23. T EAM STEPPS 05.2 Mod 1 05.2 Page 23 TeamSTEPPS ® TeamSTEPPS in the ED Slide 23 TeamSTEPPS in the ED Intervention Targets Trauma resuscitations Escalating response Ebola Treatment Center Transitions / Handoffs Throughput Team culture

24. T EAM STEPPS 05.2 Mod 1 05.2 Page 24 TeamSTEPPS ® TeamSTEPPS in the ED Slide 24 TeamSTEPPS Application Trauma Resuscitations Team Structure Leadership Escalating Response Situation Monitoring Ebola Treatment Center Situation Monitoring Transitions / Handoffs Communication Throughput Situation Monitoring Team Culture Mutual Support

25. T EAM STEPPS 05.2 Mod 1 05.2 Page 25 TeamSTEPPS ® TeamSTEPPS in the ED Slide 25 Getting Started Relevance Solution-oriented Practical / Pragmatic Not the “flavor of the month” or “catch your buddy”

26. T EAM STEPPS 05.2 Mod 1 05.2 Page 26 TeamSTEPPS ® TeamSTEPPS in the ED Slide 26 The Plan Knowledge Acquisition Live Didactic LMS Application Simulation Real Change Practical Tools Sustain

27. T EAM STEPPS 05.2 Mod 1 05.2 Page 27 TeamSTEPPS ® TeamSTEPPS in the ED Slide 27 New Knowledge Live Didactic LMS Flexible Custom video Memorable (Star Wars) Thought leaders

28. T EAM STEPPS 05.2 Mod 1 05.2 Page 28 TeamSTEPPS ® TeamSTEPPS in the ED Slide 28 Simulation Put the concepts into practice Engaging Real scenarios Real team Real environment “Now I get it”

29. T EAM STEPPS 05.2 Mod 1 05.2 Page 29 TeamSTEPPS ® TeamSTEPPS in the ED Slide 29 Trauma Resuscitations Target Team Structure Leadership Tools Brief / Huddle checklists Room configuration Education / Orientation

30. T EAM STEPPS 05.2 Mod 1 05.2 Page 30 TeamSTEPPS ® TeamSTEPPS in the ED Slide 30 Escalating Response Target Get the right resources to the right patient at the right time Tools Code STAR

31. T EAM STEPPS 05.2 Mod 1 05.2 Page 31 TeamSTEPPS ® TeamSTEPPS in the ED Slide 31 Ebola Treatment Center Target New multidisciplinary high-stakes process Tools Adapted Team Performance Observation Tool Simulation

32. T EAM STEPPS 05.2 Mod 1 05.2 Page 32 TeamSTEPPS ® TeamSTEPPS in the ED Slide 32 Transitions / Handoffs Issue Critical patients admitted to the ICU Tools Routine pre-departure assessment See something / say something Pre-departure checklist SBAR / I PASS THE BATON

33. T EAM STEPPS 05.2 Mod 1 05.2 Page 33 TeamSTEPPS ® TeamSTEPPS in the ED Slide 33 Throughput Issue Hospital congestion Tools Regular huddle schedule Active pulling

34. T EAM STEPPS 05.2 Mod 1 05.2 Page 34 TeamSTEPPS ® TeamSTEPPS in the ED Slide 34 Team Culture Target Culture change Tool Caught in the Act Cross-disciplinary shadowing - “walk a mile”

35. T EAM STEPPS 05.2 Mod 1 05.2 Page 35 TeamSTEPPS ® TeamSTEPPS in the ED Slide 35 Sustain TeamSTEPPS Action Council (TAC) Multidisciplinary Empowered / Empowering Goals / Objectives Interface with Ops Achievements Code STAR Psychiatric patient care Trauma registration

36. T EAM STEPPS 05.2 Mod 1 05.2 Page 36 TeamSTEPPS ® TeamSTEPPS in the ED Slide 36 Sustain New Hires Refreshers Recruit instructors / master trainers

37. T EAM STEPPS 05.2 Mod 1 05.2 Page 37 TeamSTEPPS ® TeamSTEPPS in the ED Slide 37 Questions and Answers

38. T EAM STEPPS 05.2 Mod 1 05.2 Page 38 TeamSTEPPS ® TeamSTEPPS in the ED Slide 38 Thank You! For more information, please contact our team at: AHRQTeamSTEPPS@aha.org