1. International Quality Improvement Collaborative for Congenital Heart Surgery
Hello everyone and thank you for joining us.
Welcome to the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries.
We are very excited to present our sixth learning module.

2. Vision
Facilitate a collaborative of healthcare teams from around the world creating a culture of patient safety & quality for children receiving congenital heart surgery in developing countries
As many of you are familiar with already, the Internal Quality Improvement Collaborative vision is to facilitate a collaborative of healthcare teams from around the world creating a culture of patient safety and quality for children receiving congenital heart surgery in developing countries.

3. Mission
Our mission is to reduce mortality and major complications for children undergoing congenital heart surgery.
Our mission is to reduce mortality and complications for children undergoing congenital heart surgery.

4. Objective
Create tailored quality improvement strategies to reduce mortality and major complications for developing world programs.
Employ a telemedicine platform to facilitate distance learning, dialogue, disseminate knowledge & skills.
We hope to achieve this mission by creating tailored quality improvement strategies to reduce mortality and major complications as well as by employing a telemedicine platform to facilitate distance learning, dialogue, and the dissemination of knowledge and skills.

5. Drivers of Mortality Team-based practice through nurse empowerment
Reduce surgical site infections and bacterial sepsis
Safe perioperative practices
Three key drivers of mortality have been identified: Team-Based practice through nurse empowerment, reduction of surgical site infections and bacterial sepsis, and safe perioperative practices. .

6. Key Driver Diagram Team-based Practice Change Strategies Key Drivers
Reduction
In 30 day mortality associated with congenital heart
surgery
Key Drivers
Change Strategies
Utilize a surgical safety checklist to prompt and document evidence-based process measures (i.e. antibiotics given within 60 minutes of surgical incision)
Focus on hand hygiene for ALL clinical personnel in contact with patient care.
Empowering nurses
Evidence-based nursing practice
Scripting nurses in ward and ICU on how to give reports
Accurate 24hr total patient intakes and outputs
Accurate daily recording of patient weight
Effective Communication-SBAR
Safe Operative Practice
Reduce Surgical Site Infections &
Bacterial Sepsis
Team-based Practice
Aim
The Key driver diagram that you see on the screen here is helpful in visualizing the relationship between the change strategies, the key drivers for these change strategies, and the ultimate aim of the collaborative.

7. Learning Modules
Learning Module I: Team-based practice and nurse empowerment
Learning Module II: Reducing surgical site infection and bacterial sepsis
Learning Module III: Safe perioperative practice
In order to meet our objectives, we have developed learning modules around our identified change strategies. The Learning Modules are designed to facilitate didactic and participatory learning through the monthly webcasts.

8. Learning Modules
Contain quality improvement strategies for each of the 3 drivers that impact mortality addressed during the webinars.
Each module contains a series of 3 educational sessions.
Sessions advance from beginning, intermediate, and advance-level of learning & acquisition of skills.
Each Learning Module includes a series of three educational sessions advancing from beginning to intermediate to advanced-level.

9. Timeline for Webcasts 2010 Timeline for Webcasts
Phase II
Level of Learning Modules
QI Strategies
Beginning Level
Intermediate Level
Advance Level
Learning Modules
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Team-based Practice
2/17
5/19
8/18
Reducing Infections
3/17
6/16
9/15
Safe Surgical Practices
4/21
7/21
10/20
Today, we are excited to present to you our intermediate learning module on Safe Surgical Practices. Our next webinar will take place on August 18th and will encompass the beginning level learning module on Team-based Practice.
The color of each Learning Module corresponds to the date the that topic will be presented during that month’s webcast. For example, Team-based Practice will be the topic 2/17, 5/19, and 8/18.

10. Data Entry Map
Founding Sites
New Sites
Before we begin the learning module for today, we will first provide you with a brief update on site participation and data entry. From this map you are able to see that there are currently 14 sites from across the world participating in the International Quality Improvement Collaborative. As noted with the blue arrows, there are 5 founding centers who joined the collaborative in As noted with the green arrows, there are 9 sites from 7 different countries who joined us this year.

11. Cumulative Site Participation
As shown by this graph, the collaborative launched in September of 2008 with five centers. Site participation underwent significant growth in 2010 bringing the number of sites who are currently enrolling to 14.
*Graph captures only sites that have entered > 10 patients into the IQIC Database.

12. Cumulative Patient Enrollment
With all your hard work, we continue to increase patient enrollment. As of July 15th, enrollment reached 3880 patients. Thank you all for continuing to do such an amazing job!
Month

13. Implementation of a Surgical Safety Checklist for Congenital Cardiac Surgery (Intermediate Module) July 21, 2010

14. Schedule April 21, 2010- Beginning Module
Introduction to checklist
July 21, Intermediate Module
Strategies for implementing the checklist
October 20, Advanced Module
Review of strategies to ensure sustained use following successful implementation

15. Agenda and Goals
What we have learned from our teleconferences with participating sites
Review checklist video as an example of how it may be used to improve safety
Review a strategy to successfully implement a checklist at your own institution
Next steps leading to the final webinar

16. What Have We Learned from Our Teleconferences?
Variable checklist utilization currently exists across sites
All sites have reported a high level of acceptance among operating room staff for adopting the checklist as an important safety intervention
Participation and leadership across sites for checklist implementation has been diverse and truly multidisciplinary!

17. What Have We Learned from our Teleconferences?
Most sites are still unsure how to move forward with recruiting additional local leaders
Most sites are still unsure how to implement a pilot phase to test the checklist
Most sites are still unsure how the checklist should be used in practice
All sites have the dedication and leadership necessary to succeed!

18. Introduction to Checklist Video
Video designed to demonstrate how the checklist can be used to facilitate communication between team members
Checklist content may change depending upon the local needs and culture of each hospital
Each section of the checklist will be presented separately to allow for questions and discussion
Please take note how the use of the checklist during each section may have to be changed to fit the needs of your own environment

19. Sign In

21. Sign In Discussion
Are there any questions regarding the sign-in portion of the checklist?
Do any of the sites currently practice a sign-in or similar procedure prior to anesthesia induction?
For sites that do not perform a sign-in, are there any obstacles that you anticipate in adopting such a practice?

22. Time Out

24. Time Out Discussion
Are there any questions regarding the time out portion of the checklist?
Do any of the sites currently practice a time out or similar procedure prior to anesthesia induction?
For sites that do not perform a time out, are there any obstacles that you anticipate in adopting such a practice?

25. Sign Out

27. Sign Out Discussion
Are there any questions regarding the sign-out portion of the checklist?
Do any of the sites currently practice a sign-out or similar procedure?
For sites that do not perform a sign-out, are there any obstacles that you anticipate in adopting such a practice?

28. Handover

30. Handover
Are there any questions regarding the handover portion of the checklist?
Do any of the sites currently practice a handover or similar procedure?
For sites that do not perform a handover, are there any obstacles that you anticipate in adopting such a practice?

31. Identify (and recruit!) leaders from each discipline
How to Implement the Checklist: Strategies for a Successful Pilot Phase
Identify (and recruit!) leaders from each discipline
Nursing, anesthesia, Critical Care, surgery, and perfusion
Review of the checklist by each leader for feedback on content
How should it be changed to meet the needs of their discipline?

32. How to Implement the Checklist: Strategies for a Successful Pilot Phase
Modification of checklist from multidisciplinary feedback as necessary prior to piloting
Trial the checklist for 5-10 cases by pilot team
Make further adjustments to the checklist as necessary after obtaining further input

33. How to Implement the Checklist: Strategies for a Successful Pilot Phase
Recruitment of additional team members to pilot an additional cases
Obtain further feedback on checklist content
Make final modifications to the checklist in preparation for operating room-wide use
Consider making posters for operating rooms and Intensive Care Units once the final version of the checklist is developed

34. Next Steps
Monthly teleconferences to assess progress and provide guidance as necessary
Time-lines for the pilot strategy previously discussed will depend upon the needs of each hospital
Frequent correspondence is encouraged between teleconferences

35. Next Steps
Use of discussion boards on IQIC database (beginning next week)
Consider site visits to provide in-person assistance as needed
Next webinar will focus on strategies for ensuring sustained use of the checklist as your institution

36. Thank you!

37. Acknowledgements
Shawn Rangel, MD, FACS Surgeon, Department of General Surgery
David Roberson, MD, FACS Surgeon, Department of Otolaryngology
Francis Fynn-Thompson, MD Surgeon, Cardiovascular Surgery
Michelle Lyden, MSN, NP, MPA Quality and Safety Research Manager
Traci Wolbrink, MD Chief Fellow, Pediatric Critical Care
Patricia Hickey, PhD, RN, MBA, FAAN VP, Cardiovascular/Critical Care Services
Jeanne Ahern, BSN, MHA, RN, CCRN Nurse Manager, CICU
Annette Saltamartini Imprescia, RN, CCRN Clinical Educator, CICU
Beverly Small, RN, CCRN Nurse, CICU
Annette Schure, MD Anesthesia, Perioperative & Pain Medicine
Patricia Galvin, RN, MSN, CNOR Clinical Coordinator, Cardiovascular Surgery
Ravi Thiagarajan, MD Attending, Cardiology Department
Kathy Jenkins, MD, MPH VP, Patient Safety and Quality
Ashley Racine, BA Data Coordinator, PPSQ

38. Acknowledgements
Laura Clark, BS Training Coordinator, Simulator Program, Division of Critical Care Medicine
Kathryn Franklin, BS Nurse, Cardiovascular Surgery
Gavin Hayes, BS System Specialist, Simulator Program, Division of Critical Care Medicine
Susan Jay, RN, BSN, CNOR Nurse, Operating Room
Gregory Matte, CCP, LP Perfusion Clinical Coordinator, Cardiovascular Surgery
Peter Weinstock, MD Director, Simulator Program, Division of Critical Care Medicine