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Keystone Surgery: Improving Perioperative Care in Michigan

Keystone Surgery: Improving Perioperative Care in Michigan. Chris George, RN MS Project Manager MHA Keystone Center for Patient Safety and Quality. Preventable Harm. 230 million surgeries / yr worldwide More common than births ( 36 million / yr) 1 in 25 people

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Keystone Surgery: Improving Perioperative Care in Michigan

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  1. Keystone Surgery: Improving Perioperative Care in Michigan Chris George, RN MS Project Manager MHA Keystone Center for Patient Safety and Quality

  2. Preventable Harm • 230 million surgeries / yr worldwide • More common than births ( 36 million / yr) • 1 in 25 people • 25% in-patient surgeries followed by complication • 7 million disabling complications / yr • 0.5 – 5% deaths following surgery • 1 million deaths / yr • 50% of all hospital adverse events linked to surgery • At least 50% of adverse surgical events are avoidable http://www.who.int/patientsafety/challenge/safe.surgery/en/

  3. Keystone Surgery • Learning Community- few existing forums for hospitals to come together to share experiences and improve care. Keystone Surgery Cohort 1 • 76 hospitals • 36 urban, 38 rural (including 7 critical access) Keystone Surgery Cohort 2 • 25 hospitals • 14 CAH

  4. Keystone SurgeryCollaborative Goals • Eliminate surgical site infections, by ensuring that 90% of patients receive evidence-based interventions for preventing surgical site infections • Eliminate mislabeled specimens • Learn from our mistakes, in particular focusing on the National Quality Forum’s “Never” events (wrong site surgery and retained foreign bodies) • Have 60% of your staff reporting positive safety and teamwork climate using a measurement instrument that is psychometrically sound. • Develop a safety scorecard for perioperative care

  5. The Johns Hopkins Comprehensive Unit-Based Safety Program (CUSP) • Educate staff on science of safety http://www.jhsph.edu/ctlt/training/patient_safety.html • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools J Patient Safety 2005; Jt Comm J Qual Saf. 2004;30(2):59-68. http://www.jhsph.edu/ctlt/training/patient_safety.html

  6. 2008 OR Teamwork Climate

  7. Bar Chart “The Physicians And Nurses Here Work Together As A Well-Coordinated Team.” NOTE: this item is typically negatively correlated with annual nurse turnover rates % of respondents that agree

  8. Step 5: Implement Teamwork Tools • Daily Goals • J Crit Care 2003;18:71-75 • Morning Briefing • Jt Comm J Qual Patient Saf. 2005;31:476-9 • Learning from Defects • Jt Comm J Qual Patient Saf. 2006;32:102-8; • Am J Med Qual 2009;24(3):192-5. • Team Check Up Tool • Jt Comm J Qual Patient Saf. 2008;34:619-623 • Shadowing • Jt Comm J Qual Patient Saf. 2008;34:614-8 • Briefing and Debriefing • Jt Comm J Qual Saf. 2009;35(8):391-397

  9. NEJM Special Article: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

  10. Briefing Checklist Jt Comm J Qual Saf 2006;32(6): 351-355

  11. Briefing Checklist Jt Comm J Qual Saf 2006;32(6): 351-355

  12. Briefing Checklist Jt Comm J Qual Saf 2006;32(6): 351-355

  13. Briefing Checklist: Before Every Procedure

  14. De-briefing Checklist

  15. William Beaumont Hospital Royal Oak campus 37,133 briefings and debriefings Jt Comm J Qual Saf. 2009;35(8):391-397.

  16. Provider Perceptions Jt Comm J Qual Saf. 2009;35(8):391-397.

  17. Briefing ComplianceAll Keystone Surgery Teams7/1/2008 - 8/31/2009

  18. Briefing Problem IdentificationAll Keystone Surgery Teams7/1/2008 - 8/31/2009Categories

  19. Debriefing ComplianceAll Keystone Surgery Teams7/1/2008 - 8/31/2009

  20. Debriefing Problem IdentificationAll Keystone Surgery Teams7/1/2008 - 8/31/2009

  21. Challenges • Surgical teams are complex • Diffusion of innovation in ORs challenging • Data collection burdensome • Linking improvement in culture with improved patient outcomes

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