CUSP for Safe Surgery: The Surgical Unit-Based Safety Program. SUSP/Cohort 3 One Year Review. Sean Berenholtz, MD, MHS, FCCM February 11, 2014. First Year Review. The SUSP vision Where the project is right now Next Steps. The power of collective wisdom.
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One Year Review
Sean Berenholtz, MD, MHS, FCCM
February 11, 2014
The SUSP vision
Where the project is right now
Many ideas grow better when transplanted into another mind than the one where they sprang up. —Oliver Wendell Holmes
To achieve significant reductions in surgical site infection and surgical complication rates
To achieve significant improvements in safety culture
1 in 25 people will undergo surgery
7 million (25%) in-patient surgeries followed by complication
1million (0.5 – 5%) deaths following surgery
50% of all hospital adverse events are linked to surgery AND are avoidable
* N Engl J Med; 370;4:341-351. (January 23, 2014)
A study that retrospectively examined a random sample of records for 61,523 hospitalized patients across 4,372 hospitals.
Patients examined were those with acute myocardial infarction, congestive heart failure, pneumonia, and those with conditions requiring surgery.
Adverse event-rates has declined significantly from 2005-2011 for those with myocardial infarction and congestive heart failure.
Adverse event rates remained steady for those patients that had conditions that required surgery; rates of infection-related and post-procedural adverse events increased among patients who required surgery.
*The Joint Commission, Sentinel Event Data; http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf;29.Wrong-patient, Wrong-site, Wrong-procedure Events Reviewed by The Joint Commission *
Has increased compliance in SCIP measures reduced SSI rates in your organization?
Why might this be?
Informed by science
Embeds adaptive CUSP work into technical work
Led by clinicians and supported by management
Guided by measures
Mechanical bowel prep with
Pre-op wash clothes
Enhanced sterile technique
*Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2).
Where Is SUSP Now & Where Are We Going?Where Is SUSP Now & Where Are We Going?
State and hospital enrollment
SSI data update
Our path forward
Coordinating Entity: Maryland Hospital Association
Calvert Memorial Hospital
Carroll Hospital Center
Harford Memorial Hospital
MedStar Franklin Square Medical Center
MedStar Harbor Hospital
MedStar Montgomery Medical Center
MedStar St. Mary's Hospital
MedStar Union Memorial Hospital
Mercy Medical Center
Sinai Hospital of Baltimore
The Johns Hopkins Hospital
Upper Chesapeake Medical Center
Bon Secours Baltimore Health System
Holy Cross Hospital
Laurel Regional Hospital
Prince George's Hospital Center
University of Maryland St. Joseph Medical Center
Western Maryland Health System
Coordinating Entity: Armstrong Institute for Patient Safety & Quality
Indiana University Health - Arnett
Lehigh Valley Health - Cedar Crest
Lehigh Valley Health- Muhlenburg
Sanford USD Medical Center
Southwest General Health Center
Ochsner Medical Center
Indiana University Health - Ball Memorial Hospital
Coordinating Entity: Iowa Healthcare Collaborative
Alegent Creighton Health Immanuel Medical Center
Alegent Creighton Health Lakeside
Alegent Creighton Health Mercy BLUFFS? Hospital
Alegent Creighton Health Midlands Hospital
Bergan Mercy Medical Center
Creighton University Medical Center
Coordinating Entity: Connecticut Hospital Association
Coordinating Entity: Georgia Hospital Association
Gwinnett Medical Center – Lawrenceville
Gwinnett Medical Center- Duluth
Liberty Regional Medical Center
Spalding Regional Hospital
Atlanta Medical Center
Upson Regional Medical Center
Hamilton Medical Center
Medical Center of Central Georgia
Habersham Medical Center
Floyd Medical Center
Tift Regional Medical Center
Ty Cobb Regional Medical Center
Check out the SUSP website for great resources
-Using SUSP Audit tools
-Learning from Defects
-Briefings and Debriefings
-Optional SUSP Tools
Teams have initiated discussion via MedConcert:
-Enhanced sterile techniques
-Other (type in the chat box)
*SSI rate (%) = (# of SSIs / Total # of cases)
-Challenges with DUA’s
-Hospital teams are less familiar with SUSP data reporting capabilities
-State Coordinators tracking the data transfer process
-Plan to educate teams on generating SSI data reports during upcoming state coaching calls
Is your hospital downloading progress reports to view your current SSI rates?
How have you used your SSI data to foster engagement with project stakeholders?
What can we do to help you be successful in sharing your data?
-Educate staff on the Science of Safety
-Staff Safety assessment
-Debrief HSOPS results with front line teams and leadership
-Learning from defects/investigating SSI
-Briefing and debriefing tools
Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011.
Safety culture is related to outcomes
Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press
Have you reviewed your HSOPS results?
What have you uncovered?
Have you discussed these results with your SUSP team and staff?
Have the HSOPS results driven your approach to your SUSP project?
-A combination of technical topics and hospital team presentations
-Survey will open in October 2014
-The NPT will be conducting quarterly interviews to learn more about your SUSP project.
We would like to spend some time hearing from you—
What have been your breakthroughs?
What are your hopes and expectations for the coming year?
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