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April 28 , 2014 and April 30, 2014

CUSP for Safe Surgery (SUSP) Kickoff Webinar. April 28 , 2014 and April 30, 2014. Some quick administrative announcements. You need to dial into the conference line to hear audio: Dial in Number: 1-800-311-9401 Passcode: 83762

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April 28 , 2014 and April 30, 2014

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  1. CUSP for Safe Surgery (SUSP) Kickoff Webinar April 28, 2014 and April 30, 2014

  2. Some quick administrative announcements • You need to dial into the conference line to hear audio: • Dial in Number: 1-800-311-9401 • Passcode: 83762 • Please contact your Coordinating Entity for a copy of these slides if you have not already received them • We will make a recording of this webinar available to you. • We want you to interact with us today. You can: • Type comments in the chat box. • Or even better, speak up.

  3. Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has. -- Margaret Mead ”

  4. SUSP Kickoff Agenda • Introductions • SUSP Project Overview • Building your SUSP Team • Intro to Building and Measuring Safety Culture • Current Team Experiences • Next Steps

  5. Meet the SUSP National Project Team introductions

  6. Peter Pronovost, MD, PhD, FCCM Principal Investigator Charles Bosk, PhD Principal Investigator Ethnographer Cliff Ko, MD, MS, MSHA, FACS Principal Investigator

  7. Liza Wick, MD State Coach Content Expert Bradford Winters, MD State Coach Content Expert Julius Pham, MD, PhD State Coach Content Expert Deb Hobson, RN State Coach Content Expert

  8. Mike Rosen, PhD State Coach Content Expert Sallie Weaver, PhD State Coach Content Expert Sean Berenholtz, MD, MHS, FCCM State Coach Content Expert Lisa Lubomski, PhD State Coach Content Expert

  9. Tricia Francis, MA, MS, PMP SUSP Project Manager Kathryn Taylor, RN, MPH SUSP Program Manager Kristina Weeks, MHS Co-Investigator

  10. Cathy Van De Ruit, PhD Ethnographer Jeremiah Bowman American College of Surgeons KseniaGorbenko, PhD, MA Ethnographer

  11. Nasir Ismail, MS SUSP Safety Culture Coordinator Mary Twomley, MS SUSP Senior Research Coordinator Laura Vail, MS SUSP IT Specialist Erin Hanahan, MPH SUSP Senior Research Coordinator

  12. Poll – Who is on the call? What is your role in your clinical area? • Surgeon • Quality improvement practitioner • Infection preventionist • OR Nurse • OR technician • Anesthesiologist • OR manager • Other

  13. We have embarked on a unique journey. Susp project overviewSean Berenholtz, MD, MHS, FCCM

  14. Learning Objectives After this session, you will be able to: • Distinguish SUSP approach from that of other national improvement projects • Describe the connection between SUSP and safety culture work as structured in the Comprehensive Unit-based Safety Program (CUSP) • List the steps for developing a local SSI prevention bundle DRAFT – final pending AHRQ approval

  15. Why is Your SUSP Work Important?1 • 1 in 25 people will undergo surgery • 7 million (25%) complications follow in-patient surgeries • 1 million (0.5 – 5%) deaths follow surgery • 50% of all hospital adverse events are linked to surgery AND are avoidable

  16. Surgical Care Improvement Project (SCIP)2

  17. Engagement Questions Respond in the chat. In our institution, near perfect compliance with SCIP measures did not result in decreased SSI rates. • Have other people on the call observed the same trends? • Why might that be?

  18. What is SUSP? SUSP is CUSP for Safe Surgery • National improvement effort • Designed to reduce surgical site infections (SSI) and other surgical complications. • CUSP is the acronym for “Comprehensive Unit-based safety program”

  19. What is SUSP? • This project will teach you to embed adaptive work (CUSP) in your technical work (surgical care). • Unlike other SSI prevention projects, you will develop your own SSI prevention ‘bundle.’ • There is no one ‘right’ bundle for SSI prevention • Engage frontline staff to identify local defects

  20. What is SUSP? Agency for Healthcare Research and Quality AHRQ-funded project • Individual hospitals participate until August 31, 2015 • Participation is free • Participation is open to hospitals • Of all sizes • In all 50 states • For any surgical procedure type

  21. SUSP Leverages Leaders In The Field

  22. SUSP Enrollment by Coordinating Entity International Hospitals Located in Canada and UK

  23. SUSP Enrollment by Coordinating Entity

  24. SUSP Enrollment by Cohort

  25. Our Shared Project Goals • To achieve significant reductions in surgical site infection and surgical complication rates • To achieve significant improvements in safety culture

  26. Key Concepts: Adaptive And Technical Work Sweet Spot

  27. Key Concepts: Technical and Adaptive Work

  28. Intervention Requires Technical & Adaptive Despite years of technical intervention, rates rose F Sentinel Event Alert: Wrong-sided surgery Aug 98 Sentinel Event Alert: Follow-up review of wrong-sided surgery Dec 01 Wrong Site Surgery Summit I Jan 03 Universal Protocol 2004 Wrong Site Surgery Summit II Feb 07 Revised Wrong Site Surgery Definition Jun 10 E C B D A

  29. Comprehensive Unit-based Safety Program (CUSP) CUSP is a model to guide adaptive work3 • Educate staff on the science of safety • Identify defects • Partner with a Senior Executive • Learn from defects • Improve teamwork and communication

  30. How is SUSP different? • Informed by science and backed with evidence • Led by clinicians and supported by management • Guided by national and local measures • National implementation tailored to local context

  31. Building on Previous State Level Success Michigan Keystone ICU program • Reductions in central line-associated blood stream infections (CLABSI)4,5 • Reductions in ventilator-associated pneumonias (VAP) 6 • Improvements in safety climate 7

  32. …And National Level Highlights National On the CUSP: Stop BSI program8 • A national initiative to implement a proven culture change model, CUSP, and interventions to prevent CLABSI. • A total of 1,071 ICU’s in 45 states • A 43% reduction in CLABSI rates • The number of ICU’s that achieved CLABSI rate of zero, more than doubled.

  33. While Safety Culture Increases Hospital-acquired Infection Rates Drop • “Needs improvement”: Less than 60% of respondents reporting good safety or teamwork culture • Statewide in 2004, 82-84% needed improvement, in 2007 22-23%7

  34. This Improvement Model Works In The OR Colorectal NSQIP SSI Rate at Hopkins9

  35. Case Study: Laparoscopic GI Surgery Trays Problem Lap tray had 137 instruments including many unnecessary implements JHH unionized employees process open instruments, while contractors process lap instruments. Reduced lap tray instruments by 60% to 54 key instruments. Fewer instruments to count and turnover saves money and time. Barriers Intervention Impact

  36. Case Study: Laparoscopic GI Surgery Trays 137 instruments 54 instruments

  37. Case Study: Antibiotic Irrigation Problem Frontline providers questioned the inconsistent use of antibiotic irrigation between surgeons Prominent surgeons used antibiotic irrigation A literature review yielded no evidence to support continued use, so removed from hospital formulary $537,000annual savings on antibiotic irrigation WITH surgeon buy-in Barriers Intervention Impact

  38. Case Study: Antibiotic Irrigation

  39. SUSP Project Management Guide • We have developed monthly modules to guide you through this process. • Each module has ‘deliverables’ for your team, to help you keep your work on track. • Your Coordinating Entity sets up monthly coaching calls to enable horizontal learning. • Share what you learn on state coaching calls. • You will learn as much (if not more) from each other as you will from us! Checking In: Any questions about your Coordinating Entity?

  40. SUSP Project Structure • Kick-off / Project Initiation • Onboarding Phase (Months 1 – 6) • Module 1: How To Use The SUSP Portal: A Training Call for Facilitators • Module 2: Train Everyone on the Science of Safety & Identifying Defects • Module 3: Engage Senior Executives in SSI Prevention Work • Module 4: Debrief your Safety Culture Scores and SSI data • Module 5: Build your SSI Prevention Bundle • Module 6: Perform an SSI Investigation • Implementation Phase (Months 7 – 14) • Sustainability Phase (Months 15 – 18)

  41. SUSP Project Structure • Onboarding Phase (Months 1 – 6) • Implementation Phase (Months 7 – 14) • Module 7: Implement your SSI Prevention Bundle • Module 8: Cohort 5 SUSP Team’s Experience • Module 9: Emerging Evidence: A Surgeon’s Perspective • Module 10: Learn from Defects I • Module 11: Learn from Defects II • Module 12: Optimize Briefings and Debriefings • Module 13: Audit Your Briefing and Debriefing Process • Module 14: Annual progress call • Sustainability Phase (Months 15 – 18)

  42. SUSP Project Structure • Onboarding Phase (Months 1 – 6) • Implementation Phase (Months 7– 14) • Sustainability Phase (Months 15 – 18) • Module 15: HSOPS Re-administration and Culture Debriefing • Module 16: Sustain and Spread Your Surgical Safety Improvements • Module 17: Learn From Defects • Module 18: Deep Rooting Your Data/Sign Off

  43. Polling Question How ready is your organization to enable frontline participation in improvement workand address frontline patient safety priorities? • Totally ready • Getting ready • Not ready at all • Not sure

  44. References • World Health Organization. New Scientific Evidence Supports WHO Findings: A Surgical Safety Checklist Could Save Hundreds of Thousands of Lives. http://www.who.int/patientsafety/challenge/safe.surgery/en/. Accessed August 7, 2013. • Centers for Medicare and Medicaid Services. National Impact Assessment of Medicare Quality Measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.PDF. Published March 2012. Accessed August 7, 2013. • The Joint Commission, Sentinel Event Data. http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf;29. AccessedAugust 8, 2013. • Pronovost P, Needham D Berenholtz S, et al. An Intervention to Decrease Catheter-related Bloodstream Infections in the ICU. N Engl J Med. 2007;356(25):2660. • Pronovost P, Goeschel C, Colantuoni E, et al. Sustaining Reductions in Catheter Related Bloodstream Infections in Michigan Intensive Care Units: Observational Study. BMJ. 2010; 340:c309.

  45. References • Berenholtz S, Pham J, Thompson D, et al. Collaborative cohort Study of an Intervention to Reduce Ventilator-associated Pneumonia in the Intensive Care Unit. Infect Control HospEpidemiol. 2011; 32(4): 305–314. • Sexton JB, Berenholtz SM, Goeschel CA, et al. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Medicine. 2011 May;(39(5):934-9. • Website of the National Implementation of the Comprehensive Unit-based Safety Program to Eliminate Health Care-Associated Infections. http://www.onthecuspstophai.org/. Accessed August 7, 2013. • Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2). • The Joint Commission. J Qual Patient Saf. 2010;36:252-6http://www.ahrq.gov/cusptoolkit/

  46. Who is in the room with you? Building your susp teammike rosen, phd

  47. Polling Question • Do you have a SUSP team? • Yes • No • If so, who is on your team? • Anesthesiologist • CRNA • Infection Preventionist • OR nurse • QI lead • Scrub tech • Senior Executive • Surgeon • Surgical clinical reviewer • Surgical floor nurse • other

  48. Learning Objectives After this session, you will be able to: • Develop a strategy to engage frontline and executive team members in SUSP work • Utilize basic strategies to encourage surgeon participation in SUSP work • Identify SUSP team members and plan your first meeting

  49. StephMullens CST Lead Tech Sean Berenholtz MD Anesthesia Lead Renee Demski MBA Senior Director Quality Johns Hopkins Medicine Elizabeth Wick MD Surgery Lead Mary Grace Hensel RN Manager OR Kevin Driscoll CRNA CRNA Lead Tracie Cometa RN Lead RN Deb Hobson RN “Coach” Lucy Mitchell RN NSQIP SCR

  50. Perioperative SUSP Team Members Essential Team Members • Surgeons • Anesthesiologists • CRNAs • Circulating nurses • Scrub nurses / OR techs • Perioperative nurses • Executive partner • Nurse leaders Enhancing Team Members • Physician assistants • Nurse educators • Anesthesia assistants • Infection preventionists • OR directors • Patient safety officers • Chief quality officers • Ancillary staff

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