1 / 67

Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair

Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair AAOS Orthopaedic Surgery Safety Summit AAOS Patient Safety Committee. Disclosure. Consultant – Blue Cross Blue Shield Association TJR - Centers of Distinction Program

hera
Download Presentation

Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair AAOS Orthopaedic Surgery Safety Summit AAOS Patient Safety Committee

  2. Disclosure • Consultant – Blue Cross Blue Shield Association TJR - Centers of Distinction Program • Consultant (Unpaid) - Smith and Nephew • Investor – emmiSolutions • Chair – AAOS Orthopaedic Surgery Safety Summit • Chair – AAOS Patient Safety Committee

  3. Is there an Orthopaedic Surgery Safety Problem 2012?MediaABC News Report - Maryland 2012 • Report on Surgical Errors • CMS -only 14% errors reported in hospitals • Advised patients ask about checklists • Report • SSI’s shoulder surgery • Wrong site pediatric eye surgery

  4. Is there an Orthopaedic Surgery Safety Problem 2012?HealthGrades - 2010 • >350,000 patient safety errors/year 2006-2008 • Cost $9B • 1/10 safety errors results deaths • >100,000 surgical error deaths/year • Top 5% Hospitals – only 43% reduction safety incidents • Wrong Site Surgery (WSS) rates - 1/20,000 surgeries • Hospital SSI rates 2-3% • NO evidence safety/quality improvement 2000-2010

  5. Is there an Orthopaedic Surgery Safetyproblem 2012? JC 2009-2010 • Wrong Site/Procedure/Patient Surgery (WSS) • Mandatory State –bsed WSS Reporting • Minnesota (48 - WSS) • Pennsylvania (58 - WSS) • 35.4 WSS/wk. in US(estimated)

  6. JC Sentinel Events Data Base 2007-2011 54Orthopaedic WSS

  7. Is there a Orthopaedic Surgery Safety Problem 2012?Hospital Data JC - 2011 • >7 wrong site/side/level/implant/procedure/patient surgeries /day • System errors – NOT Surgeon errors • Most frequent causes: • inadequate/missing surgical information • scheduling discrepancies/errors • irregularities in pre-op holding process • inadequate/absent surgical site marking • poor communication • distractions in OR • inadequate/absent OR process/‘time-out’ Mark Chassin MD, MPP, MPH

  8. Is there an Orthopaedic Surgery Safety problem 2012? • ABOS Certification/Recertification Data Base – 2011 • WSS Rate - 1/30,000 orthopaedic surgeries • NO CHANGE 2000-2011

  9. Surgical Safety/Quality/Value Timeline 1997 - AAOS - ‘Sign Your Site’ Program - (safety) 1999 - IOM Report - To Error is Human: Building a Safer Health System – (safety) (44-88,00 deaths in hospitals/year from medical errors) 2001 - IOM Report – Crossing the Quality Chasm: A New Health System for the 21st Century (quality) 2003 - VA National Directive to reduce Risk WSS (safety) 2004 - JCAHO – ‘Universal Protocol’ (safety/quality) 2004 - SCOAP** (safety/quality) • voluntary hospital-based surgical safety/quality – Washington

  10. Surgical Safety/Quality/Value Timeline 2007 - SCIP* (quality) • mandated national surgical quality standards 2007 - WHO ‘Safe Surgery-Saves Lives’ (safety/quality) 2009 - Checklist Manifesto –Atul Gwande MD (safety and quality) 2010 - Berwick*** CMS Administrator (safety/quality/value) • CMS payments - financial penalties for Never Events • CMS/PQRS payments – financial incentives for ‘quality reporting’ 2012 – CMS Public Quality Data Reporting Program (safety/quality/value) • Hospital SSI Rates • Surgical Re-admission Rates * Surgical Care Outcome Assessment Program – Washington State Hospital Association ** Surgical Care Improvement Program – US Department of Health and Human Services *** Former President and CEO, Institute for Healthcare Improvement (IHI)

  11. Evidence Surgical Safety/Quality/Value Programs are Effective 2006 – Central Line Checklists – Peter Pronovost MD • Reduction central line infections - 40% to <1% 2008 – WHO ‘Safe Surgery - Saves Lives’ - Atul Gwande MD • 50% reduction surgical mortality/complications(multi-nation study) 2010 – Surgical Care Outcomes Assessment Program (SCOAP) • Universal Protocol (UP) adopted in all Washington OR’s • < Complications - appendectomy, colectomy, bariatric surgery • < Hospital Costs

  12. Evidence Safety/Quality/Value Programs are Effective 2010 – Northern New England Cardiovascular Disease Study Group • improved Cardiovascular surgery outcomes - participating medical centers 2011 – VA Surgical Safety Program • reduced surgical errors 25% - 2006-2009

  13. AAOS Orthopaedic Surgery Safety/Quality Survey 2011 • Survey Goals • Assess safety/quality in orthopaedics • Evaluate differences by: • sub-specialty • length of practice • practice type • Evaluate orthopaedicleadership attitudes regarding safety/quality • Assess orthopaedic safety practices/culture /errors • Identify opportunities/barriers for change

  14. Survey Participants

  15. Participating Practice Types

  16. Participating Orthopaedic Sub-Specialties

  17. Participant Surgical Settings

  18. ResultsPositive Findings • >90% use Universal Protocol (UP) in Hospital OR’s • 82% Believe UP Improves Surgical Safety/Quality • No differences in utilization/understanding UP by: • Years in practice • Sub-specialty

  19. ResultsNegative Findings • Surgical errors reported ALL orthopaedic settings • Most ‘undereducated’ safety science • <50% UP use in surgi-centers - rare in office/procedure rooms • Few surgeon safety leaders/champions • Younger surgeons < team communication knowledge

  20. Model SafeOrthopaedic Surgical Care

  21. HistoricalOrthopaedic Surgery Culture

  22. ModelOrthopaedic Surgery ‘Culture of Safety’

  23. DefinitionSafe Orthopaedic Surgical Care • Safe surgical care is: • surgical care delivered with a highly reliable surgical system • designed to reduce, with a goal of eliminating, preventable harm/s • continuously monitored through safety data collection • effectively integrating interfaces between surgical: • patient and family • physicians, surgeons and staff • suppliers and equipment • and environments.* * Modified from Dev Raheja - Safer Hospital Care

  24. DefinitionQuality Orthopaedic Surgical Care • Quality Surgical Care is: • standardized surgical care based upon • medical evidence and/or • consensus-based ‘best’ surgical practices • continually improved through innovation • validated through surgical quality data collection and analysis • achieving optimal composite surgical outcomes

  25. DefinitionValue Orthopaedic Surgical Care • Value in surgical care: • focused on patient-centered outcomes • evaluated continually with surgical benchmarking • supported by onlyessential resources ($$$) • effectively coordinated through the entire surgical care episode* * Modified from Michael Porter – Redefining Healthcare

  26. RelationshipSafety, Quality and Value

  27. What is needed to improve Orthopaedic Surgical Safety? • Change historicalorthopaedic surgical behaviors • Implement surgicalsafety science and behaviors into ALL orthopaedic settings • Shift focus from ‘surgeon’ to ‘team’ performance • Establish sustainable ‘culture’ of surgical safety • Build and maintain orthopaedicsafety/quality data bases • Validate safety programs in orthopaedic settings • Collaboration with other safety stakeholder organizations

  28. Key Elements Orthopaedic Surgical Safety • 6 C’s • (1) Communication – effective surgical team communication • (2) Consent – accurate timely informed consent • (3) Confirmation – proper surgical site marking/identification • (4) Checklists – use validated standardized processes • (5) Concentration – focused team without distraction • (6) Collection – systematic safety/quality data collection Submitted to CORR 10/2012 – Kuo, Robb

  29. AAOS Surgical Safety Program 2012 • 2011 Fall Board Workshop • TeamSTEPPS • 80 Hospital/Surgicenter training sites 2012-2014 • 2012 Spring Board Workshop • Develop orthopaedic checklists • Establish/collaborate orthopaedic safety data bases • Surgical Safety Board Oversight Work Group 2012-2014 • Chair - Dr. Fred Azar • Orthopaedic Surgery Safety Summit • Chicago – 2012 • Orthopaedic Surgery Sub-Specialty Pilot Programs • Validate Pilot Safety Programs 2012-2014

  30. Orthopaedic Safety Summit Goals • Unifyorthopaedicsregarding safety • Reduce errors/ ‘preventable harm/s’ • wrong site/side/level/procedure/implant/patient surgery • surgical complications • readmissions • Establishsurgical safety as a specialty priority • Improveorthopaedicoutcomes • Collaborate with other surgical safety stakeholder organizations

  31. Participating/Presenting Organizations 1. American College of Surgeons (ACS) 2. Surgical Care Outcomes Assessment Program (SCOAP) 3. Centers for Disease Control and Prevention (CDC) 4. Centers for Medicare and Medicaid Services (CMS) 5. Agency for Healthcare Research and Quality (AHRQ) 6. The Joint Commission (TJC) 7. Ambulatory Surgical Center Association (ASCA) 8. Accreditation Association for Ambulatory Healthcare (AAAH) 9. Association of Operating Room Nurses (AORN) 10. Webster Healthcare Consulting 11. Pascal Metrics

  32. Participating Orthopaedic Organizations 1. American Academy of Orthopaedic Surgeons (AAOS) 2. American Association for Hand Surgery (AAHS) 3. American Orthopaedic Foot and Ankle Society (AOFAS) 4. American Association of Hip and Knee Surgery (AAHKS) 5. American Orthopaedic Society for Sports Medicine (AOSSM) 6. American Shoulder and Elbow Society (ASES) 7. American Society for Surgery of the Hand (ASSH) 8. American Spinal Injury Association (ASIA) 9. Arthroscopy Association of North America (AANA) 10. Cervical Spine Research Society (CSRS) 11. Hip Society (HS) 12. Knee Society (KS)

  33. Participating Orthopaedic Organizations 13. Limb Lengthening and Reconstruction Society (LLRS) 14. Musculoskeletal Tumor Society (MSTS) 15. North American Spine Society (NASS) 16. Orthopaedic Trauma Association (OTA) 17. Pediatric Orthopaedic Society of North America (POSNA) 18. Scoliosis Research Society (SRS) 19. Society of Military Orthopaedic Surgeons (SMOS) 20. American Academy of Orthopaedic Surgeons (AAOS) Board of Directors (BOD) Board of Specialty Societies (BOS) Board of Councilors (BOC) Council on Research and Quality (CoRQ) Patient Safety Committee (PSC)

  34. Summit Work Group Safety Projects Hand/Foot Ankle – Opioid Abuse Hip/Knee/Tumor – SSI Prevention ‘Bundle’ Pediatrics – Peds Patient/ Family Checklist Spine – Wrong Level Spine Surgery Sports – ‘UP’ inSurgicenters Trauma – Hip Fracture

  35. Patient Safety Summit • Next Steps • Develop Pilot Projects • Explore data relationships • ACS, SCOAP • Explore Global SSI Prevention Program • CDC, AHRQ, AAOS • Unified Orthopaedic Safety Information Statement • Explore BOS Safety role

  36. Safety Barriers Surgeonresistance to change Inadequatesurgeonknowledge Limited utilization of surgical team safety science Limited surgeon data contribution and benchmarking Inadequate surgeonleadership

  37. Orthopaedic Surgical SafetyJourney Safety is no Accident AAOS Sign Your Site Program 1997

  38. Paradigm ShiftsOrthopaedicSafety Programs Education • Orthopaedic education programs • New focus/balance safety, quality and value science in all orthopaedic education programs/products • Orthopaedic Quality Institute • Safety Summit • Standardization system-based focus vs. implant/surgical technique focus

  39. Paradigm ShiftsOrthopaedicSafety Programs Data • New safety/quality data programs • CMS Public Reporting (PACA) • national benchmarking • regional benchmarking (by state) • HVHC - Dartmouth Institute – private benchmarking collaborative • System performance vs. surgeon performance • System focus ‘prevention harm’ vs. ‘good results’ • Deming – count bad light bulbs not good light bulbs • Patient outcomes vs. surgeon outcomes reporting • Multi-center vs. single center trials reporting

  40. Paradigm ShiftsOrthopaedicSafety Programs Clinical • New standardized system-based interdisciplinary surgical care programs • GeisingerProvenCare • Patient contract • Intermountain Health System • ACO’s • ‘Bundled Care’ products • NorthShore University HealthSystem • Care reliability (LOS, Costs) • Complication prevention • Readmission management

  41. AAOS Orthopaedic Surgery SafetySummit Chicago, 2012 • 6 Ortho Sub-Specialty Work Groups • Conference Calls. April - July • Safety Webinar • Tuesday, July 31 • Safety Summit • Sunday, August 5 - Monday, August 6

  42. Hand – Foot/Ankle Work Group • Opioid misuse/abuse • Orthopaedic prescribing practices • Orthopaedic education • Build consensus standards • Collaboration – national organizations/federal government/advocacy

  43. Is there an Orthopaedic Surgery Safety Problem 2012? Orthopaedic Evidence • Orthopaedic surgical outcomes highly variable - by surgeon/hospital/healthcare system/region • Limited local, regional, national orthopaedicsafety/quality data • Slow adoption Safety/Quality communication and process • Few recognized surgeon safety leaders/champions

  44. Hip, Knee, Tumor Work Group • SSI Prevention ‘bundle’ • Pre-op checklist • Diabetic optimization • smoking cessation • OR checklist • Skin Prep • Antibiotic optimization • Post-op checklist • Wound care optimization • PIM/OKO modules • Collaboration – AHRQ, AAHKS, HS, KS, MSTS, CMS, AORN

  45. Pediatric Work Group • Patient/Family Checklist • 10-15 elective procedures • Focus – patient safety, quality, value • Collaboration – POSNA, SRS, Peds Hospitals • Pilot Study

  46. Spine Work Group • Wrong-level Surgery Prevention • Sign Mark and X-ray (SMaX) • OR Checklist • Confirmation with imaging • Pilot Study • Develop PIM • Collaboration - NASS • Educate

  47. Sports Work Group • Universal Protocol (UP)- Surgicenters & Offices • Pilot Project • Scheduling • Pre-op Holding • OR • Patient focus • Collaboration – AOSSM, AANA, JC

  48. Trauma Work Group • Hip FX Quality Pathway • Checklists/order-sets • Pilot Study • SSI Prevention • New SSI Quality ‘bundle’ • Pilot study • Hip FX PIM/s • Collaboration - CDC, AHRQ, OTA, AGS

  49. AAOSSafeOrthopaedic Surgical Programs • Surgical Team Communication • effective patient and surgical team communication • TeamSTEPPS • human factors supporting a Culture of Safety • distraction-free/focused OR environment • Standardized Surgical Processes • accurate timely patient-centered informed consent • proper marking and confirmation of: • site - side - level - implant - procedure - patient • regular use standardized surgical checklists • Surgical Data • Systematic surgical data collection and analysis

More Related