Transcript Surgeon Presentation

Insert Your Hospital’s
Logo Here
Safe Surgery 2015: South Carolina
Presentation - Surgeons
[ Insert Implementation Team Member Names]
[ Insert Hospital Name]
Our Hospital’s Implementation
Team
[insert picture of your checklist implementation
team]
Could This Happen Here?
The Case
• 45 y.o. at high risk for breast cancer.
• Elective bilateral total mastectomies.
• Patient wants immediate reconstruction by
plastic surgeon.
• General surgeon does mastectomy.
• Preference card is lost so instrument set not
standard.
• Very small room.
• Scrub tech leaves because of family emergency.
• Circulator becomes scrub nurse.
More Facts
• Circulating nurse is now covering two OR’s.
• Plastic surgeon comes into room “early”.
• Wants to begin reconstruction before general
surgeons is finished.
• Plastic surgeon “disruptive” saying procedure
going “too slow”.
• General surgeon insists on completing
mastectomies first.
What Happened Here
• Both breast specimens were lost.
• Surgeons had never worked together before
and did not talk before procedure.
• No “plan” for how surgery was to take place.
• Nursing staff very stressed by surgeons and
level of workload.
• Complete system breakdown in processing
specimens.
What Could Have Helped?
• Discussion among the surgical team, where
the following things were discussed prior to
skin incision:
– Surgeon shares the operative plan where s/he
discusses anything that the team should be aware
of.
– Team discusses the equipment that is needed for
the case.
• Discussion at the end of the case where
surgical teams confirms specimen labeling.
Does anybody want to share
something that has happened to
them?
Safe Surgery 2015: South Carolina
• To use of the South Carolina Surgical Safety Checklist
in every operating room for every patient in our
state.
• To customize the checklist for our hospital’s unique
needs.
• To be part of a larger goal in partnership with the
South Carolina Hospital Association and Safe Surgery
2015 [Directed by Dr. Atul Gawande at the Harvard
School of Public Health].
• Our state will become the model for improving
surgical safety throughout the United States.
What is the Evidence?
Type of implementation
Scope of implementation
Impact of
implementation
WHO Surgical Safety Checklist in OR
8 diverse global hospitals
• In-hospital mortality rate1:
1.5%  0.8%
• Post-op complication rate1:
11.0%  7.0%
Team training and use of briefing/
debriefing/checklists in OR
74 VA hospitals
18% decline in annual rate
of mortality vs. 7% decline
in control group of hospitals
Comprehensive set of surgeryrelated checklists in hospital
including during surgery
6 'high-quality' Dutch
hospitals
• In-hospital mortality rate:
1.5%  0.8%
• Post-op complication rate:
15.4%  10.6%
1. For 4 pilot sites located in developed countries (USA, Canada, UK, New Zealand), results were a decline in the in-hospital mortality rate
from 0.9% to 0.6% and a statistically significant decline in post-op complication rate from 10.3% to 7.1%
Source: Haynes, AB, et al, N Engl J Med 360:491-9, 29 Jan 2009; de Vries, EN, et al,N Engl J Med 363:1928-37, 11 Nov 2010; Neily, J, et al, J
Amer Med Assn 304:1693-1710, 20 Oct 2010; discussions with Safe Surgery Saves Lives team members
Virginia Mason Hospital, Seattle
• In order for the Checklist to work well it has to
be used “right”.
• Improving communication between all
members of the OR team is critical to
successful implementation.
2010 Annual Meeting of the American Society Anesthesiologists
South Carolina Checklist Template
Our Hospital’s Checklist
• [Insert your hospitals checklist]
How Did We Customize Our
Checklist?
• Summarize items that you customized for your
hospital.
Don’t We Already Do All of This?
• It is more than the time out and our usual
safety checks.
• This is our chance to build on the time out and
make it contribute significantly to every case.
• Encouraging a conversation at the beginning
and end of surgery to improve
communication.
• Providing structure and consistency so that
every patient gets what they need every time.
Show Checklist Demonstration
Video
• [Insert your hospital’s demonstration video or
another video that you would like to show]
• If you do not have a video many hospitals
have role-played using the checklist.
We are very good at what we do….
We can be even BETTER
We Are Not as Good as We Think
Makary et al., J Am Coll Surg 2006; 202: 746-52
How Can the Checklist Help Us Be
Better?
• It makes sure that we do the things that our
surgical patients need every time.
• It improves communication, teamwork and
the culture of safety in our hospital.
• Can make surgical teams more efficient – It
has been known to save time.
Physician Acceptance is the Critical
Factor in Successful and
Meaningful Use of the Checklist
HOW YOU ACT DURING THE TIME
OUT/CHECKLIST MATTERS
• The Team is looking to you for leadership.
• You are setting the tone for the rest of the
operation.
• Others will follow your patterns of
communication.
• This is an opportunity to make your plan clear,
answer questions, demonstrate openness and
professionalism.
How Do We Feel in the OR
•
•
•
•
Stressed
Focused
“It’s time to do the CHECKLIST”
I don’t want to do it – I never did this before –
it makes me feel weird
• I am already safe - I don’t need to do it
• Maybe the surgeon in the next room needs it
The “Scrub Sink Trance”
SURGEONS CAN MAKE A
DIFFERENCE
• It is our responsibility to work to improve the
safety and outcomes of our patients.
• We are not powerless to make change.
• We are part of a surgical team and often in the
position of leading that team – that is a
privilege and an opportunity to make a
difference.
Teamwork
• Communication
• Coordination
• Team performance valued over individual
performance
• Wise use of resources
• Leadership
What Can You Do?
•
•
•
•
•
Activate people by using their names.
Set the Tone – Make everyone feel “safe”.
Tell the team what you are going to do.
Encourage team members to speak up.
Stop to Debrief at the end of the case.
This isn’t just about the surgeon
and what you need . Everyone is
in the room for the patient and all
of the people around you need
your help, encouragement and
leadership. Surgery is a team
effort and the most effective and
safe surgeons recognize that.
Safety is staying
back from the Edge
The Checklist can
help you do that.
The Checklist Has Already Helped
• [insert examples of what the checklist has
caught during the testing or how people feel
about using the checklist.]
• Please see Talking to Your Colleagues –
Presentation Guide and Tips Document.
Next Steps
• Culture of Safety Survey, many of you have
already taken it. If you haven’t, please complete
it.
• Room-by-room and team-by-team
implementation.
• We are rolling the checklist out slowly over the
next [insert #] weeks.
• Will talk to you and rehearse before we ask you
to use it in your room with a live patient.
• After you start using the checklist we will assess
teamwork in the OR using an observation tool.
Our Plan
• [Insert your timeline for checklist
implementation].
How Can You Help?
• Work with us on putting the checklist into
your rooms.
• Talk to your colleagues about this project.
• Give us feedback.
Contact Us with Questions &
Feedback
[Insert person to contact, email and phone
number]