TeamSTEPPS

Executive Briefing Drawn from the Agency for Healthcare Research and Quality AHRQ April 29, 2020

A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association

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What is TeamSTEPPS?

o An evidence-based teamwork system o Designed to improve: o Quality o Safety o Efficiency of health care o Practical and adaptable o Provides ready-to-use materials for training and ongoing teamwork 2 April 29, 2020

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Why Use TeamSTEPPS?

o Goal: Produce highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes o Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error o Team skills are not innate; people must be trained 3 April 29, 2020

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Importance of Communication

o Communication failure has been identified as the leading root cause of sentinel events over the past 10 years (The Joint Commission) o Communication failure is a primary contributing factor in almost 80% of more than 6,000 root cause analyses of adverse events and close calls (VA Center for Patient Safety) 4 April 29, 2020

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What can TeamSTEPPS Do for Us?

Emergency Department 1

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After implementation of multiple medical team training programs:

• Improved observed team behaviors.

• Enhanced staff attitudes toward teamwork.

• Reduced observed clinical errors.

Clinical Units in a Medical Center 2

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After implementation of SBAR to improve communication among clinical caregivers

patient days).

: • Reduced rate of adverse drug events (from 30 to 18 per 1,000 • Improved medication reconciliation at patient admission from 72% to 88% and at discharge from 53% to 89%.

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Morey, JC, Simon, R, Jay GD, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: Evaluation results of the MedTeams project. Health Serv Res. 37:1553-1581, 2002 Haig, K., Sutton S, Whittington, J. SBAR: A shared mental model for improving communication between clinicians. JL Comm J Qual Patient Saf 32(3):167-75, March 2006.

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What can TeamSTEPPS Do for Us? Cont.

Labor and Delivery Units 1

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After implementation of multiple teamwork strategies and tools:

• A 50% reduction in the Weighted Adverse Outcome Score (WAOS). The WAOS describes the adverse event score per delivery.

• A 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse event.

Intensive Care Units (ICU) 2

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After implementation of a “Patient Daily Goals” form to facilitate staff communication:

• A 50% decrease in mean ICU length of stay from 2.2 days to 1.1 days.

1.

2.

Mann, S, Marcus, R, Sachs, B. Lessons from the cockpit: How team training can reduce errors on L&D (Grand Rounds) Contemporary OB/Gyn v51 i1:34(8), January 2006.

Pronovost, P, Berenholtz, S, Dorman, T, Lipsett, PA., Simmonds, T, Haraden, C. Improving communication in the ICU using daily goals. J Cri Care 18(2):71-5, Jun 2003.

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What More Can TeamSTEPPS Do?

Operating Rooms (OR)

•

After implementation of a “pre-op” brief:

• Increased OR communication.

1,2 • Increased administration of properly timed prophylactic antibiotics prior to incision from 84% to 95%.

induction from 92% to 100%.

1 1 • Increased pre-op deep vein thrombosis prophylaxis prior to • Error avoidance: Pre-op brief revealed seven patients (3.3%) with previously unidentified severe surgical risks — surgery cancelled.

1 • A 16% reduction in nursing turnover rate.

2 • A 19% increase in OR employee satisfaction.

2 1.

2.

Awad, SS, Fagan, SP, Bellows, C., Albo, D, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 190(5): 770-4, Nov 2005.

Leonard, M,, Graham, S, Bonacum, D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 13 Suppl 1:i85-90, Oct 2004.

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What Makes TeamSTEPPS Different?

o Evidence-based and field-tested o Comprehensive o Customizable o Easy-to-use teamwork tools and strategies o Publicly available 8 April 29, 2020

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What Will Our Teams Learn?

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How Does TeamSTEPPS Work?

o o o

I. Assessment

o Clearly define the need

II. Planning, Training, and Implementation

o Plan to sustain the effort o Train individuals o Implement and test the strategies

III. Sustainment

o Integrate into daily practice o Monitor and measure programs 10 April 29, 2020

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What Do We Need to Make This Work?

o o o o o o Clearly define the need Focus on enhancing teamwork and establishing a teamwork and safety culture Support from senior leadership Allocate sufficient resources o Personnel o o Time Resources Measure success Reward and reinforce teamwork 11 April 29, 2020

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How Do We Start?

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Create a sense of urgency Pull together the guiding team Formulate a change vision and strategy Communicate your vision for understanding and buy-in Attend a NYSPFP training Contact your NYSPFP Project Manager with questions More resources on TeamSTEPPS available at: http://teamstepps.ahrq.gov/ 12 April 29, 2020

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Resources Available

TeamSTEPPS resources include: o o o o o o Three teamwork training curricula Course Management Guide Multimedia course materials TeamSTEPPS Implementation Guide Measurement tools More resources on TeamSTEPPS available at: http://teamstepps.ahrq.gov/ 13 April 29, 2020