Transcript WHO safesurgery 2015 presentation to the BOARD

A Few Notes About This
Presentation
• This presentation is designed to be given to an interdisciplinary group of clinicians.
• We recommend that you hold this type of meeting
after you have had a chance to have one-on-one
conversations with some of your colleagues that
might be skeptical.
• We have provided descriptions and some notes that
might be helpful to you in the notes section of this
presentation.
• We recommend that this presentation is divided
among the members of the implementation team.
Insert Your Hospital’s
Logo Here
Safe Surgery 2015: South Carolina
Presentation – Inter-Disciplinary Group
[ 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 year old with breast cancer.
• Elective mastectomy.
• 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 the
mastectomy first.
What Happened Here
• The breast specimen was 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
WHO Surgical Safety Checklist
in OR
Team training and use of
briefing/ debriefing/checklists
in OR
Comprehensive set of surgeryrelated checklists in hospital
including during surgery
A Customized Version of the
WHO Surgical Safety Checklist
Scope of
implementation
8 diverse global hospitals
74 VA hospitals
6 'high-quality' Dutch
hospitals
Tertiary University Medical
Center in the Netherlands
Impact of
implementation
•
•
In hospital mortality rate 1.5% 0.8%.
Measured checklist compliance and found that
mortality was significantly lower in patients with
completed checklists.
•
18% decline in annual rate of mortality vs. 7%
decline in control group of hospitals
One year later, facilities that participated in the
program experienced a risk-adjusted morbidity
reduction of 17% versus 6%.
•
•
•
In-hospital mortality rate: 1.5%  0.8%
Post-op complication rate: 5.4%  10.6%
•
Crude mortality decreased from 3.13% 
2.85%.
Measured checklist compliance and found that
mortality was significantly lower in patients with
completed checklists.
•
Sources: 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 304:16931710, 20 Oct 2010; van Klei WA et al. Young,Xu Y, et al. Association Between Implementation of a Medical Team Training Program and Surgical Mortality.
Arch Surgery. 2011. Dec; 146(12):1368-73. Effects of the Introduction of the WHO “Surgical Safety Checklist” on In-Hospital Mortality. Annals of Surgery.
2012 Jan 1; 255(1):44-9.
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 Surgeons 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”
How Do Anesthesiologists/CRNA’s
Feel in the OR
• Stressed and focused
• “I don’t want to do it – I never did this before – it makes me feel weird – it
messes up the way I work”
• “I am already safe - I don’t need to do it”
• “Maybe the team in the next room needs it”
• "Don't these other guys know what they're doing?"
• "Didn't we all just check this stuff? Or did they?”
• "If everyone had the attention to detail that I do, this would not be necessary”
• "Don't make me do another G*% D&#$ piece of paper!!”
• "If it doesn't take long, and we have to, well OK”
• "This really doesn't take that long, and if it keeps us all out of courtrooms. . ."
How Nurses Feel in the OR
• “Before going into the OR I need to prepare my approach
depending on surgeon or team.”
• “I know when there will be a battle and I need to prepare my
response.”
• “Try to stay positive during the surgical case, no matter what
happens.”
• “We carry the load to ensure that the safety checks are
completed.”
• “I don’t want to be the enforcer but sometimes need to be for
patient safety.”
• “I am not the right person to convince a surgeon who refuses to do
this.”
• “I feel shut down when there is not open communication.”
How Do Scrub Techs Feel in the OR
• “I am part of the team and am responsible for patient safety
as much as everyone else.”
• “I don’t want to waste time fighting about this- I wish we
could just do it!”
• “ I am ready to change my approach, depending on who I
am working with in the OR.”
• “The majority of the team will listen and participate, but I
may need to help remind the surgeons to follow policies.”
• “Willing to back up circulator and to take on equal
responsibility to ensure that this is completed for my
patient.”
• “I think that it is the right thing to do.”
• “If I were the patient I would want it done for me.”
The “Scrub Sink Trance”
“Reverence for Induction”
“Respect for the Counts”
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 one person
and what they 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
• We are administering a culture survey because we
want to know you think about the teamwork,
communication, and safety in our operating rooms.
Please complete the culture survey.
• Room-by-room and team-by-team implementation.
• We are rolling the checklist out slowly over the next
[insert #] weeks.
• We 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]