DRAFT – final pending AHRQ approval CUSP for Safe Surgery: The Surgical Unit-Based Safety Program...

DRAFT – final pending AHRQ approval

CUSP for Safe Surgery: The Surgical Unit-Based Safety Program

SUSP/Cohort 3One Year Review

Sean Berenholtz, MD, MHS, FCCMFebruary 11, 2014

DRAFT – final pending AHRQ approval2

First Year Review

The SUSP vision

Where the project is right now

Next Steps


Many ideas grow better when transplanted into another mind than the one where they sprang up. —Oliver Wendell Holmes

The power of collective wisdom


The goals of the SUSP Project

To achieve significant reductions in surgical site infection and surgical complication rates

To achieve significant improvements in safety culture


Why is Your SUSP Work Important?

1 in 25 people will undergo surgery

7 million (25%) in-patient surgeries followed by complication

1 million (0.5 – 5%) deaths following surgery

50% of all hospital adverse events are linked to surgery AND are avoidable

http://www.who.int/patientsafety/challenge/safe.surgery/en/


A study that retrospectively examined a random sample of records for 61,523 hospitalized patients across 4,372 hospitals.

Patients examined were those with acute myocardial infarction, congestive heart failure, pneumonia, and those with conditions requiring surgery.

Adverse event-rates has declined significantly from 2005-2011 for those with myocardial infarction and congestive heart failure.

Adverse event rates remained steady for those patients that had conditions that required surgery; rates of infection-related and post-procedural adverse events increased among patients who required surgery.

*

* N Engl J Med; 370;4:341-351. (January 23, 2014)

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Wrong-patient, Wrong-site, Wrong-procedure Events Reviewed by The Joint Commission *

* The Joint Commission, Sentinel Event Data; http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf;29.


Polling Question

Has increased compliance in SCIP measures reduced SSI rates in your organization?

Why might this be?


Key concepts: Adaptive and Technical Work

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TechnicalWork

Adaptive Work

Sweet Spot


Technical Work Adaptive Work

• Procedural components of work, like performing skin prep

• The ‘intangible’ components of work, like ensuring an OR team holds each other accountable for quality skin prep

• Work that we know we ‘should’ do, like letting skin prep dry before incision

• Work that shapes the attitudes, beliefs, and values of clinicians, so they consistently perform tasks the way they know they ‘should’

• Work that lends itself to checklists or protocols

• Culture change is not a checklist

Key concepts: Adaptive and Technical Work


How is SUSP different?

Informed by science

Embeds adaptive CUSP work into technical work

Led by clinicians and supported by management

Guided by measures


SUSP can be tailored to your environment

No single SSI prevention bundle– Frontline staff identifies local defects– Develop a SSI prevention bundle to address

local defects

Measure local safety culture using Hospital Survey of Patient Safety (HSOPS)

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Goal: 15%

Q3 2009

Q4 2009

Q1 2010

Q2 2010

Q3 2010

Q4 2010

Q1 2011

Q2 2011

Q3 2011

Q4 2011

Q1 2012

Q2 2012

Q3 2012

Q4 2012

Q1 2013

Apr-13

42%

17%

29%

26%

16%

20%19% 18%

21%

24%

15%

21%

12%

17%19%

14%

Quarter 3Skin preparation protocolPre-op wash clothes

Quarter 4CUSP kickoffAntibiotic deficiencies addressed

Quarter1Pre-op warmingEnhanced sterile techniqueIntervention checklist

Quarter4Briefing/DebriefingMechanical bowel prep with oral antibiotics

CUSP Works in the OR Colorectal NSQIP SSI Rate at Hopkins (Wick 2012)

* Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2).

*


WHERE IS SUSP NOW & WHERE ARE WE GOING?

Armstrong Institute for Patient Safety and Quality

Where Is SUSP Now & Where Are We Going?


Where Is SUSP Now?

State and hospital enrollment

SSI data update

HSOPS completion

Our path forward

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SUSP Enrollment by Coordinating Entity

Armstrong Institute for Patient Safety & Quality Hawaii Safer Care SUSP Collaborative Arkansas Hospital Association Iowa Healthcare Collaborative (HEN) Colorado Hospital Association Maryland Hospital Association Connecticut Hospital Association Michigan Health & Hospital Association (HEN) Florida Hospital Association Nevada Health Insight (HEN) Georgia Hospital Association (HEN) Tennessee Hospital Association (HEN) Premier Healthcare Alliance (HEN) Massachusetts Hospital Association

SUSP Enrollment by Coordinating Entity

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SUSP Enrollment by Coordinating Entity and Cohort

Coordinating Entity Number of Hospitals EnrolledArmstrong Institute 32Arkansas Hospital Association 10Colorado Hospital Association 8Connecticut Hospital Association 7Florida Hospital Association 11Georgia Hospital Association 14Hawaii 14HealthInsight Nevada 4Iowa Healthcare Collaborative 13Maryland Hospital Association 18Massachusetts Hospital Association 8Michigan Health & Hospital Association 46Premier Healthcare Alliance 8Tennessee Hospital Association 10

Total EnrollmentCohort 1 10Cohort 2 103Cohort 3 47Cohort 4 42Total 202


A big THANK YOU to all of our Cohort 3 SUSP Teams!

Coordinating Entity: Connecticut Hospital AssociationDanbury Hospital Coordinating Entity: Georgia Hospital AssociationGwinnett Medical Center – LawrencevilleGwinnett Medical Center- DuluthLiberty Regional Medical CenterSpalding Regional HospitalAtlanta Medical CenterUpson Regional Medical CenterHamilton Medical CenterMedical Center of Central GeorgiaHabersham Medical CenterFloyd Medical CenterTift Regional Medical CenterTy Cobb Regional Medical CenterEmory

Coordinating Entity: Maryland Hospital AssociationCalvert Memorial HospitalCarroll Hospital CenterHarford Memorial HospitalMedStar Franklin Square Medical CenterMedStar Harbor HospitalMedStar Montgomery Medical CenterMedStar St. Mary's HospitalMedStar Union Memorial HospitalMercy Medical CenterSinai Hospital of BaltimoreThe Johns Hopkins HospitalUpper Chesapeake Medical CenterBon Secours Baltimore Health SystemHoly Cross HospitalLaurel Regional HospitalPrince George's Hospital CenterUniversity of Maryland St. Joseph Medical CenterWestern Maryland Health System

Coordinating Entity: Armstrong Institute for Patient Safety & QualityCanton-Potsdam HospitalCooper HealthIndiana University Health - ArnettLehigh Valley Health - Cedar CrestLehigh Valley Health- MuhlenburgSanford USD Medical CenterSouthwest General Health CenterOchsner Medical Center Indiana University Health - Ball Memorial Hospital Coordinating Entity: Iowa Healthcare CollaborativeAlegent Creighton Health Immanuel Medical CenterAlegent Creighton Health LakesideAlegent Creighton Health Mercy BLUFFS? HospitalAlegent Creighton Health Midlands HospitalBergan Mercy Medical CenterCreighton University Medical Center


Team Calls and Resources

Check out the SUSP website for great resources

https://armstrongresearch.hopkinsmedicine.org/susp.aspx

SUSP Tools

CUSP Tools

HSOPS Toolkit

Recordings and Slide Presentations for SUSP Webinars

-Using SUSP Audit tools

-Executive Partnerships

-Learning from Defects

-Briefings and Debriefings

-Optional SUSP Tools

-HICPAC Guidelines

https://armstrongresearch.hopkinsmedicine.org/susp.aspx


John Muir Video

SUSP Teams Are Engaged: Video submissions


SUSP Teams Are Engaged: MedConcert

Teams have initiated discussion via MedConcert:

Susan Overman– Wound classification documentation practices

Heidi LePard- Literature pertaining to c-section SSI’s

Dana Bonistalli– Forced air warming practices

MedConcert Link:https://www.medconcert.com/

https://www.medconcert.com/

https://www.medconcert.com/


Polling QuestionWhat technical processes are you currently working on? (multi answer)

-Skin preparation

-Antibiotic timing/selection/re-dosing

-Normothermia

-Enhanced sterile techniques

-OR Traffic

-Glucose control

-Hyperoxia

-Other (type in the chat box)


Summary of SSI Data Submission

Total # of cohort 3 hospitals 47 SSI data available

NHSN Hospitals 39 19

NSQIP Hospitals 6 5

NHSN & NSQIP 2

Undeclared data source 0

Questions? Email the SUSP help desk! [email protected]


Your Data to Date

*SSI rate (%) = (# of SSIs / Total # of cases)

Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-130

2

4

6

8

10

12

14

16

Cohort 3 Unadjusted Overall SSI rates

Cohort 3-NHSN Cohort 3-NSQIP

Time period

SSI R

ate

(%)

13-Feb 13-Mar 13-Apr 13-May 13-Jun 13-Jul 13-Aug 13-Sep 13-Oct 13-Nov 13-Dec

NHSN: Cohort 3 6 (10/155) 5 (8/142) 5 (10/179) 5 (11/185) 5 (10/193) 5 (10/168) 2 (4/185) 4 (9/181) 4 (7/153) 2 (3/113) 0 (0/27)

NHSN: Total hospitals 19 19 19 19 19 19 19 19 19 19 19

NSQIP: Cohort 3 15 (8/51) 6 (3/44) 8(5/60) 3(2/54) 6 (3/50) 3(2/51) 11 (1/9) 11 (1/9) 0 (0/1)

NSQIP: Total hospitals 4 5 5 5 5 5 2 1 1


Timely data reports guide your project improvement work

Hospital teams can generate monthly SSI data reports after the CE transfers data files from NHSN

Currently, data submission rates are low because:-Competing priorities-Challenges with DUA’s-Hospital teams are less familiar with SUSP data reporting capabilities

Summary of plan to get more data into the portal-State Coordinators tracking the data transfer process-Plan to educate teams on generating SSI data reports during upcoming state coaching calls


How are you using your data to drive progress?

Is your hospital downloading progress reports to view your current SSI rates?

How have you used your SSI data to foster engagement with project stakeholders?

What can we do to help you be successful in sharing your data?


Polling QuestionWhat tools/strategies have you been using to address adaptive challenges in your SUSP work?

-Educate staff on the Science of Safety

-Staff Safety assessment

-Debrief HSOPS results with front line teams and leadership

-Executive partnership

-Learning from defects/investigating SSI

-Briefing and debriefing tools

-Others


Why Safety Culture Matters

Safety culture is related to outcomes

– Patient outcomes• Patient care experience

• Infection rates, sepsis

• Postop. hemorrhage, respiratory failure, accidental puncture/laceration

• Treatment errors

– Clinician outcomes• Incident reporting, burnout, turnover

Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011.


Why Safety Culture Matters

2. Safety culture influences the effectiveness of other safety and quality interventions

– Can enhance or inhibit effects of other interventions

3. Safety culture can change through intervention

– Best evidence so far for culture interventions that use multiple components

Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press


SUSP HSOPS Baseline Results

Cohort Time Phase # Hospitals Submitted Data

Total Hospitals

Date Submission Rates

1 10/15/2012-12/1/12 7 11 64%

2 1/18/13-3/18/13 32 54 59%

3 4/9/2013 – 6/8/2013 36 46 78%

4 10/28/2013- 2/16/2013 37 42 88%

Total 112 153 73%


Cohort Start Date Close Date

1 7/1/2014 8/15/2014

2 7/1/2014 8/15/2014

3 10/1/2014 11/15/14

4 4/1/2015 5/16/2015

Follow-up (Approximately 16 months after baseline administration)

HSOPS Re-Administration Schedule


HSOPS Review and Debriefing

Have you reviewed your HSOPS results?

What have you uncovered?

Have you discussed these results with your SUSP team and staff?

Have the HSOPS results driven your approach to your SUSP project?


What will this next year look like?

Project calls

-A combination of technical topics and hospital team presentations

Re-administering HSOPS

-Survey will open in October 2014

Select interviews

-The NPT will be conducting quarterly interviews to learn more about your SUSP project.

On-going monthly state level coaching calls


Date Topic Cohort PresenterTuesday, February 11 @4PM (EST) Annual Update 3 Sean Berenholtz

Tuesday, March 11 @4PM (EST) Blood Management 3 Steven Frank

Tuesday, April 8 @4PM (EST) Hospital Team Experiences 3 Hospital Teams

1.

2.

Tuesday, May 13 @4PM (EST) Re-op Optimization 3 Tom Varghese

Tuesday, June 10 @4PM (EST) Hospital Team Experiences 3 Hospital Teams

1.

2.

Tuesday, July 8 @4PM (EST) (pending) Surgeon Technique/Videotaping

3 Caprice Greenberg

Tuesday, August 12 @4PM (EST) Hospital Team Experiences 3 Hospital Teams

1.

2.

CUSP for Safe Surgery (SUSP) Project Call ScheduleImplementation Phase


Horizontal Learning Initiative

Medconcert professional networking site

Peer to peer sharing and collaboration- Hospital team presentations during cohort 3

project calls- State coaching calls- Other ideas


Additional Resources

Armstrong Institute Training Opportunities– http://www.hopkinsmedicine.org/armstrong_institute/training_service

s/cusp_offerings/

AHRQ CUSP Toolkit– http://www.ahrq.gov/professionals/education/curriculum-tools/cuspto

olkit/

Armstrong Institute CUSP Tools– http://

www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/cusp_guidance.html

http://www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/



http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/



http://www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/cusp_guidance.html




Share your Story!

We would like to spend some time hearing from you—

What have been your breakthroughs?

What are your hopes and expectations for the coming year?


Content Call Evaluation

We want to ensure that the content calls provide useful and pertinent information for the SUSP teams. For this reason we request that you complete a brief evaluation following

each call. The evaluation may be found at the following link:

https://www.research.net/s/SUSP_Cohort3

If you are not able to reach the link from the slide, please cut & paste the URL into your browser.




DRAFT – final pending AHRQ approval CUSP for Safe Surgery: The Surgical Unit-Based Safety Program...

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