draft – final pending ahrq approval cusp for safe surgery: the surgical unit-based safety program...
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CUSP for Safe Surgery: The Surgical Unit-Based Safety Program
SUSP/Cohort 3One Year Review
Sean Berenholtz, MD, MHS, FCCMFebruary 11, 2014
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First Year Review
The SUSP vision
Where the project is right now
Next Steps
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Many ideas grow better when transplanted into another mind than the one where they sprang up. —Oliver Wendell Holmes
The power of collective wisdom
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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
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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/
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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.
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Polling Question
Has increased compliance in SCIP measures reduced SSI rates in your organization?
Why might this be?
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Key concepts: Adaptive and Technical Work
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TechnicalWork
Adaptive Work
Sweet Spot
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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
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How is SUSP different?
Informed by science
Embeds adaptive CUSP work into technical work
Led by clinicians and supported by management
Guided by measures
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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).
*
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WHERE IS SUSP NOW & WHERE ARE WE GOING?
Armstrong Institute for Patient Safety and Quality
Where Is SUSP Now & Where Are We Going?
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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
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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
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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
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John Muir Video
SUSP Teams Are Engaged: Video submissions
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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/
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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)
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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]
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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
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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
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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
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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?
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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
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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.
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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
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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%
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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
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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?
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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
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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
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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
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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
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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?
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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.