safe surgery saves lives: a national initiative to improve surgical safety in canada chris w. hayes...
TRANSCRIPT
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Safe Surgery Saves Lives:A National Initiative to Improve Surgical Safety in Canada
Chris W. Hayes
Medical Officer, CPSI
Medical Director, Quality & Patient Safety, St. Michael’s
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The 2nd Global Patient Safety Challenge
• 234 million surgeries globally1
• Death 0.4-0.8%2,3
• Complications 3-16%2,3
• 1 million deaths• 7 million disabling
complications1. Weiser, TG. Lancet 20082. Gawande, AA. Surgery 19993. Kable AK. Int J Qual Health Care 2002
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Ten Objectives of Safe Surgery Saves Lives
1. Correct patient / correct site2. Prevent harm from anaesthetics3. Prepare for airway emergencies4. Prepare for high blood loss5. Avoid allergic reactions6. Minimize surgical site infections7. Prevent retention of instruments/ sponges8. Accurately secure and identify specimens9. Effectively communicate critical information10. Establish surveillance of capacity/ volume/ results
Reliably do what we think we should be doing
Decrease harm
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How to Achieve the Objectives?
Use a Checklist!
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Aviation and Checklists
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Aviation and Checklists
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ICU and Checklists
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ICU and Checklists
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OR and Checklists
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OR and Checklists
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How to Achieve the Objectives?
Let’s Use a Checklist!Let’s Use a Tool to Improve Team Communication!
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Testing the WHO Checklist
London, UK EURO EMRO
WPRO I
SEARO
AFRO
PAHO I
Amman, JordanToronto, Canada
New Delhi, India
Manila, Philippines
Ifakara, Tanzania
WPRO II
Auckland, NZ
PAHO II
Seattle, USA
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The Publication – January 15th 2009
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The Results
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So we have evidence…
How do we translate it into practice?
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Safe Surgery Saves Lives (SSSL) & CPSI
Canadian SSSL Working Group
MANDATE:– lead further development, adaptation, and support for
the implementation of the SSSL Campaign in Canada
TIMELINE:– WHO request for endorsements coincided with official
launch - June 2008– CPSI began communication and solicited endorsements– Canadian Working Group established August 2008
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Canadian SSSL Working Group
Membership
• Chair: Chris Hayes• Special Advisor: Bryce Taylor• Representatives from the RCPSC, CNA,
CMA, CAS, CAGS, ORNAC, Accreditation Canada, SHN
• Early adopters• Representatives from aviation, human factors
and cognitive psychology• CPSI – Project Support
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Canadian SSSL Working Group
The working group’s immediate goals were asfollows:
• Phase I – August 2008-July 2009– Adapt the WHO Safe Surgery Checklist for use in
Canada– Adapt the WHO Safe Surgery implementation
documents– Launch an awareness/ marketing campaign– Develop an online community of practice – Develop a mentor list for organizations wanting more
support
www.safesurgerysaveslives.ca
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Canadian Version Safe Surgery Checklist
• Align with the WHO Checklist
• Include all WHO checklist items
• Reconfigure checklist using human factors principles
• Add elements that are reflective of a Canadian context
• Align efforts between SSI, VTE initiatives
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What did we do?
• Coordinated launch of media campaign with release of paper
• Large-scale communication with all stakeholder groups
• Presentation and booth at national conferences
• Visiting speaking events at hospitals/ regions• Monthly virtual grand rounds• 2 national workshops (Mar 09, Mar 10)
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What happened? Media campaign
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An Initiative with a Voice!
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What happened? Media campaign
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What happened?
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What else happened?
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What else happened?
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What was the impact?
• Conducted nation-wide telephone survey of OR managers
• 76 questions to assess checklist implementation and impact
• Survey conducted between May and August 2010
• 92.1% (383/416) response rate
G. Ross Baker, Ph.D1, and Virginia Flintoft1, BN, MSc. 1Department of Health Policy, Management and Evaluation, University of TorontoUnpublished results
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What was the impact?
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What was the impact?
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What was the impact?
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What was the impact?
• Awareness and use of SSC high in 1st year– Is this optimal use?
• Perception of improved communication, teamwork and patient safety
• Still significant barriers to full adoption
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Ongoing plan for SSSL
• Continued support for roll-out across Canada• Continue to stay connected internationally • Working with Health Quality Councils/
provinces to support their agenda• Work with local QI teams to support
implementation / adoption• Sharing successes / tools / stories• Online Community of Practice
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Summary
• Simple tools to improve communication can improve safety
• Large-scale KT efforts can be successful• Use of media, internet, local leaders and
support tools can be effective• Under the right circumstances change can be
driven…quickly….• ….but sustainable…have to wait and see
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Thank you!!
www.safesurgerysaveslives.ca
National SSSL Working Group
Rob Barrett Craig Bosenberg Paul Hendry Bonnie McLeod Bryce Taylor
Paula Beard Susan Brien Sonia Hill Marie Owen Jason Thompson
Douglas Bell Donna Davis Gregory Kennedy
Anna Pevreal Marlies Van Dijk
Bill Berry Lizzie Edmondson
Deon Louw Ioana Popescu Stan Vuksic
Peter Blair Virginia Flintoft Cindy Macfarlane Melanie Rathgeber
Daniel Wong
Cecilia Bloxom Norma Freeman Anne MacLaurin Tanis Rolefstad