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

1. CUSP for Safe Surgery: The Surgical Unit-Based Safety Program March 3 & 5, 2014 Sean Berenholtz, MD, MHS, FCCM

2. Some quick administrative announcements • You need to dial into the conference line to hear audio • Dial in Number: 1-800-311-9401 • Passcode: 83762 • A copy of these slides can be found on our SUSP recruitment website • A recording of this webinar will be available on the recruitment website by March 6, 2014.

3. Learning Objectives • IdentifySUSP program • Project goals and interventions • Participation requirements and timeline • Describe steps to enroll in SUSP

4. Why is Your SUSP Work Important? http://www.who.int/patientsafety/challenge/safe.surgery/en/ • 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

5. How is SUSP different than SCIP (Surgical Care Improvement Project

6. Your Team Addresses Local Needs Questions? Email the SUSP help desk! SUSP@jhmi.edu • No single SSI prevention bundle • Frontline staff identifies local defects • Fix defects with executive support • Measure local safety culture using Hospital Survey of Patient Safety (HSOPS)

7. SUSP Project Overview

8. SUSP Project Overview • AHRQ funding project • Individual hospitals participate for 18 months years • Leveraging leaders in field • Armstrong Institute, ACS NSQIP, AHRQ, University of Pennsylvania, WHO • All hospitals in any state, as well as hospitals in the District of Columbia and Puerto Rico are encouraged to participate.

9. Who can join SUSP? Questions? Email the SUSP help desk! SUSP@jhmi.edu Participation in the program is available to any hospital in any state, as well as hospitals in the District of Columbia and Puerto Rico. Hospitals may participate through their state hospital association, state patient safety agency, hospital engagement network (HEN) or other convening group.

10. SUSP Enrollment by Coordinating Entity

11. SUSP Enrollment by Coordinating Entity and Cohort

12. Our Shared Project Goals Questions? Email the SUSP help desk! SUSP@jhmi.edu • To achieve significant reductions in surgical site infection and surgical complication rates • To achieve significant improvements in safety culture

13. How Are We Achieving Our Goals? Reducing Surgical Site Infections Translating Evidence Into Practice (TRiP) Comprehensive Unit based Safety Program (CUSP) • Emerging Evidence • Local Opportunities to Improve • Collaborative learning • Summarize the evidence • Identify local barriers to implementation • Measure performance • Ensure all patients get the evidence • Engage • Educate • Execute • Evaluate Educate staff on science of safety Identify defects Assign executive to adopt unit Learn from one defect per quarter Implement teamwork tools Technical Work Adaptive Work http://www.hopkinsmedicine.org/armstrong_institute

14. We’re Building on Previous Successes N Engl J Med 2006;355:2725-32. BMJ 2010;340:c309. Infect Control HospEpidemiol. 2011;32(4): 305-314. www.onthecuspstophai.org • Michigan Keystone ICU program • Reductions in central line-associated blood stream infections (CLABSI) 1,2 • Reductions in ventilator-associated pneumonias (VAP) 3 • National On the CUSP: Stop BSI program 4

15. Percent of Units with Zero CLABSIs and Achieving Project Goal (<1/1000 CL days) *Data drawn from Interim Project Report – Figure 5 – Cohorts 1 through 3 www.onthecuspstophai.org

16. We Focus on Systems, Not Individuals Questions? Email the SUSP help desk! SUSP@jhmi.edu • Harm is preventable • Many healthcare acquired infection and complications are preventable; should be viewed as defect • Technical and adaptive work • Engaging frontline staff to identify and fix local opportunities to improve • Framing as social problem that can be solved • Clinical communities

17. 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.

18. How is SUSP Different? Questions? Email the SUSP help desk! SUSP@jhmi.edu • Informed by science • Led by clinicians and supported by management • Guided by measures • local and national

19. SUSP Interventions

20. No single SSI prevention bundle • Deeper dive into SCIP measures to identify local defects • Emerging evidence • Abxredosing and weight based dosing • Maintenance of normogylcemia • Mechanical bowel preparation with oral abx • Standardization of skin preparation • Capitalize on frontline wisdom • CUSP/Staff Safety Assessment

21. Auditing tools Questions? Email the SUSP help desk! SUSP@jhmi.edu • Antibiotic • Selection, dosing, redosing • Normothermia • Glucose Control • Skin Prep • SSI investigation • Others

22. Comprehensive Unit-based Safety Program (CUSP) Questions? Email the SUSP help desk! SUSP@jhmi.edu • Educate staff on science of safety • Identify defects • Assign executive to adopt unit • Learn from one defect per quarter • Implement teamwork tools

23. Briefings and Debriefings 1 Arch Surg. 2008;143(11): 1068-1072. 2 J Am Coll Surg. 2009;208:1115-1123. 3 JtComm J QualSaf. 2009;35(8):391-397. 4 N Engl J Med. 2009;360:491-9. • Reductions in communication breakdowns and OR delays 1 • Reductions in procedure and miscommunication-related disruptions and nursing time spent in core 2 • Improved communication and teamwork, feasible given current workload 3 • Reductions in rate of any complications, SSI and mortality 4

24. What data will teams need to collect?* Questions? Email the SUSP help desk! SUSP@jhmi.edu • Monthly NHSN and/or NSQIP SSI data by surgical specialty area • Numerator and denominator • Annual teamwork/culture data using the AHRQ Hospital Survey of Patient Safety (HSOPS) • Will work with CEs to ensure data reporting meets their needs *If data is already collected/available (ie: ACS NSQIP or NHSN), we will work with your team to import if you desire

25. Surgical Site Infection Data Entry: NSQIP Questions? Email the SUSP help desk! SUSP@jhmi.edu Target audience: Coordinating Entities and hospital administrators Data transferred directly from NSQIP Unadjusted data transferred on a monthly basis Adjusted data (Odds) transferred every 6 months

26. Surgical Site Infection Data Entry: NHSN & Manual Entry Questions? Email the SUSP help desk! SUSP@jhmi.edu Data transfer process – done by the coordinating entities or hospital administrator Unadjusted data transferred on a monthly basis Adjusted data (SIR) transferred every 6 months

27. What do teams need to do? • Attend the Cohort 5 kickoff webinar (~2 hours) • Monday, April 28 @ 10AM (EST) OR • Wednesday, April 30 @ 2PM (EST) • Assemble a multidisciplinary team • Including Preop, OR and Postop staff • Participate in monthly project webinars • All webinars recorded and archived online • Participate in monthly coaching calls • Regularly meet as a team to implement interventions and monitor performance Questions? Email the SUSP help desk! SUSP@jhmi.edu

28. Once enrolled, the SUSP website is your go to place for everything! armstrongresearch.hopkinsmedicine.org • Previously recorded cohort project call webinars • Manuals • Toolkits • Data portal • Who uses the portal? • SUSP project leads • HSOPS coordinators • SSI data coordinators • Coordinating Entities • What’s the portal used for? • Data viewing, summation, sharing • Hospital Survey of Patient Safety (HSOPS) • Sharing of information • Talk with other SUSP hospitals on our social network!

29. 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).

30. Why should you be a part of SUSP? Questions? Email the SUSP help desk! SUSP@jhmi.edu • Improve patient outcomes • ACS NSQIP comparative feedback • Platform that links data collection, reporting, and training with social networking to improve communication and sharing • Finding ‘value’ in our work • Teams own their own data for publication

31. What are current SUSP hospitals saying?

32. Join us on our journey to improve the safety of our patients! How to enroll or recruit hospitals into SUSP • Everything you need is online! • Download ALL enrollment documents online! • Complete the team registration form online! Visit the SUSP recruitment website Have questions? Email the SUSP help desk! SUSP@jhmi.edu

33. State hospital associations: Important due dates and deadlines By March 21: Complete the Coordinating Entity Participating Agreementand email to SUSP@jhmi.edu or fax to 410-637-4380. Download the Coordinating Entity Project Manual for guidance on kick-starting your recruiting efforts Everything you need is here: SUSP recruitment website Have questions? Email the SUSP help desk! SUSP@jhmi.edu

34. Hospitals: Important due dates and deadlines • By April 9: Have your hospital leadership complete the Hospital CEO Participating Agreement • By April 16: Complete three additional forms • Online Project Team Registration Form • Data Use Agreement • Clinical Team Participating Agreement • Upload copies of these forms when submitting the Online Project Team Registration Form. You can also return the forms to the SUSP help desk at SUSP@jhmi.edu or by fax: 410-637-4380 Everything you need is here: SUSP recruitment website Have questions? Email the SUSP help desk! SUSP@jhmi.edu

35. Next steps Questions? Email the SUSP help desk! SUSP@jhmi.edu • Visit our recruitment website • CEs: begin recruiting hospitals • Independent hospitals: Return all enrollment forms to SUSP@jhmi.edu no later than April 16. Have questions? Email the SUSP help desk! SUSP@jhmi.edu

36. SUSP from the CE perspective Dana Bonistalli Project Manager, Quality Policy & Advocacy
Maryland Hospital Association 18 hospitals enrolled and engaged in SUSP!