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

1. CUSP for Safe Surgery: The Surgical Unit-Based Safety Program SUSP/Cohort 3 One Year Review Sean Berenholtz, MD, MHS, FCCM February 11, 2014

2. First Year Review The SUSP vision Where the project is right now Next Steps

3. The power of collective wisdom Many ideas grow better when transplanted into another mind than the one where they sprang up. —Oliver Wendell Holmes

4. 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

5. 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 1million (0.5 – 5%) deaths following surgery 50% of all hospital adverse events are linked to surgery AND are avoidable

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

7. *The Joint Commission, Sentinel Event Data; http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf;29. Wrong-patient, Wrong-site, Wrong-procedure Events Reviewed by The Joint Commission *

8. Polling Question Has increased compliance in SCIP measures reduced SSI rates in your organization? Why might this be?

9. Key concepts: Adaptive and Technical Work Sweet Spot

10. Key concepts: Adaptive and Technical Work

11. How is SUSP different? Informed by science Embeds adaptive CUSP work into technical work Led by clinicians and supported by management Guided by measures

12. 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)

13. * CUSP Works in the OR Colorectal NSQIP SSI Rate at Hopkins (Wick 2012) Quarter 4 CUSP kickoff Antibiotic deficienciesaddressed Quarter4 Briefing/Debriefing Mechanical bowel prep with oral antibiotics Quarter 3 Skin preparationprotocol Pre-op wash clothes Quarter1 Pre-op warming Enhanced sterile technique Intervention checklist Goal: 15% *Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2).

14. Armstrong Institute for Patient Safety and Quality Where Is SUSP Now & Where Are We Going? Where Is SUSP Now & Where Are We Going?

15. Where Is SUSP Now? State and hospital enrollment SSI data update HSOPS completion Our path forward

16. SUSP Enrollment by Coordinating Entity SUSP Enrollment by Coordinating Entity

17. SUSP Enrollment by Coordinating Entity and Cohort

18. A big THANK YOU to all of our Cohort 3 SUSP Teams! Coordinating Entity: Maryland Hospital Association Calvert Memorial Hospital Carroll Hospital Center Harford Memorial Hospital MedStar Franklin Square Medical Center MedStar Harbor Hospital MedStar Montgomery Medical Center MedStar St. Mary's Hospital MedStar Union Memorial Hospital Mercy Medical Center Sinai Hospital of Baltimore The Johns Hopkins Hospital Upper Chesapeake Medical Center Bon Secours Baltimore Health System Holy Cross Hospital Laurel Regional Hospital Prince George's Hospital Center University of Maryland St. Joseph Medical Center Western Maryland Health System Coordinating Entity: Armstrong Institute for Patient Safety & Quality Canton-Potsdam Hospital Cooper Health Indiana University Health - Arnett Lehigh Valley Health - Cedar Crest Lehigh Valley Health- Muhlenburg Sanford USD Medical Center Southwest General Health Center Ochsner Medical Center Indiana University Health - Ball Memorial Hospital Coordinating Entity: Iowa Healthcare Collaborative Alegent Creighton Health Immanuel Medical Center Alegent Creighton Health Lakeside Alegent Creighton Health Mercy BLUFFS? Hospital Alegent Creighton Health Midlands Hospital Bergan Mercy Medical Center Creighton University Medical Center Coordinating Entity: Connecticut Hospital Association Danbury Hospital Coordinating Entity: Georgia Hospital Association Gwinnett Medical Center – Lawrenceville Gwinnett Medical Center- Duluth Liberty Regional Medical Center Spalding Regional Hospital Atlanta Medical Center Upson Regional Medical Center Hamilton Medical Center Medical Center of Central Georgia Habersham Medical Center Floyd Medical Center Tift Regional Medical Center Ty Cobb Regional Medical Center Emory

19. 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

20. SUSP Teams Are Engaged: Video submissions John Muir Video

21. 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/

22. Polling Question • What 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)

23. Summary of SSI Data Submission Questions? Email the SUSP help desk! SUSP@jhmi.edu

24. Your Data to Date *SSI rate (%) = (# of SSIs / Total # of cases)

25. 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

26. 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?

27. Polling Question • What 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

28. Why Safety Culture Matters Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011. 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

29. Why Safety Culture Matters Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press • Safety culture influences the effectiveness of other safety and quality interventions • Can enhance or inhibit effects of other interventions • Safety culture can change through intervention • Best evidence so far for culture interventions that use multiple components

30. SUSP HSOPS Baseline Results

31. HSOPS Re-Administration Schedule Follow-up (Approximately 16 months after baseline administration)

32. 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?

33. 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

34. CUSP for Safe Surgery (SUSP) Project Call Schedule Implementation Phase

35. 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

36. Additional Resources • Armstrong Institute Training Opportunities • http://www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/ • AHRQ CUSP Toolkit • http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/ • Armstrong Institute CUSP Tools • http://www.hopkinsmedicine.org/armstrong_institute/training_services/cusp_offerings/cusp_guidance.html

37. 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?

38. 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.