Safe Surgery Saves Lives

1. Safe Surgery Saves Lives Your Organization Your Name Insert Your Logo Here

2. Safety Stories • Example: aviation tragedy • Korean Airlines • Cockpit culture stopped the first officer [from alerting the pilot to asserting and arguing] about the imminent danger • Suggestions and clues are not clear messages • An example from your organization where the lack of communication was a risk for patient safety? • Close Calls? • Actual Adverse Event?

3. Surgical Safety is a Serious Issue • Canadian Adverse Events Study (Baker et al. 2004) • More than 50% of adverse events involved surgery • The Healthcare Insurance Reciprocal of Canada reports that since inception (20 years, with most claims occurring in the last 7-8 years) • Surgical claims account for $27 Million, 40% could have been prevented with the checklist or approximately $10 Million • Claim types: • 210 retained foreign body; • 94 wrong body part; • 9 wrong patient • Add local data

4. WHO Safe Surgery Saves Lives Meeting Geneva

5. The Faces of Harm

6. Evidence that checklist works

7. The Checklist and Communication

8. The Canadian Surgical Safety Checklist A suggested starting point for patients safety • Adapted from WHO • By Canadian experts • Including aviation and human factors professionals • Includes elements of other patient safety initiatives • Safer healthcare now! • VTE and surgical site infection • Time-out • Hospitals are encouraged to further adapt it to fit their current procedures

9. What issues does this checklist address? • All important safety elements are reviewed for all patients all the time • Correct patient, operation and operative site • Safe Anaesthesia and Resuscitation • Minimize the risk of infection • Effective Teamwork • Communication is a root cause of nearly 70% of the events reported to the Joint Commission from 1995-2005. • Preparedness for the unexpected • Anyone in the team can speak up if patient safety is at risk

10. Doors closed? Checked!

11. The eight original pilot sites EURO EMRO PAHO I London, UK Amman, Jordan Toronto, Canada WPRO I Manila, Philippines PAHO II Seattle, USA WPRO II Auckland, NZ AFRO Ifakara, Tanzania SEARO New Delhi, India

12. Impact at the pilot sites ~ 8000 operations Morbidity Mortality 11% 7%* (p<.001) 1.5% 0.8%* (p<.003) (actual 4% reduction) (actual 0.7% reduction) 3.2%* HIC (P<.001) 4.9%* LIC P<.001 0.3% HIC ns 1.1%* LIC P<.006 HIC = High Income Countries; LIC = Low Income Countries

13. Findings published on January 2009

14. Strengths of the Surgical Safety Checklist • Customizable to your setting and needs • Deployable in an incremental fashion • Supported by scientific evidence and expert consensus • Evaluated in diverse settings around the world • Ensures adherence to established safety practices • Minimal resourcesrequired to implement a far-reaching safety intervention

15. The View from Aviation “The estimate that up to 23,000 people died in 2004 in Canadian hospitals because of preventable adverse events is staggering. Checklists have been used in aviation to standardize and increase the reliability of systems. One wonders whether such checklists would have been introduced much earlier in medicine if surgeons shared the fate of their patients, as pilots share that of their passengers.” Adrian Boelen, retired pilot, Dorval, Que

16. Endorsed by professional groups CMA, CAN, CAS, ORNAC, RCPSC 1000 + downloads of the checklist 150 participants at the March workshop 500 + implementation kits delivered in one week Continuous spread To most provinces and territories To other surgical disciplines Endoscopy, OB, pediatrics, emergency … Urban and rural hospitals Some organizations and provinces aspire to making the Checklist a standard operating procedure The Checklist in Canada

17. Why should your hospital adopt it? • Significant commitment needed, but … • Insignificant costs to implement yet there is clear evidence of improved safety • Issues and omissions are being picked up! • It is adaptable and flexible! It is yours! • Takes 2-3 minutes but can save time over the course of a day • A great team-building opportunity! • You will be a leader in patient safety in Canada and the world • You only need: • Ongoing vigilance • A champion (or better, champions) at all levels! • Data collection (a method to understand how safety is improving) • Commitment from senior management and the board

18. Canadian Patient Safety Institute Mandate of the in-country Working Group: Lead further development, adaptation, and support for the Safe Surgery Saves Lives Campaign within the Canadian context Goals: Patients: reduced surgical complications and deaths Providers: provide highest quality of care Collaborate with national and international organizations to bring you the best resources Design tools and resources to assist organizations and OR teams in all implementation stages Website www.safesurgerysaveslives.ca

19. What can you do to get ready? • Endorse the checklist • Read the fact sheet and news release • Watch with your team • How-to and how not-to do it videos • Presentations: Atul Gwande, Bryce Taylor • Download the checklist • (4 versions Microsoft Word format) • Review references Available at: www.safesurgerysaveslives.ca

20. How to prepare for implementation Get ready Implement • Review the implementation kit • How: how-to guide • What: detailed explanation • Why: info, rationale, and FAQ • Follow the adaptation guideline (human factors) • List your organization on the surgical safety map • Communicate with peers on the Safe Surgery Community of practice Sustain Available at: www.safesurgerysaveslives.ca

21. How to sustain the change Get ready Implement • Participate in “virtual grand rounds” • Become a mentor/coach • Ask questions • Collaborate with others • Share successes and barriers Let us know of your successes and concerns! We are learning too! Sustain Available at: www.safesurgerysaveslives.ca

22. Patient involvement – bad timing!

23. Your turn