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Conquering Sepsis Mortality: Teamwork Makes the Dream Work `

Conquering Sepsis Mortality: Teamwork Makes the Dream Work `. Christa A. Schorr RN, MSN, FCCM Assistant Professor of Medicine Cooper Medical School of Rowan University Director of Databases for Quality Improvement and Research Program Director of Critical Care Clinical Trials

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Conquering Sepsis Mortality: Teamwork Makes the Dream Work `

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  1. Conquering Sepsis Mortality: Teamwork Makes the Dream Work ` Christa A. Schorr RN, MSN, FCCM Assistant Professor of Medicine Cooper Medical School of Rowan University Director of Databases for Quality Improvement and Research Program Director of Critical Care Clinical Trials Cooper University Hospital

  2. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis SSC North American Summits Underway 2007 Sepsis 2012: What's Hot and What's Not Sponsored by: New Jersey Hospital Association

  3. Establish teams locally

  4. 4 Phases of Teamwork = Alignment Identification Collaboration High performance

  5. Aligning the team • Clarify values, purpose and vision • Set realistic, quantifiable objectives • Clarify roles and responsibilities • Organize for effectiveness • Establish team guidelines

  6. Establish an Aim Statement Example: By March 2013 Our team intends to improve time to antibiotics for ED admissions to ≤3 hours Improvement will be measured by a 25% increase in antibiotic indicator compliance (60% currently - goal 75%) 6

  7. Multidisciplinary cross-departmental alignment 7

  8. Will the teams be receptive?

  9. Patrick Lencioni 2002

  10. Develop Transform enthusiasm leadership Tr us t camaraderie Conflict resolution competence No Egos Lead Follow

  11. Identification phase • Refine roles and responsibilities • Manage conflict, clarify expectations and re-establish accountability • Promote and set team identity

  12. Recruiting the team Received 2008 AACN Excellence in Collaboration Award Multidisciplinary

  13. Teamwork behaviors • Leadership • Situational awareness • Workload management • Resource management • Briefings • Debriefings Sehgal N et al J Gen Intern Med 2008 December; 23(12): 2053-2057

  14. Manojlovich M and DeCicco, B. Am J Crit Care 2007

  15. Value of nurses at the bedside • Empower nurses to recognize and report severe sepsis

  16. Collaboration phase • Learn how each team performs best • Develop feedback paths • Promote increasing autonomy for higher performance

  17. Role of Collaboration ICU ED 18

  18. Effective interventions for change Active involvement Audit and feedback Local consensus process Reminders-prompts Interactive educational material Interventions targeting barriers 19 Gross P. 2009. Jt Comm on Qual Improvement. 26(9) 547-553

  19. Feedback Data - Data and more data

  20. Facilitate guideline recommendations • January 2005-March 2008 • 15,022 subjects at 165 sites • Result: • sustained continuous quality improvement Critical Care Medicine. 38(2):367-374, February 2010

  21. Critical Care Medicine. 38(2):367-374, February 2010

  22. Protocols:Implementation Consistently Reduces Mortality * * * ‡ † ‡ *P < .05 compared with control; †In-hospital mortality; ‡28-day mortality. Sebat F, et al. Chest. 2005;127:1729-1743; Kortgen A, et al. Crit Care Med. 2006;34(4):943-949;Shapiro NI, et al. Crit Care Med. 2006;34(4):1025-1032;Micek ST, et al. Crit Care Med. 2006;34(11):2707-2713.

  23. Schramm GE Crit Care Med 2011 Vol. 39, No. 2

  24. High performance phase • Anticipate each other’s behavior and operate with extreme efficiency • Encourage innovative thinking • Solve problems quickly • Practice team renewal

  25. Celebrate -team renewal

  26. DreamTeam + Plan = Success

  27. Thank you

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