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Keystone Surgery: Improving Perioperative Care in Michigan

Preventable Harm. 230 million surgeries / yr worldwideMore common than births ( 36 million / yr) 1 in 25 people25% in-patient surgeries followed by complication7 million disabling complications / yr0.5 5% deaths following surgery1 million deaths / yr50% of all hospital adverse events lin

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Keystone Surgery: Improving Perioperative Care in Michigan

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    1. Chris George, RN MS Project Manager MHA Keystone Center for Patient Safety and Quality Keystone Surgery: Improving Perioperative Care in Michigan

    2. Preventable Harm 230 million surgeries / yr worldwide More common than births ( 36 million / yr) 1 in 25 people 25% in-patient surgeries followed by complication 7 million disabling complications / yr 0.5 – 5% deaths following surgery 1 million deaths / yr 50% of all hospital adverse events linked to surgery At least 50% of adverse surgical events are avoidable

    3. Keystone Surgery Learning Community- few existing forums for hospitals to come together to share experiences and improve care. Keystone Surgery Cohort 1 76 hospitals 36 urban, 38 rural (including 7 critical access) Keystone Surgery Cohort 2 25 hospitals 14 CAH

    4. Keystone Surgery Collaborative Goals Eliminate surgical site infections, by ensuring that 90% of patients receive evidence-based interventions for preventing surgical site infections Eliminate mislabeled specimens Learn from our mistakes, in particular focusing on the National Quality Forum’s “Never” events (wrong site surgery and retained foreign bodies) Have 60% of your staff reporting positive safety and teamwork climate using a measurement instrument that is psychometrically sound. Develop a safety scorecard for perioperative care

    5. The Johns Hopkins Comprehensive Unit-Based Safety Program (CUSP) Educate staff on science of safety http://www.jhsph.edu/ctlt/training/patient_safety.html Identify defects Assign executive to adopt unit Learn from one defect per quarter Implement teamwork tools

    6. 2008 OR Teamwork Climate

    7. Bar Chart

    8. Step 5: Implement Teamwork Tools Daily Goals J Crit Care 2003;18:71-75 Morning Briefing Jt Comm J Qual Patient Saf. 2005;31:476-9 Learning from Defects Jt Comm J Qual Patient Saf. 2006;32:102-8; Am J Med Qual 2009;24(3):192-5. Team Check Up Tool Jt Comm J Qual Patient Saf. 2008;34:619-623 Shadowing Jt Comm J Qual Patient Saf. 2008;34:614-8 Briefing and Debriefing Jt Comm J Qual Saf. 2009;35(8):391-397

    9. NEJM Special Article: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

    10. Briefing Checklist

    11. Briefing Checklist

    12. Briefing Checklist

    13. Briefing Checklist: Before Every Procedure

    14. De-briefing Checklist

    15. William Beaumont Hospital Royal Oak campus

    16. Provider Perceptions

    17. Briefing Compliance All Keystone Surgery Teams 7/1/2008 - 8/31/2009

    18. Briefing Problem Identification All Keystone Surgery Teams 7/1/2008 - 8/31/2009 Categories

    19. Debriefing Compliance All Keystone Surgery Teams 7/1/2008 - 8/31/2009

    20. Debriefing Problem Identification All Keystone Surgery Teams 7/1/2008 - 8/31/2009

    21. Challenges Surgical teams are complex Diffusion of innovation in ORs challenging Data collection burdensome Linking improvement in culture with improved patient outcomes

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