The Journey To Ariadne Labs. Bill Berry, MD, MPH Chief Medical Officer Principle Research Scientist
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1 The Journey To Ariadne Labs Bill Berry, MD, MPH Chief Medical Officer Principle Research Scientist
2 A Little History
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6 Flight Controls FREE & CORRECT
7 The Problem
8 The 3 Central Problems in Surgical Safety Throughout the World Unrecognized as public health issue Lack of data on surgery and outcomes We know what to do, but we don t do it consistently
9 Global Annual Procedure Rates
10 The Safe Surgery Saves Lives Program
11 Guiding Principles Simple Widely applicable Measurable Addresses serious and avoidable surgical complications Causes no harm
12 Four Categories for Surgical Standards: CONTROL OF INFECTION AND CONTAMINATION ANESTHESIA AND PATIENT MONITORING SURGICAL OPERATOR QUALITY ASSURANCE
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14 International Pilot Study 8 Evaluation Sites - Nearly 8,000 Patients PAHO I Toronto, Canada EURO London, UK EMRO Amman, Jordan PAHO II Seattle, USA WPRO I Manila, Philippines AFRO Ifakara, Tanzania SEARO New Delhi, India WPRO II Auckland, NZ
15 Results All Sites Baseline Checklist P value Cases Death 1.5% 0.8% Any Complication 11.0% 7.0% <0.001 SSI 6.2% 3.4% <0.001 Unplanned Reoperation 2.4% 1.8% 0.047
16 Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229) The checklist was easy to use 78.6% The checklist improved operating room safety 79.0% The checklist took a long time to complete 18.3% Communication was improved through use of the checklist The checklist helped prevent errors in the operating room If I were having an operation, I would want the checklist to be used. 84.3% 78.2% 92.6%
17 How Does The Checklist Work?
18 Two Ways Assuring critical processes are completed Guaranteeing critical conversations take place
19 Abx Given 0-60 Mins Except Dirty Cases Adherence to All Six Safety Indicators Site C Baseline (n=524) Checklist (n=598) 98.1% 96.9% 94.1% 94.2% SSI 4% 2.0%* Death 1.0% 0.0%* Any Complication 11.6% 7.0%* *p<0.05
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23 What Does It Look Like To Use The Checklist
24 The Story Of Ariadne Labs
25 HANDOUT 3 RESEARCH PATHWAY Measurement 4. White Paper 5. Planning 6. Convening of Experts 7. Tool / Product Design 2. Idea Fleshed Out 3. Background Research Design 8. Testing 9. Spread This is the Ariadne Labs destination 1. Kernel of an Idea Spread 10. Pull Back 3/16/2015 Retreat Meter_AZ
26 The Heart Of Ariadne Simple Critical Moments High Leverage High Impact
27 Critical Moments Birth Surgical Procedures End of Life
28 Challenges Of Standard Academic Siloed Research Single investigator driven Often ending with a publication A disconnection between discovery and implementation
29 The Matrix
30 Current Projects Improving care of mothers and babies in developing countries Decreasing caesarian rates Helping patients get what they want at the end of life Improving primary care globally Keep patients safe in the operating room by improving teamwork and communication
31 AHRQ Safety Program for Ambulatory Surgery Jeff Durney, MS Quality Improvement Advisor
32 How do you spread the checklist in 500+ ambulatory surgery centers nationwide?
33 What is an Ambulatory Surgery Center? Most are free standing facilities Some are attached to a hospital Majority are physician owned and operated Some are run by management companies Most provide multispecialty services Wide range of procedures performed More procedures are moving to this setting
34 Program Goals 1. Reduce surgical infection and complication rates within participating ambulatory surgery centers (ASCs) 2. Improve safety culture through improved teamwork and communication achieved through the effective use of: - Surgical safety checklist - Proven patient safety practices
35 Program Funding The National Program Partners Partners in ASC Quality
36 Program Vitals Duration 12 months with optional 6-month sustainability period Strategies Participating Centers* Educational webinars Infection control and prevention Surgical safety checklist implementation Data collection Facility demographic information Patient safety culture survey Monthly process and outcome measures Program office hours Cohort 1-55 Cohort Cohort 3-73 AAOS Pilot - 12 Cohort Additional Cohorts Planned *Goal: Reach 520 Centers in all 50 states including Washington, DC and Puerto Rico
37 Program Reach 37
38 Challenges in this Environment Limited resources Physician ownership Same physicians not present every day Limited QI/PI capacity Tremendous variation in all of these areas
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40 Lessons from Cohorts 1 & 2 Program running on autopilot Lack of any direct contact with centers No knowledge of local implementation activities No follow-up/coaching of implementation teams No one holding teams accountable for changes
41 and we wonder why nothing changes
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44 Introducing the Quality Improvement Advisor
45 Why Jeff Durney? From the Cockpit to Ariadne Labs
46 Quality Improvement Advisor Introduced with Cohort 3 Goals Serve as a coach to centers enrolled in the program Connect participants to program resources Monitor and encourage local implementation efforts Key activities Coaching calls Learning groups
47 Coaching Calls Six calls with each center participating in the program Initial call Relationship building Readiness assessment Follow-up calls Assess engagement in the program to date Evaluate implementation activities Provide coaching on all program content Collect program feedback Over 150 calls completed to date
48 Learning Groups We learned from previous participants that the webinars weren t enough We want to create: A sense of community An environment where centers can help each other and brainstorm to solve problems We want to: Make it easier for centers to get help if they need it Check-in to assess progress in the program Learn from one another Capture feedback 10 groups facilitated to date
49 What have we learned from 150+ phone calls and 10 learning groups?
50 Initial Impact of the Quality Improvement Advisor Coaching Calls Improved center satisfaction a friendly voice bringing a personal touch Increased center engagement Better center retention in the program Strengthening implementation capacity through individualized coaching strategies Learning Groups New ideas shared are being tested in some centers Networking outside of the groups Sense of community is developing within the program
51 The People Side of Change
52 Why is this work important?
53 53 Questions?
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