International Association for Ambulatory Surgery. Dr Ian Jackson President

Transcription

1 International Association for Ambulatory Surgery Dr Ian Jackson President

2 The International Association for Ambulatory Surgery (IAAS) The IAAS is an international scientific society whose membership brings together the National Societies involved in the day surgery process from across the world. Founded in 1995 by 12 national associations and is registered as a non-governmental organization in Belgium. Currently, IAAS counts 22 members

3 Our Members ASC SAMBA BAAS, BADS, DSDK, NVDK, SUOPA, AFCA, BAO, HAAS, FIDS, NORDAF, APCA, ASECMA, SADS, RAAS CASA, JSSSA APCACE ADSC, ADSNA

4 Members Australian Day Surgery Association (ADSC) Ambulatory Surgery Center Association (ASC) Belgian Association of Ambulatory Surgery (BAAS) British Association of Day Surgery (BADS) China Ambulatory Surgery Alliance(CASA) Danish Association of Day Surgery (DSDK) Dutch Association of Day Care & Short Stay (NVDK) Finnish Ambulatory Anaesthesiologists Suomen Päiväkirurgiset Anestesiologit (SUOPA) French Association of Ambulatory Surgery (AFCA) German Association for Ambulatory Surgery (BAO) Hungarian Association of Ambulatory Surgery (HAAS) Indian Association of Day Surgery Italian Federation of Ambulatory Surgery (FIDS) JSSSA(Japanese Short Stay Surgery Association) Norwegian Day Surgery Association (NORDAF) Portuguese Association of Ambulatory Surgery (APCA) Society of Ambulatory Anaesthesia (SAMBA) Spanish Association of Major Ambulatory Surgery (ASECMA) Swedish Association of Day Surgery (SADS) ASSOCIATE MEMBERS Australian Day Surgery Nurses Association (ADSNA) Italian Association of Private Day Surgery Hospitals Italian Society of Ambulatory Surgery and Day Surgery (SICADS) CORRESPONDING MEMBERS Peruvian Association of Ambulatory Surgery (APCACE) Romanian Association of Ambulatory Surgery (RAAS)

5 Our Mission The mission of the IAAS is to promote the worldwide development and growth of high quality ambulatory surgery (day surgery). Day surgery has proven itself to be a high-quality, safe and cost-effective approach to surgical health care. In this light, IAAS members work together to carry out this mission free of partisan spirit and prejudice and are committed to the values of solidarity and equity of access to healthcare.

6 Our Role Provide our expertise in all facets of the day surgery process Management Design Nursing Surgical Anaesthesia Also, share experiences across a wide range of models of Health Provision

7 Our Activities We promote the development of high quality ambulatory surgery We provide training and technical support in ambulatory surgery for surgeons, anaesthetists, nurses and managers We promote the international exchange of knowledge and experience in ambulatory surgery

8 Our Activities We collaborate with International healthcare bodies We stimulate research and benchmarking We stimulate the formation of national associations for ambulatory surgery

9 Biennial International Congresses First International Congress was held in Brussels in th IAAS Meeting Copenhagen Denmark, 8 11 May 2011

10 Biennial International Congresses

11 Biennial International Congresses

12 Publications

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14 REGISTRATION FEES Category Early registration Late registration IAAS member (IM) 484 eur 544 eur Trainee (IM) 242 eur 250 eur Nurse (IM) 125 eur 181 eur

15 MEETING PROGRAMME TOPICS New anesthetic procedures in Ambulatory Surgery. Ambulatory Surgery progress and development in the world. Safety in Ambulatory Surgery. New technologies in Ambulatory Surgery. Research and teaching in Ambulatory Surgery.

16 MEETING PROGRAMME SOCIAL PROGRAMME Barcelona Touristic Tour. Gaudi s Tour. Congress Dinner: on Monday May 11 th. Fee: 30 euros.

17 CONGRESS VENUE Barcelona International Convention Centre ( CCIB ).

18 CONGRESS VENUE Barcelona International Convention Centre ( CCIB ). CCIB, Barcelona International Convention Centre sqm

19 ACCOMMODATION Estimated prices in Barcelona for May star hotels 4 star hotels 3 star hotels 2 star hotels Hostels EUR/night EUR/night EUR/night EUR/night EUR/night/pax

20 ACCOMMODATION

21 SEE YOU HERE IN BCN 2015!!!!

22 Patient safety in day surgery Dr Ian Jackson President International Association for Ambulatory Surgery

23 Where is York?

24 Scotland

25 Bar stool in Scotland

26 York Minster

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31 Risk of Harm 1 in 1,000,000 1 in 250,000 1 in 124,000 1 in 10

32 Safety in Hospital - UK Healthcare is a high hazard industry Approx. 10% (900,000) of patients admitted to hospital experience an incident 72,000 of these incidents/adverse events contribute to the death of patients

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34 My timeline of working in NHS 1981 MS DOS & IBM PC 1982 Commodore 64 released 1984 Apple Mac, DELL founded 1986 PIXAR founded 1987 Windows Motorola ASUS founded 1990 ARCHIE first search engine 1991 Web launched to public 1992 Windows Windows NT Windows Google 1998 imac, Paypal 2000 Windows ME 2001 Windows XP 2002 Blackberry 2004 Mozilla Firefox 2007 iphone released 2009 Windows ipad released 2012 Windows 8 Qualified Woodend terminal/printer for biochemistry results Consultant Anaesthetist 1 IBM PC for database work in department Secretaries had electric typewriter

35 1989 Managers Vision In 5 years we would be able to Sit at a desk with our own PC Find patient letters, results etc Find where patients were in hospital Enter details into an electronic record He didn t last long

36 2014 Reality I can sit at desk, or in theatre and review Casenote library all letters for past 10+ years Pathology and Radiology reports and view X-Ray Preoperative assessments Patient BP, Temp, HR, SaO 2 and NEWS chart (live) Patient Inpatient Care Record Record of attendences at Emergency Department Find all at risk patients in the hospital and review them It has taken us 24 years!

37 Improving reliability Improving reliability Level I Level 2 Training, vigilance & hard work Design systems for reliability constraints, decision aids, reminders, checklists, bundles Level 3 Prevent design for reliability Identify make failures visible Mitigate prevent / treat harm due to failures

38 Reliability definitions Reliability Failures Success rate Chaotic More than 2 in 10 Less than 80% Level 1 1 failure in 10 90% Level 2 1 failure in % Level 3 1 failure in %

39 Safety There are no quick fixes This stuff is difficult The blame culture is deeply ingrained in; Our professions Healthcare Wider society There is a difficult balance between accountability and a just culture

40 So where are you? When a serious incident happens to a patient Do you talk about the need to educate? Do you talk about need to change protocol? Do you talk about the importance of handover? Do you discipline those involved?

41 Designing for reliability Level 1 Intent, vigilance, hard work, audit, discipline Level 2 Design of processes informed by reliability science and knowledge of human factors Level 3 System-wide focus on becoming a highly reliable organisation

42 Have you ever.? Put the wrong fuel in the car? Sent an e mail to the wrong person by mistake? Deleted the wrong document? Locked yourself/your keys in/out? Forgotten to lock the door? Given a patient the wrong medicine? And if so, when??

43 Factors affecting human attention Fatigue Stress, anxiety, fear Competing demands Environmental conditions Clutter, motion, poor lighting, noise Too many handoffs Shift work

44 Day Surgery Busy environment Large numbers of patients

45 5 steps to safety Briefing Sign in Time out Sign out Debriefing

46 5 steps to safety Briefing Sign in Time out Sign out Debriefing

47 Briefing What is it? The plan for the day is discussed by all team members When? Initiate the briefing before the first case of the day, once all team members are available in the department Why? Ensure a shared understanding of the plan for the day Anticipate and prepare for problems

48 Briefing Who is leading the briefing? It can be any member of staff Consider rotating the lead People Team members introduce themselves Clarify roles, responsibilities, actions and interactions Is anyone missing? Does everyone feel comfortable about today? Qualify any supervision/assessment considerations Remember - we re part of a team Everybody has a valid role, perspective and opinion

49 Briefing List Overview of the list Any changes? Anticipated events e.g. Fire Alarm test, Industry observer Details of each case Be clear about the plan, expectations, special considerations e.g. latex allergy/positioning Any equipment problems? Any special equipment required?

50 5 steps to safety Briefing Sign in Time out Sign out WHO CHECKLIST Debriefing

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52 5 steps to safety Briefing Sign in Time out Sign out Debriefing

53 Debriefing What went well? What didn t go well? What could we do better next time?

54 Safety Issues for our patients Based on model by James Reason

55 Reliable Health Care Systems Prevent failure Identify and mitigate failure identify failure when it occurs and intercede before harm is caused, or mitigate the harm caused by failures that are not detected Redesign process based on critical failures identified Three tier strategy - Institute for Healthcare Improvement

56 Stress Test Look at both dolphins jumping out of the water. They are identical. A closely monitored, scientific study revealed that, in spite of the fact that the dolphins are identical, a person under stress would find differences in the two dolphins. The more differences a person finds between the dolphins, the more stress that person is experiencing.

57 So how can IT help safety? Consider my world.. We set up preoperative assessment in early 1990 s Fragmented process and all based on a separate paper record

58 Patient Pathway Referring Doctor Paper Specialist Consultation Diagnostics + Optimisation Paper Paper Preoperative Assessment Paper Schedule & Admission Successful Discharge Paper Recovery Paper Paper Method to return patients unsuitable for surgical or medical reasons Unplanned Overnight Admission Paper = DANGER! Paper + People= DISASTER!

59 Day surgery Preoperative assessment run by rotating staff. Difficulties supporting them when they found a problem with a patient Development of Ian s Box Not unusual to find forms to review Patient maybe due in the next day

60 Safety Issues for our patients Dependence on single individuals Lack of timely review Reliance on internal mail Reliance on paper trail Based on model by James Reason

61 Electronic System Not just about the system PROCESS Important to engage with those involved to help consider the process The high level design and map of information flows can help streamline the clinical process

62 Preoperative Assessment Design of system helped drive Agreement of single assessment process Agreement to move towards unified assessment team The design of a clinical process to manage patients

63 So what did we end up with? Electronic Preoperative Assessment module Integrated so part of developing EPR Direct access from Theatres module Method to manage problem patients

64 Management of problem patients Use of electronic Worklists Patient can be referred to department for action Patient can be referred back to Preassessment staff for action

65 How does it work? No Problems - Listed Preoperative Assessment + Diagnostics Problem Patient Worklist for Anaesthetic Department Ability to highlight difficult patients link written advice feedback to nurses Electronic Review patients

66 Advantages All communication electronic No single individual involved Open worklist so anaesthetists and nursing staff can see if patient has been reviewed Feedback loop to the nurses