Uplifting Surgical Patient Safety

Similar documents
Course: Acute Trauma Care Course Number SUR 1905 (1615)

The Quality Journey of

Los Angeles Medical Center Policies and Procedures

ROTATION: TRAUMA AND CRITICAL CARE (L AND A SURGERY)

Enhanced Recovery Implementing Meaningful Change

Why Focus on Perioperative Services?

Post-operative "Fast-Track" pathways for lung resection. Dennis A. Wigle Division of Thoracic Surgery Mayo Clinic

Perioperative management of the higher risk surgical patient with an acute surgical abdomen undergoing emergency surgery

A Patient Safety Programme in reducing the Number of Models of Oxygen Regulators and Enhancing Staff Competency on their Use

APPLICATION FORM. Sepsis: A Health System s Journey Toward Optimal Patient Care & Outcomes. Director of Quality

Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care

Outline. Disproportionate Cost of Care. Health Care Costs in the US 6/1/2013. Health Care Costs

SURGICAL RESIDENT CURRICULUM FOR NORTH CAROLINA JAYCEE BURN CENTER. Residency years included: PGY1 _X PGY2 PGY3 _X PGY4 PGY5 Fellow

SURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF GENERAL and PEDIATRIC SURGERY

Enhancing Psychosocial Care for Patients with Palliative Care Needs in the Acute Medical Wards

Clinical Pathway: TICKER Short Stay (Expected LOS 5 days) For Patients not eligible for other TICKER Clinical Pathways

Annual report of Hong Kong Society of Critical Care. Medicine Limited (HKSCCM) 2012

Specialized Nursing Postgraduate Diploma, Faculty of Nursing, University of Iceland, Reykjavik, Iceland

Hub and Spoke Network

QUALITY NET REPORTING

Organisational Audit Questions - Links to recommendations, standards and evidence

The curriculum is based on achievement of the clinical competencies outlined below:

Penn State Milton S. Hershey Medical Center. Division of Trauma, Acute Care & Critical Care Surgery

Situational awareness: SBAR training

Supplementary Online Content

The deteriorating patient recognition and management Dave Story

Equivalence Guidance for GMP Domain 1

Volume to Value Transition in the USA

Optimal Resources for Children s Surgical Care. Keith T. Oldham, MD. ACS Quality and Safety Conference New York, New York July 22, 2017

SURGICAL RESIDENT CURRICULUM FOR THE DIVISION OF CARDIOTHORACIC SURGERY

4/10/2013. Learning Objective. Quality-Based Payment Models

Can nurses Compliance to Ventilator Care Bundle Help to Prevent Ventilator Associated Pneumonia in ICU? Mok Chi Man, RN (SP) ICU, PYNEH, HKEC

Mohamad Fakih, MD, MPH

PQRS Success in 2015:

ENVIRONMENT Preoperative evaluation clinic. Preoperative evaluation clinic. Preoperative evaluation clinic. clinic. clinic. Preoperative evaluation

Goals: Hospital Medicine at the Edges: A Specialty in Evolution Robert Harrington, MD, SFHM President, SHM

Hospital Authority Finance Internship Programme

Fundamental Critical Care Support (FCCS)

Creating Synergy for Community Health

Transitions Through the Care Continuum: Discussions on Barriers to Patient Care, Communications, and Advocacy

History of Trauma Surgery

Change In Patient s Perception And Knowledge Regarding Anaesthetic Practice After A Preoperative Anaesthesia Clinic Visit

Cost Effectiveness of Physician Anesthesia J.P. Abenstein, M.S.E.E., M.D. Mayo Clinic Rochester, MN

EMS Subspecialty Certification Review Course. Learning Objectives. Scope of Practice

ENHANCED SKILLS PROGRAM IN HOSPITAL MEDICINE

Improving Hospital Performance Through Clinical Integration

2018 DOM HealthCare Quality Symposium Poster Session

The Health Care Improvement Foundation 2017 Delaware Valley Patient Safety and Quality Award Entry Form 1. Hospital Name Jefferson Health

Clinical Pathway: Ventricular Septal Defect (VSD) or Atrial Septal Defect (ASD) Repair

Virtual Care Solutions Moving Care from the Hospital to the Home

2016 HCPro, a division of BLR. All rights reserved. These materials may not be duplicated without express written permission.

ENVIRONMENT Preoperative evaluation clinic, Preoperative holding area. Preoperative evaluation clinic, Postoperative care unit, Operating room

Saving Lives with Best Practices and Improvements in Sepsis Care

For Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert

5/9/2015. Disclosures. Improving ICU outcomes and cost-effectiveness. Targets for improvement. A brief overview: ICU care in the United States

*Your Name *Nursing Facility. radiation therapy. SECTION 2: Acute Change in Condition and Factors that Contributed to the Transfer

NEW JERSEY HOSPITAL PERFORMANCE REPORT 2014 DATA PUBLISHED 2016 TECHNICAL REPORT: METHODOLOGY RECOMMENDED CARE (PROCESS OF CARE) MEASURES

Peri-operative Pain Management - a multi-disciplinary team-based approach

Achieving Organizational Excellence Through Health

Claims Denial Management: What Are Third Party Payers Really Telling You about Your Documented Quality-of-Care and Compliance?

Condition O: Obstetrical Crisis

National Blood Clot Alliance

Appendix 6 1 Emergency Radiological Interventions 6

Learning Objectives. Registration and Continental Breakfast 7:00 AM -7:30 AM

CNA SEPSIS EDUCATION 2017

Benefits of Tele-ICU Management of ICU Boarders in the Emergency Department

COBAFOLIO: DOCUMENTING THE EVIDENCE OF COMPETENCE

9/17/2018. Place of Service Type of Service Patient Status

Documentation 101: CDI JULY 19, 2017

Centers for Medicare & Medicaid Services (CMS) Quality Improvement Program Measures for Acute Care Hospitals - Fiscal Year (FY) 2020 Payment Update

Duke University Health System Experience of Redesigning Care for Improved Quality and Efficiency CAITLIN DALEY, DR. GEORGE CHEELY, DR.

TRAUMA AND EMERGENCY SURGERY CORE OBJECTIVES: PGY 4

Enhanced Recovery in NSQIP (ERIN): an update on the collaborative. Julie Thacker, LianeFeldman, and Julia Berian ACS NSQIP National Conference 2015

Review of Clinical Service Enhancement: Bereavement Support Service in Kwong Wah Hospital

How Anesthesia Helps ASCs Maximize Value-Based Purchasing Performance. Thursday October 27, 2016

Pediatric Surgery Curriculum Clinical Base Year

NEW JERSEY HOSPITAL PERFORMANCE REPORT 2012 DATA PUBLISHED 2015 TECHNICAL REPORT: METHODOLOGY RECOMMENDED CARE (PROCESS OF CARE) MEASURES

Iowa Healthcare Collaborative - HEN 2.0 Measures

Frequently Asked Questions (FAQ) Updated September 2007

Understanding Patient Choice Insights Patient Choice Insights Network

anaesthetic services Chapter 15 Services for neuroanaesthesia and neurocritical care 2014 GUIDELINES FOR THE PROVISION OF ACSA REFERENCES

19th Annual. Challenges. in Critical Care

Total Joint Partnership Program Identifies Areas to Improve Care and Decrease Costs Joseph Tomaro, PhD

POLICIES AND PROCEDURES

The Royal College of Surgeons of England

Sepsis Mortality - A Four-Year Improvement Initiative

Exemplary Professional Practice: Accountability, Competence and Autonomy

Increase Your Bottom Line by Eliminating Physician Driven Denials. Olakunle Olaniyan MD President Case Management Covenants

TRAUMA CENTER REQUIREMENTS

Carol J. Peden BSC, MB ChB, MD, FRCA, FFICM, MPH Royal United Hospital, Bath

Study Title: Optimal resuscitation in pediatric trauma an EAST multicenter study

Rural-Relevant Quality Measures for Critical Access Hospitals

Coroner's Corner - Inquest into the death of Gwendoline Mead

TeleICU And What It Means To You

Kingston Hospital NHS Foundation Trust Length of stay case study. October 2014

Stopping Sepsis in Virginia Hospitals and Nursing Homes Hospital Webinar #2 - Tuesday, March 21, 2017

Deanna Jung, DNP, APRN, AGACNP-BC, ACCNS-AG

Interactive Trauma: Beyond the Moment of Impact

Physician Executive Council. Using the Perioperative Surgical Home to Improve Joint Replacement

Sepsis Screening & Code Sepsis in Critical Care Units (Medical, Surgical, & CCU)

Transcription:

Uplifting Surgical Patient Safety from silo thinking to safety circle Dr. TANG Kam Shing Service Director (Quality and Safety)/ Honorary Consultant (A&IC) New Territories West Cluster/ Hospital Authority HA Convention 2014 8 th May 2014

Votes of thanks Dr. Albert CY Lo Dr. CW Man Dr. SK Leung Dr. CC Cheung Dr. KK Lam Dr. WS Chan Dr. KC Lam Dr. CK Koo Dr. WM Kwan Dr. HK Tsang Dr. Jasperine Ho Ms. PF Tang Ms. Quinnie Lee Ms. MN Li

What I am going to share Patient journey of a typical complicated surgical patient Need to change to patient journey approach Our initial journey along the path in NTWC Surgical Quality and Safety Circle Initial problems and small success Conclusion

Why bother about surgical patient journey?

A surgical patient s journey AED MO AED Surgery ICU SUR MO SUR AC ICU MO CXR, AXR MED MO ICU AC M&G MED MO ANA MO Anesthesia ANA AC DR MO Radiology DR SMO

Finally.. SUR: I will go in if percutaneous drainage could not be done tonight Waiting for ICU/ Radiology reply ICU: I will ask radiology to do it as 1 st case if surgeons not going in tonight Waiting for surgical reply Anesthetists: We will go ahead if radiologist is not doing it tonight Waiting for surgeons Radiology: Will do it as 1 st case if surgeons not going in tonight Waiting for ICU reply

If you are the patient s son, sitting outside ICU waiting How would you feel? What would you do?

But wait a minute Hospitals has been divided into departments and divisions since they exist We have been saving countless patients life by this structure/approach Why we need to change to patient journey approach in caring for our patients? Is it just another Q&S buzz word??

Hospital organization vs. patient journey In early 20 th century (1937) Medicine was largely ineffective A few diseases that you can actually treat Pneumococcal pneumonia antiserum Congestive heart failure bleeding + crude digitalis + oxygen tent Syphilis arsenic and mercury The Youngest Science: Notes of a Medicine Watcher (Lewis Thomas) Doctor/ Nurse know it all and do it all by himself/ herself Culture of working in silos and small circles Autonomy became highest value Minimal need to collaborate Patient journey typically very short

Hospital organization vs. patient journey Take a look at where are we now. >4000 medical and surgical procedures >6000 drugs Exploding complexity requiring multiple specialists/ therapists A typical hospital stay 1970s 2 full time equivalent of clinicians 1990s 15 full time equivalent of clinicians Very well trained specialists working in silos Minimal cross talk and sharing Patients travelling across all these silos

Silos of specialists/ departments We hope that With multiple very expensive/ sophisticated components taking care of parts Our patient will get great care But will they get it? Let s imagine we are building a jet fighter that would outperform any existing ones Chinese 殲二十 engines + Russian PAK FA navigation system + US F 22 body A multi million pile of junk that cannot fly

Where to start The change in culture from specialists silos to a circle of healthcare workers caring for the patient is never going to be easy Such a change has to be taken in phases and it is going to take years evolution rather than revolution Setback would occur Do we have a practical concept framework? We need a roadmap or checklist to bring about such changes

Steps to significant change 1. Establishing a sense of urgency 2. Creating the guiding coalition 3. Developing a vision and strategy 4. Communicating the change vision 5. Empowering employees/ colleagues for board based actions 6. Generating short term wins 7. Consolidating gains and producing more changes 8. Anchoring new approaches in the culture Probably where we are right now Leading Change (John P. Kotter)

Establish sense of urgency Surgical Outcome Monitoring and Improvement Program (SOMIP) Suboptimal outcomes of elective and emergency surgical patients in TMH Persistent similar findings over consecutive years Phases of accepting bad news acceptance We need to do something about this Short term fixes Long term improvements

Creating the guiding coalition A lot of differences in views and response in the 3 departments (SUR, ANA, ICU) just the way it is not my problem, it is their problem not possible to fix need to improve but how A core of surgeons/ anesthetists/ intensivists group came together to form a circle Formal endorsement by CCE Letter sent to all senior surgeons to invite and thank them for joining Quality and Safety Division provide executive support

Developing vision and strategy What is our aim? Where to start? How to make changes? Education? Guidelines? How could we obtain resources for this?

Surgical Quality and Safety Circle (SQSC) Vision: Improve care of complicated surgical patients to decrease mortality and morbidity. Cultural shift: Allow dissents, just culture, speak up culture, safety culture Strategy: SUR, ANA, ICU Start with patient journey approach and look into ways to do things better Concentrate on evidence based practices cracks that patients tend to fall through our care Tools Communication improvement/ standardization Protocols for evidence based practices Education

Surgical Quality and Safety Circle (SQSC) Members of the circle Surgery: COS + Team heads of surgical teams Anesthesia: 3 senior anesthetists ICU: 2 senior intensivists Q&S: SD(Q&S) + audit team A discussion and collaboration platform Convener EP(Q&S) as coordinator and case reviewer Meeting every 1-2 months after 5pm

Surgical Quality and Safety Circle Selected patients (SQSC) Elective and emergency patients according to pre-defined selection criteria Entered into SQSC database of Q&S every month Whole patient journey (from admission to discharge) reviewed by Q&S audit team Summary prepared by EP(Q&S)

Communicate change vision Establishment of SQSC briefed in the following meetings in NTWC Cluster Management meeting Division Head meeting Chief of Services meeting Cluster Clinical Governance committee meeting Surgical department meeting Anesthesia and ICU department meeting Terms of reference and logistics of SQSC sent to all senior surgeons/ anesthetists/ intensivists In retrospect More informal communication probably needed Communication to middle level probably needed to be strengthened

Empowering colleagues for actions Obstacles for actions Departmental barriers Inertia associated with common practices Differences in perspectives of different specialties Value and principles What we have done Some culture change Joint taskforce for specific clinical problem e.g. massive GI hemorrhage Joint educational seminar Focus on good level evidence as driving force for change In retrospect Some actions could be coordinated better Some actions would need more resources support

Generating short term wins

Common lapses identified Communication between Surgeons/ ICU/ Anesthetists Difference in opinion and plan of care for marginal cases Who is responsible for co-ordination for complicated cases with multiple options Difference in knowledge/ attitude of certain conditions Lack of guidelines/ protocols in management of emergencies crossing specialties Acute severe GI bleeding Severe sepsis/ septic shock

Pre-operative liaison Mostly marginal cases with acute surgical problems to go in or not to go in? to support or not to support? Differences in opinion and expectation between different specialties Conflicts between specialties Suboptimal care Incomplete information to relatives Unrealistic expectations Pre-operative liaison: Formal pre-operative liaison established Aim to promote communication among seniors from Surgery, Anesthesia and ICU.

Protocols and guidelines New inter-departmental protocols and guideline Workflow on emergency interventional radiology procedure Gastrointestinal bleeding protocol Logistics for Pok Oi Hospital patients with acute surgical problem who may benefit from Intensive Care New protocols under recent development Sepsis bundle

Inter-departmental education Inter-departmental education program Advances in management of abdominal trauma and recent evidence on upper GI bleeding Bleed or clot? Current evidence on thromboembolism prophylaxis in the critically ill Traumatic lung injury: Myth and facts of chest drain, extended FAST, pain control Medical and surgical management of abdominal compartment syndrome Rational use of antibiotics, fluid and inotropes in managing urosepsis Perioperative cardiovascular assessment and management Changing to case based interactive sessions for better staff engagement SQSC bulletin to be published in Q&S website

Bridge between frontline and management Clinical problems/ message pass to top management One page summary to CCGC members

Conclusion

We are nowhere near success yet

THANK YOU