Safe Surgery 2015: South Carolina Presentation - Surgeons

[ Insert Implementation Team Member Names][ Insert Hospital Name]

Insert Your Hospital’s Logo Here

Our Hospital’s Implementation Team

[insert picture of your checklist implementation team]

Could This Happen Here?

The Case• 45 y.o. at high risk for breast cancer.

• Elective bilateral total mastectomies.

• Patient wants immediate reconstruction by plastic surgeon.

• General surgeon does mastectomy.

• Preference card is lost so instrument set not standard.

• Very small room.

• Scrub tech leaves because of family emergency.

• Circulator becomes scrub nurse.

More Facts

• Circulating nurse is now covering two OR’s.

• Plastic surgeon comes into room “early”.

• Wants to begin reconstruction before general surgeons is finished.

• Plastic surgeon “disruptive” saying procedure going “too slow”.

• General surgeon insists on completing mastectomies first.

What Happened Here

• Both breast specimens were lost.• Surgeons had never worked together before

and did not talk before procedure.• No “plan” for how surgery was to take place.• Nursing staff very stressed by surgeons and

level of workload.• Complete system breakdown in processing

specimens.

What Could Have Helped?• Discussion among the surgical team, where the

following things were discussed prior to skin incision:– Surgeon shares the operative plan where s/he

discusses anything that the team should be aware of.– Team discusses the equipment that is needed for the

case.

• Discussion at the end of the case where surgical teams confirms specimen labeling.

Does anybody want to share something that has happened to

them?

Safe Surgery 2015: South Carolina• To use of the South Carolina Surgical Safety Checklist

in every operating room for every patient in our state.• To customize the checklist for our hospital’s unique

needs.• To be part of a larger goal in partnership with the

South Carolina Hospital Association and Safe Surgery 2015 [Directed by Dr. Atul Gawande at the Harvard School of Public Health].

• Our state will become the model for improving surgical safety throughout the United States.

What is the Evidence?Type of implementation Scope of implementation Impact of

implementation

WHO Surgical Safety Checklist in OR

8 diverse global hospitals • In-hospital mortality rate1: 1.5% 0.8%

• Post-op complication rate1: 11.0% 7.0%

Team training and use of briefing/ debriefing/checklists in OR

74 VA hospitals 18% decline in annual rate of mortality vs. 7% decline

in control group of hospitals

Comprehensive set of surgery-related checklists in hospital

including during surgery6 'high-quality' Dutch

hospitals

• In-hospital mortality rate: 1.5% 0.8%

• Post-op complication rate: 15.4% 10.6%

1. For 4 pilot sites located in developed countries (USA, Canada, UK, New Zealand), results were a decline in the in-hospital mortality rate from 0.9% to 0.6% and a statistically significant decline in post-op complication rate from 10.3% to 7.1%Source: Haynes, AB, et al, N Engl J Med 360:491-9, 29 Jan 2009; de Vries, EN, et al,N Engl J Med 363:1928-37, 11 Nov 2010; Neily, J, et al, J Amer Med Assn 304:1693-1710, 20 Oct 2010; discussions with Safe Surgery Saves Lives team members

Virginia Mason Hospital, Seattle

• In order for the Checklist to work well it has to be used “right”.

• Improving communication between all members of the OR team is critical to successful implementation.

2010 Annual Meeting of the American Society Anesthesiologists

South Carolina Checklist Template

Our Hospital’s Checklist

• [Insert your hospitals checklist]

How Did We Customize Our Checklist?

• Summarize items that you customized for your hospital.

Don’t We Already Do All of This?

• It is more than the time out and our usual safety checks.

• This is our chance to build on the time out and make it contribute significantly to every case.

• Encouraging a conversation at the beginning and end of surgery to improve communication.

• Providing structure and consistency so that every patient gets what they need every time.

Show Checklist Demonstration Video

• [Insert your hospital’s demonstration video or another video that you would like to show]

• If you do not have a video many hospitals have role-played using the checklist.

We are very good at what we do….We can be even BETTER

Makary et al., J Am Coll Surg 2006; 202: 746-52Makary et al., J Am Coll Surg 2006; 202: 746-52

We Are Not as Good as We Think

How Can the Checklist Help Us Be Better?

• It makes sure that we do the things that our surgical patients need every time.

• It improves communication, teamwork and the culture of safety in our hospital.

• Can make surgical teams more efficient – It has been known to save time.

Physician Acceptance is the Critical Factor in Successful and

Meaningful Use of the Checklist

HOW YOU ACT DURING THE TIME OUT/CHECKLIST MATTERS

• The Team is looking to you for leadership.• You are setting the tone for the rest of the

operation.• Others will follow your patterns of

communication.• This is an opportunity to make your plan clear,

answer questions, demonstrate openness and professionalism.

How Do We Feel in the OR

• Stressed• Focused• “It’s time to do the CHECKLIST”• I don’t want to do it – I never did this before –

it makes me feel weird• I am already safe - I don’t need to do it • Maybe the surgeon in the next room needs it

The “Scrub Sink Trance”

SURGEONS CAN MAKE A DIFFERENCE

• It is our responsibility to work to improve the safety and outcomes of our patients.

• We are not powerless to make change.• We are part of a surgical team and often in

the position of leading that team – that is a privilege and an opportunity to make a difference.

Teamwork

• Communication• Coordination• Team performance valued over individual

performance• Wise use of resources• Leadership

What Can You Do?

• Activate people by using their names.• Set the Tone – Make everyone feel “safe”.• Tell the team what you are going to do.• Encourage team members to speak up.• Stop to Debrief at the end of the case.

This isn’t just about the surgeon and what you need . Everyone is in the room for the patient and all

of the people around you need your help, encouragement and leadership. Surgery is a team

effort and the most effective and safe surgeons recognize that.

Safety is staying back from the Edge

The Checklist can help you do that.

The Checklist Has Already Helped

• [insert examples of what the checklist has caught during the testing or how people feel about using the checklist.]

• Please see Talking to Your Colleagues – Presentation Guide and Tips Document.

Next Steps• Culture of Safety Survey, many of you have already

taken it. If you haven’t, please complete it.• Room-by-room and team-by-team implementation.• We are rolling the checklist out slowly over the

next [insert #] weeks. • Will talk to you and rehearse before we ask you to

use it in your room with a live patient.• After you start using the checklist we will assess

teamwork in the OR using an observation tool.

Our Plan

• [Insert your timeline for checklist implementation].

How Can You Help?

• Work with us on putting the checklist into your rooms.

• Talk to your colleagues about this project.• Give us feedback.

Contact Us with Questions & Feedback

[Insert person to contact, email and phone number]