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THE SAFE SURGERY CHECKLIST….
MORE THAN JUST A GOOD CATCH
April 8, 2016
Welcome! Gina Peck
Project Coordinator/Technical Host
Carla Williams
Patient Safety Improvement Lead
Please enter any questions in the Q and A box
Slides for today’s
presentation
Today’s call will be recorded
Before we get started
Our Guest Speakers
Leslie Deuchar; a patient advisor on the AHS Surgery Strategic Clinical Network
Stacy Kozak ; the manager of the Surgery Strategic Clinical Network at Alberta Health Services.
Dr. Giuseppe Papia ; a member of the Division of Cardiac and Vascular Surgery and Critical Care Medicine at Sunnybrook HSC and SSCL Intervention Lead at CPSI.
Safe Surgery Checklist
Who Alliance for Patient Safety:
October 2004
Platform to promote Patient Safety Initiatives
Global Patient Safety Challenges
2005 Clean Care is Safer Care
2007 Safe Surgery Saves Lives
Safe Surgery Checklist
Safe Surgery Saves Lives Campaign:
Improve safety of Surgery
across the globe
Reduce the number of
surgical complications
Reduce the number of surgical deaths
No one can stop an idea whose time has come
Voltaire
Haynes et al NEJM January 2009
Mandatory reporting to Ontario Ministry of Health and Long-Term Care April 2010
Required Organizational Practice for Accreditation Canada - January 2011
Rapid dissemination of SSCL
SSCL
• Ninety-two of the 101 study
hospitals provided copies of their
checklist; of these, 90% used an
unmodified World Health
Organization (WHO) or Canadian
Patient Safety Institute checklist.
Educational materials were made
available to hospitals, but no team
training or other support was
provided.
• The key is recognizing that
changing practice is not a technical
problem that can be solved by
ticking off boxes on a checklist but
a social problem of human
behavior and interaction.
Between the healthcare we
have and the healthcare we
could have lies not just a gap,
but a chasm.
Crossing the quality Chasm (IOM)
Les Deuchar, SCN
A Christmas Story Les Deuchar, Patient Advisor Surgery SCN Core Committee
STRIKING GOLD: FINDING VALUE
IN THE SAFE SURGERY
CHECKLIST
Stacy Kozak, Surgery Strategic Clinical Network Manager
THE CHECKLIST PARADOX
The tool – a checklist – is simple The act – a briefing – is less simple
And the social process of
implementing and sustaining briefing practice is complex
The Checklist Manifesto Surgical Checklists,
System Change, Collective Competence and Complexity
Lorelei Lingard, PhD October 2013
Was the checklist used?
Were all team members paying attention? Did all team members feel able to speak up?
Striking Gold!
Surgical Services in Alberta
• ~59 AHS Facilities providing surgical care • ~275,000 cases completed in a Main OR annually • AHS is spending ~$900M on surgery related activities**
* Source: Priorities & Performance Main OR Surgical Activity by Facility 2013/2014 Report.
Includes cases completed in a Main OR which are not considered surgical procedures e.g. endoscopies and cystoscopies.
** Source: AHS Finance. Estimate does not include any physician costs, overhead allocations or hospital stays in Med/Surg units, any
surgical activity that takes place in non-OR clinics, surgery-related imaging or a host of related items.
What are Strategic Clinical Networks?
Collaborative provincial clinical groups
– Hosted by Alberta Health Services
Focused on stages of life, diseases/conditions, in order to:
– Improve patient outcomes and satisfaction
– Increase access and quality
– Build a health care system that is sustainable
2012: Addictions & Mental Health, Bone & Joint, Cancer, Cardiovascular Health & Stroke, Diabetes Obesity & Nutrition, Seniors Health 2013: Critical Care, Emergency, 2014: Respiratory Health 2015: Maternal Newborn Child & Youth 2016: Kidney Health (January 8), Primary Health Care, Population, Public & Aboriginal Health (March)
Alberta’s Journey
Transition to Ops
2010 2011 2012 2013 2014
Sites self reporting
100% compliance
Audited compliance
47% Compliance
93%
2009
SSC piloted
Alberta SSC
approved
2015
Compliance
95%
SURGERY SCN
PROJECT
Alberta’s Journey
SSC Working Group Zone Implementation Leads Measurement and Reporting
Strategy Process for alternate versions Level 1 Policy updated Research on Patients and
Providers
Transition to Ops
2010 2011 2012 2013 2014 2009
SSC piloted
Alberta SSC approved
2015
Focus groups completed Auditor training developed Engagement visits Tableau reporting Submission tracking
SURGERY SCN PROJECT
Patient Focus
PaCER conducted patient focus groups & interviews on behalf of SSCN
Patient involvement is fundamental to success of the SSC (Briefing phase) and to patient satisfaction
Patient Focus
http://www.surgery101.org/podcast/safe-surgery-checklist-1-pre-op-briefing/
2 ways
On the chart of every patient
+ observational audits on a SAMPLE of cases
Measurement
Observational
Audits
Tableau Reports
https://tableau.albertahealthservices.ca/workbooks/SafeSurgeryChecklistSSCDashboard
Changes over time
Good Catches
Examples:
• Patient anaphylactic to Penicillin; given Clindamycin instead
• Consent indicated right inguinal hernia; patient confirmed left inguinal hernia in briefing
• Implants were missing
• Antibiotics were not given pre-op; delayed skin incision until antibiotic administered
Thanks! Contact:
Giuseppe Papia
The Checklist Paradox Assumption:
The checklist can improve culture in the operating
room
“the most common cause of failure in leadership is produced by treating adaptive challenges as if they
were technical problems.”
Ron Heifetz
46
There is inconsistent evidence from observational studies that Safe Surgery Checklist improve mortality and other surgical outcomes
Safe Surgery Checklists improve perceived teamwork and communication in the operating room
Ann Surg 2013
