A Few Notes About This Presentation

1
A Few Notes About This Presentation

• This presentation is designed to be given to a
  group of surgeons.
• We recommend that you hold this type of meeting
  after you have had a chance to have one-on-one
  conversations with some of your colleagues that
  might be skeptical.
• We have provided descriptions and some notes that
  might be helpful to you in the notes section of
  this presentation.
• We recommend that surgeon leader of the
  implementation team gives this presentation.

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Insert Your Hospitals Logo Here

• Safe Surgery 2015
• Presentation - Surgeons
• Insert Implementation Team Member Names
• Insert Hospital Name

3
Our Hospitals Implementation Team

• insert picture of your checklist implementation
  team

4
Could This Happen Here?
5
The Case

• 45 year old with breast cancer.
• Elective mastectomy.
• 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.

6
More Facts

• Circulating nurse is now covering two ORs.
• 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 the
  mastectomy first.

7
What Happened Here

• The breast specimen was 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.

8
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.

9
Does anybody want to share something that has
happened to them?
10
Safe Surgery 2015

• To use of the Surgical Safety Checklist in every
  operating room for every patient.
• To customize the checklist for our hospitals
  unique needs.
• To be part of a larger goal in partnership with
  the Safe Surgery 2015 Directed by Dr. Atul
  Gawande at the Harvard School of Public Health
  and HRET.
• Improving surgical safety throughout the United
  States.

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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 surgery 6 'high-quality' Dutch hospitals In-hospital mortality rate 1.5 ? 0.8 Post-op complication rate 15.4 ? 10.6
A Customized Version of the WHO Surgical Safety Checklist Tertiary University Medical Center in the Netherlands Crude mortality decreased from 3.13 ? 2.85. Measured checklist compliance and found that mortality was significantly lower in patients with completed checklists.
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
360491-9, 29 Jan 2009 de Vries, EN, et al,N
Engl J Med 3631928-37, 11 Nov 2010 Neily, J,
et al, J Amer Med Assn 3041693-1710, 20 Oct
2010 van Klei WA et al. Effects of the
Introduction of the WHO Surgical Safety
Checklist on In-Hospital Mortality. Annals of
Surgery. 2012 Jan 1 255(1)44-9.
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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
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Safe Surgery 2015 Checklist Template
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Our Hospitals Checklist

• Insert your hospitals checklist

15
How Did We Customize Our Checklist?

• Summarize items that you customized for your
  hospital.

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Dont 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.

17
Show Checklist Demonstration Video

• Insert your hospitals 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.

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We are very good at what we do.We can be even
BETTER
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We Are Not as Good as We Think
Makary et al., J Am Coll Surg 2006 202 746-52
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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.

21
Physician Acceptance is the Critical Factor in
Successful and Meaningful Use of the Checklist
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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.

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How Do We Feel in the OR

• Stressed
• Focused
• Its time to do the CHECKLIST
• I dont want to do it I never did this before
  it makes me feel weird.
• I am already safe - I dont need to do it
• Maybe the surgeon in the next room needs it

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How Do Anesthesiologists/CRNAs Feel in the OR

• Stressed and focused
• I dont want to do it I never did this before
  it makes me feel weird it messes up the way I
  work
• I am already safe - I dont need to do it
• Maybe the team in the next room needs it
• "Don't these other guys know what they're doing?"
• "Didn't we all just check this stuff? Or did
  they?
• "If everyone had the attention to detail that I
  do, this would not be necessary
• "Don't make me do another G D piece of
  paper!!
• "If it doesn't take long, and we have to, well
  OK
• "This really doesn't take that long, and if it
  keeps us all out of courtrooms. . ."

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How Nurses Feel in the OR

• Before going into the OR I need to prepare my
  approach depending on surgeon or team.
• I know when there will be a battle and I need to
  prepare my response.
• Try to stay positive during the surgical case,
  no matter what happens.
• We carry the load to ensure that the safety
  checks are completed.
• I dont want to be the enforcer but sometimes
  need to be for patient safety.
• I am not the right person to convince a surgeon
  who refuses to do this.
• I feel shut down when there is not open
  communication.

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How Do Scrub Techs Feel in the OR

• I am part of the team and am responsible for
  patient safety as much as everyone else.
• I dont want to waste time fighting about this-
  I wish we could just do it!
• I am ready to change my approach, depending on
  who I am working with in the OR.
• The majority of the team will listen and
  participate, but I may need to help remind the
  surgeons to follow policies.
• Willing to back up circulator and to take on
  equal responsibility to ensure that this is
  completed for my patient.
• I think that it is the right thing to do.
• If I were the patient I would want it done for
  me.

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The Scrub Sink Trance
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Reverence for Induction
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Respect for the Counts
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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.

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Teamwork

• Communication
• Coordination
• Team performance valued over individual
  performance
• Wise use of resources
• Leadership

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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.

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This isnt just about one person and what they
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.
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Safety is staying back from the Edge
The Checklist can help you do that.
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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.

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Next Steps

• We are administering a culture survey because we
  want to know you think about the teamwork,
  communication, and safety in our operating rooms.
  Please complete the culture survey.
• Room-by-room and team-by-team implementation.
• We are rolling the checklist out slowly over the
  next insert weeks.
• We 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.

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Our Plan

• Insert your timeline for checklist
  implementation.

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How Can You Help?

• Work with us on putting the checklist into your
  rooms.
• Talk to your colleagues about this project.
• Give us feedback.

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Contact Us with Questions Feedback

• Insert person to contact, email and phone number