CUSP for Safe Surgery: The Surgical Unit-Based Safety

Program

March 3 & 5, 2014Sean Berenholtz, MD, MHS, FCCM

Some quick administrative announcements

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• You need to dial into the conference line to hear audio– Dial in Number: 1-800-311-9401– Passcode: 83762

• A copy of these slides can be found on our SUSP recruitment website

• A recording of this webinar will be available on the recruitment website by March 6, 2014.

Learning Objectives

• Identify SUSP program– Project goals and interventions– Participation requirements and timeline

• Describe steps to enroll in SUSP

Why is Your SUSP Work Important?

4http://www.who.int/patientsafety/challenge/safe.surgery/en/

• 1 in 25 people will undergo surgery• 7 million (25%) in-patient surgeries followed

by complication• 1 million (0.5 – 5%) deaths following surgery• 50% of all hospital adverse events are linked

to surgery AND are avoidable

How is SUSP different than SCIP (Surgical Care Improvement Project

Your Team Addresses Local Needs

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• No single SSI prevention bundle– Frontline staff identifies local defects– Fix defects with executive support

• Measure local safety culture using Hospital Survey of Patient Safety (HSOPS)

Questions? Email the SUSP help desk! SUSP@jhmi.edu

SUSP Project Overview

SUSP Project Overview

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• AHRQ funding project– Individual hospitals participate for 18 months years

• Leveraging leaders in field – Armstrong Institute, ACS NSQIP, AHRQ,

University of Pennsylvania, WHO • All hospitals in any state, as well as hospitals

in the District of Columbia and Puerto Rico are encouraged to participate.

Who can join SUSP?

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• Participation in the program is available to any hospital in any state, as well as hospitals in the District of Columbia and Puerto Rico.

• Hospitals may participate through their state hospital association, state patient safety agency, hospital engagement network (HEN) or other convening group.

Questions? Email the SUSP help desk! SUSP@jhmi.edu

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SUSP Enrollment by Coordinating Entity

  Armstrong Institute for Patient Safety & Quality   Hawaii Safer Care SUSP Collaborative

  Arkansas Hospital Association   Iowa Healthcare Collaborative (HEN)  Colorado Hospital Association   Maryland Hospital Association  Connecticut Hospital Association   Michigan Health & Hospital Association (HEN)  Florida Hospital Association   Nevada Health Insight (HEN)  Georgia Hospital Association (HEN)   Tennessee Hospital Association (HEN)  Premier Healthcare Alliance (HEN)   Massachusetts Hospital Association

• Click to edit Master text styles– Second level

• Third level– Fourth level

» Fifth level

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Coordinating Entity Number of Hospitals EnrolledArkansas Hospital Association 11Armstrong Institute 31Colorado Hospital Association 8Connecticut Hospital Association 5Florida Hospital Association 11Georgia Hospital Association 14Hawaii Safer Care SUSP Collaborative 14HealthInsight Nevada 4Iowa Healthcare Collaborative 13Maryland Hospital Association 18Massachusetts Hospital Association 8Michigan Health & Hospital Association 46Premier Healthcare Alliance 8Tennessee Hospital Association 10

Total EnrollmentCohort 1 10Cohort 2 102Cohort 3 47Cohort 4 42Total  201

SUSP Enrollment by Coordinating Entity and Cohort

Our Shared Project Goals

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• To achieve significant reductions in surgical site infection and surgical complication rates

• To achieve significant improvements in safety culture

Questions? Email the SUSP help desk! SUSP@jhmi.edu

13http://www.hopkinsmedicine.org/armstrong_institute

 

How Are We Achieving Our Goals?Comprehensive Unit

based Safety Program (CUSP)

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

Translating Evidence Into

Practice(TRiP)

1. Summarize the evidence

2. Identify local barriers to implementation

3. Measure performance

4. Ensure all patients get the evidence

• Engage• Educate• Execute• Evaluate

Reducing Surgical Site Infections

• Emerging Evidence

• Local Opportunities to Improve

• Collaborative learning

Technical Work Adaptive Work

We’re Building on Previous Successes

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1. N Engl J Med 2006;355:2725-32. 2. BMJ 2010;340:c309. 3. Infect Control Hosp Epidemiol. 2011;32(4): 305-314. 4. www.onthecuspstophai.org

• Michigan Keystone ICU program– Reductions in central line-associated blood stream

infections (CLABSI) 1,2

– Reductions in ventilator-associated pneumonias (VAP) 3

• National On the CUSP: Stop BSI program 4

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Percent of Units with Zero CLABSIs and Achieving Project Goal (<1/1000 CL days)

*Data drawn from Interim Project Report – Figure 5 – Cohorts 1 through 3

www.onthecuspstophai.org

We Focus on Systems, Not Individuals

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• Harm is preventable– Many healthcare acquired infection and complications

are preventable; should be viewed as defect

• Technical and adaptive work – Engaging frontline staff to identify and fix local

opportunities to improve

• Framing as social problem that can be solved– Clinical communities

Questions? Email the SUSP help desk! SUSP@jhmi.edu

17 The Joint Commission, Sentinel Event Data; http://www.jointcommission.org/assets/1/18/Event_Type_Year_1995-2011.pdf;29.

Wrong-patient, Wrong-site, Wrong-procedure Events Reviewed by The Joint Commission

How is SUSP Different?

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• Informed by science

• Led by clinicians and supported by management

• Guided by measures– local and national

Questions? Email the SUSP help desk! SUSP@jhmi.edu

SUSP Interventions

No single SSI prevention bundle

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• Deeper dive into SCIP measures to identify local defects

• Emerging evidence– Abx redosing and weight based dosing – Maintenance of normogylcemia– Mechanical bowel preparation with oral abx – Standardization of skin preparation

• Capitalize on frontline wisdom– CUSP/Staff Safety Assessment

Auditing tools

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• Antibiotic – Selection, dosing, redosing

• Normothermia • Glucose Control• Skin Prep • SSI investigation • Others

Questions? Email the SUSP help desk! SUSP@jhmi.edu

Comprehensive Unit-based Safety Program (CUSP)

1. Educate staff on science of safety

2. Identify defects

3. Assign executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

Questions? Email the SUSP help desk! SUSP@jhmi.edu

Briefings and Debriefings

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1 Arch Surg. 2008;143(11): 1068-1072.2 J Am Coll Surg. 2009;208:1115-1123.3 Jt Comm J Qual Saf. 2009;35(8):391-397.4 N Engl J Med. 2009;360:491-9.

• Reductions in communication breakdowns and OR delays 1

• Reductions in procedure and miscommunication-related disruptions and nursing time spent in core 2

• Improved communication and teamwork, feasible given current workload 3

• Reductions in rate of any complications, SSI and mortality 4

What data will teams need to collect?*

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• Monthly NHSN and/or NSQIP SSI data by surgical specialty area– Numerator and denominator

• Annual teamwork/culture data using the AHRQ Hospital Survey of Patient Safety (HSOPS)

• Will work with CEs to ensure data reporting meets their needs

*If data is already collected/available (ie: ACS NSQIP or NHSN), we will work with your team to import if you desire

Questions? Email the SUSP help desk! SUSP@jhmi.edu

Surgical Site Infection Data Entry: NSQIP

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• Target audience: Coordinating Entities and hospital administrators

• Data transferred directly from NSQIP• Unadjusted data transferred on a monthly

basis• Adjusted data (Odds) transferred every 6

months

Questions? Email the SUSP help desk! SUSP@jhmi.edu

Surgical Site Infection Data Entry: NHSN & Manual Entry

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• Data transfer process – done by the coordinating entities or hospital administrator

• Unadjusted data transferred on a monthly basis

• Adjusted data (SIR) transferred every 6 months

Questions? Email the SUSP help desk! SUSP@jhmi.edu

What do teams need to do?

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– Attend the Cohort 5 kickoff webinar (~2 hours)• Monday, April 28 @ 10AM (EST) OR• Wednesday, April 30 @ 2PM (EST)

– Assemble a multidisciplinary team• Including Preop, OR and Postop staff

– Participate in monthly project webinars• All webinars recorded and archived online

– Participate in monthly coaching calls– Regularly meet as a team to implement

interventions and monitor performance

Questions? Email the SUSP help desk! SUSP@jhmi.edu

Once enrolled, the SUSP website is your go to place for everything!

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• Previously recorded cohort project call webinars

• Manuals• Toolkits•Data portal– Who uses the portal?

• SUSP project leads• HSOPS coordinators• SSI data coordinators• Coordinating Entities

– What’s the portal used for?• Data viewing, summation, sharing• Hospital Survey of Patient Safety

(HSOPS)• Sharing of information

• Talk with other SUSP hospitals on our social network!

armstrongresearch.hopkinsmedicine.org

29Wick et al. Implementation of a Surgical Comprehensive Unit-Based Safety Program to Reduce Surgical Site Infections. J Am Coll Surg. 2012; 215 (2).

CUSP Works in the OR Colorectal NSQIP SSI Rate at Hopkins (Wick 2012)

Why should you be a part of SUSP?

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• Improve patient outcomes – ACS NSQIP comparative feedback

• Platform that links data collection, reporting, and training with social networking to improve communication and sharing

• Finding ‘value’ in our work• Teams own their own data for publication

Questions? Email the SUSP help desk! SUSP@jhmi.edu

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What are current SUSP hospitals saying?

Join us on our journey to improve the safety of our patients!

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How to enroll or recruit hospitals into SUSP• Everything you need is online!

– Download ALL enrollment documents online!

– Complete the team registration form online!

Visit the SUSP recruitment website

Have questions? Email the SUSP help desk! SUSP@jhmi.edu

State hospital associations: Important due dates and deadlines

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• By March 21: Complete the Coordinating Entity Participating Agreement and email to SUSP@jhmi.edu or fax to 410-637-4380.

• Download the Coordinating Entity Project Manual for guidance on kick-starting your recruiting efforts

Everything you need is here: SUSP recruitment websiteHave questions? Email the SUSP help desk!

SUSP@jhmi.edu

Hospitals: Important due dates and deadlines

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• By April 9: Have your hospital leadership complete the Hospital CEO Participating Agreement

• By April 16: Complete three additional forms– Online Project Team Registration Form– Data Use Agreement– Clinical Team Participating Agreement

• Upload copies of these forms when submitting the Online Project Team Registration Form. You can also return the forms to the SUSP help desk at SUSP@jhmi.edu or by fax: 410-637-4380

Everything you need is here: SUSP recruitment websiteHave questions? Email the SUSP help desk!

SUSP@jhmi.edu

Next steps

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• Visit our recruitment website– CEs: begin recruiting hospitals– Independent hospitals: Return all enrollment forms

to SUSP@jhmi.edu no later than April 16.

Have questions? Email the SUSP help desk! SUSP@jhmi.edu

Questions? Email the SUSP help desk! SUSP@jhmi.edu

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SUSP from the CE perspective

Dana Bonistalli Project Manager, Quality Policy & AdvocacyMaryland Hospital Association

18 hospitals enrolled and engaged in SUSP!