Summary of our Meeting “Do changes introduced in your practice go nowhere, are bogged down by negativism, distractions, disinterest, or even active resistance?.“

Summary of our Meeting“Do changes introduced in your practice go nowhere, are bogged down by negativism,

distractions, disinterest, or even active resistance?.“ JOP. 2010;6(5):257-9.

The “Bringing It Home” Challenge

Jeff Riley, Mayo Clinic, Rochester MN USA

“Bringing It Home”

Disclosure:I have advised, or managed grants to or clinical trials at Mayo Clinic in the areas of simulation and perfusion technology with the following groups:

Sorin USA Specialty CareMedtronic Maquet Getinge GroupGlobal Blood Resources Terumo Cardiovascular

• Simulation workshop feedback report

• What can we take home?

• How have participants experienced this meeting?

• Goal setting for 2011 and beyond

Two Objectives

1. Review simulation workshop feedback

2. List potential portable ideas

Having experienced the content of this meeting, I would still register for the meeting again.

1 2

0%0%

1. Yes

2. No

Sim Workshop vs. In Situ SimDelegates reported a format preference

Favorite Simulation Workstation

7.40%

25.90%

18.50%22.20%

22.20%3.70%

Checklist completion Power/battery failure

Aortic cannulation Vacuum assist

Oxygenator failure Simulation pedagogy

0%33.30%

22.20%22.20%

16.70%5.60%

Checklist completion Power/battery failure

Aortic cannulation Vacuum assist

Oxygenator failure Simulation pedagogy

Thursday Friday

n = 9 - 28 n = 6 - 24

Power/Battery Failure WorkstationThursday Friday

0%0%

54.60%

45.40%

The station was not very useful to my practic...

The station was interesting, we might use it ...

We will use some of what we learned at the st...

Very useful: We will emulate the station in o...

0% 10%

30%60%

The station was not very useful to my practic...

The station was interesting, we might use it ...

We will use some of what we learned at the st...

Very useful: We will emulate the station in o...

n = 11 n = 9

Vacuum Assist Workstation

Thursday Friday

33.30%

0%33.30%

33.30%

The station was not very useful to my practic...

The station was interesting, we might use it ...

We will use some of what we learned at the st...

Very useful: We will emulate the station in o...

0%0%33.30%

66.70%

The station was not very useful to my practic...

The station was interesting, we might use it ...

We will use some of what we learned at the st...

Very useful: We will emulate the station in o...

n = 12 n = 9

Preference for Workshop vs. Individual In Situ Sim

Thursday Friday

10.70%

21.40%

39.30%

28.60%

Not as useful to me as an individual

Somewhat more useful to me

Is more useful to me

I prefer the workshop model

68.40%

21%

5.30% 5.30%

The workshop model is is preferable

The workshop model is okay

Might have gained more from the individual ex...

Would prefer the individual simulation statio...

n = 28 n = 20

Are AmSECT and the ICEBP headed in the right direction with simulation?

Thursday Friday

0% 10%0%

5%

85%

I do not know w hat AmSECT is doing

No – AmSECT is not moving fast enough

No – AmSECT should not spend time and energy ...

Developing simulation for perfusion is anothe...

Yes – keep going

3.60% 7.10% 0%

3.60%

85.70%

I do not know w hat AmSECT is doingNo – AmSECT is not moving fast enoughNo – AmSECT should not spend time and energy ...Developing simulation for perfusion is anothe...Yes – keep going

n = 28 n = 20

Notes from the Sim Workshop Debrief

• valued the team sharing workshop aspects versus the promise of an individual In Situ simulation experience

• generally reported that the workshop station content and activities were transferable to home

• expressed concern regarding cost and equipment issues with a national re-certification effort for practicing perfusionists

Delegates:

55%

45%

Yes No

Like our anesthesiology colleagues, perfusionists should have to complete simulation-based educational activities as part of their re-certification requirements.

n = 20

Versus In Situ simulation individual rooms and the workshop format, what do you recommend?

66.70%

33.30%0%

Repeat workshop format Combination of formats

Individual experiences only n = 21

How have delegates experienced the meeting?

• What can you take home with you?– Ideas for action

• Potential pay-off for idea at home• Ease of adoption for the idea

• Dimensions for reviewing meeting content – Learning – Follow-up – Accountability

Categories of potential action items to take home

1. Perfusion science literature

2. Track your clinical results and outcomes

3. Use an error-reduction program to improve patient safety

4. Make clinical practice changes

5. Author evidence-based clinical procedure guidelines

6. Leadership

Perfusion Science Literature

1. Read ICEBP Newsletter

2. Start journal club

3. Start case report club; write a case report

4. Automatic literature review via auto notification of article keywords (PubMed)

5. Access document library of articles free of copyright constraints

6. Design and execute a research project for your team

7. Perform a meta-analysis regarding a specific hypothesis

D I F

F I C

U L

T Y

Regarding the actions for change at home related to the perfusion science literature:

1 2 3 4

0% 0%0%0%

1. We’ve got this one figured out

2. Useful ideas that I will take home and work on

3. Have thought about doing some of these

4. Interesting ideas, but not for us

Track your clinical results and outcomes

1. Evaluate your practice through the use of local databases

2. Be involved in / contribute to your STS database

3. Contribute to a perfusion registry

4. Start a quality indicator tracking program; collect, analyze, communicate

5. Do additional work at the end of a case to collect quality indicator parameter results

6. Create indicator run charts for at least two parameters for each patient

7. Share surgeon-specific and perfusionist-specific performance data: Use a data wall

D I F

F I C

U L

T Y

Regarding the actions for change at home related to track your clinical results and outcomes:

1 2 3 4

0% 0%0%0%

1. We’ve got this one figured out

2. Useful ideas that I will take home and work on

3. Have thought about doing some of these

4. Interesting ideas, but not for us

Use an error-reduction program to improve patient safety1. Start error (variance) reporting in your perfusion

practice

2. Submit your clinical errors / near misses to a benchmarking database

Regarding the actions for change at home related to use an error-reduction program to improve patient safety:

1 2 3 4

0% 0%0%0%

1. We’ve got this one figured out

2. Useful ideas that I will take home and work on

3. Have thought about doing some of these

4. Interesting ideas, but not for us

Make clinical practice changes

1. Volunteer / participate in your institutional transfusion committee

2. Create a multi-disciplinary blood management team to limit / eliminate allogeneic blood usage

3. Use more ultrafiltration, high level of evidence Decrease your prime volume; tailor ECC volumes to females

4. Autologous priming – highest level of evidence, embrace, do not make it optional

5. Allow hemodilution, tolerate lower Hct nadir to minimize blood usage while avoiding detrimental anemia

6. Expand use of platelet concentrate / gel services

7. Follow patients into ICU to collect data and interview bedside RNs

D I F

F I C

U L

T Y

Regarding the actions for change at home related to make clinical practice changes:

1 2 3 4

0% 0%0%0%

1. We’ve got this one figured out

2. Useful ideas that I will take home and work on

3. Have thought about doing some of these

4. Interesting ideas, but not for us

Author evidence-based clinical guidelines1. Evaluate your patient’s preoperative risk scores

2. Flow charting of processes, use analysis and action planning for process improvement

3. Write your first evidence-based, consensus clinical procedure guideline

4. Create a library of clinical procedure guidelines to share

5. Relate quality indicator results to clinical procedure guidelines

6. Create international clearing house for E-B CPGs

D I F

F I C

U L

T Y

Regarding the actions for change at home related to author evidence-based clinical guidelines:

1 2 3 4

0% 0%0%0%

1. We’ve got this one figured out

2. Useful ideas that I will take home and work on

3. Have thought about doing some of these

4. Interesting ideas, but not for us

Leadership1. Get involved in ICEBP group – perfusionists improving

perfusion

2. Schedule regular perfusion team meetings

3. Select team champions for specific team duties

4. Build an extended support team for your perfusion service

5. Schedule regular meetings with administration

6. Expand the paradigm of what a CCP is at your facility

7. Look for opportunities to take on more responsibility: “Let me help you”

Regarding the actions for change at home related to leadership:

1 2 3 4

0% 0%0%0%

1. We’ve got this one figured out

2. Useful ideas that I will take home and work on

3. Have thought about doing some of these

4. Interesting ideas, but not for us

Which of the action item categories will you find the easiest to implement?

1 2 3 4 5 6

0% 0% 0%0%0%0%

1. Perfusion science literature

2. Track your clinical results and outcomes

3. Use an error-reduction program to improve patient safety

4. Make clinical practice changes

5. Author evidence-based clinical procedure guidelines

6. Leadership

Which of the action item categories will you find the most difficult to implement?

1 2 3 4 5 6

0% 0% 0%0%0%0%

1. Perfusion science literature

2. Track your clinical results and outcomes

3. Use an error-reduction program to improve patient safety

4. Make clinical practice changes

5. Author evidence-based clinical procedure guidelines

6. Leadership

The “Bringing it Home” Challenge

1. Go home

2. Meet with your team

3. Pick one of the action items from the lists

4. Research your choice

5. Start doing it

6. En route evaluation at two months

7. En route report to this audience via Internet

What is your reaction to the “Bringing it Home” challenge?

1 2 3 4

0% 0%0%0%

1. Steering committee is living a dream world

2. Interesting proposal but probably won’t happen

3. My team will start something but probably won’t have anything to report

4. My team is all in and will click in with a report

Thank you!

See you in a few months