DRAFT – final pending AHRQ approval Join SUSP Affinity Groups! Learn from experts and other SUSP hospital teams who are working on what you’re working on Early recovery protocol (ERP) Preop care coordinati on SCIP measures Environmen tal management Pain management, fluid management, postop mobility Glucose control, bowel prep, oral antibiotics Antibiotic prophylaxis, normothermia, skin prep OR traffic, sterile technique, surface contamination Traci Hedrick, MD University of Virginia Melanie Morris, MD University of Alabama Skandan Shanmugan, MD University of Pennsylvania Mariana Pehar Johns Hopkins Hospital Coaching calls every other Quarterly Coaching Calls Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th !
Join SUSP Affinity Groups! Learn from experts and other SUSP hospital teams who are working on what you’re working on . Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th ! . Thomas Varghese Jr. MD, MS, FACS. - PowerPoint PPT Presentation
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DRAFT – final pending AHRQ approval
Join SUSP Affinity Groups!Learn from experts and other SUSP hospital teams who are working on what you’re working on
• Identify and evaluate evidence-based practices to optimize the health of patients prior to surgery
• Outline key factors in pre-surgical care that can improve post-operative outcomes
• Apply quality improvement tools to implement best practices toward optimizing patient health
Funding
• Agency for Healthcare Research and Quality• Life Sciences Discovery Fund• Nestle HealthCare Nutrition• UW Patient Safety Innovation Program• UW Department of Surgery
Our Shared Project Goals
To achieve significant reductions in surgical site infection and surgical complication rates
To achieve significant improvements in safety culture
Why is Your SUSP Work Important?
1 in 25 people will undergo surgery
7 million (25%) complications follow in-patient surgeries
1 million (0.5 – 5%) deaths follow surgery
50% of all hospital adverse events are linked to surgery AND are avoidable
Problems
Every year there are 210,000 Preventable Deaths• $30 billion per year
J Patient Safety Sept 2013; 9(3): 122-128
Problems
Every year there are 210,000 Preventable Deaths• ½ associated with an operation• $30 billion per year
1 in 4 colon resections readmitted within 90 days• $300 million per year
Soft Tissue Surgical Site Infections• $3 billion in direct costs
J Patient Safety Sept 2013; 9(3): 122-128Wick EC, et al. 2011; 54(12):1475-1479Eappen S JAMA. 2013;309(15):1599-1606
It takes an average of 17 years before new knowledge from randomized clinical trials is incorporated into widespread clinical practice!
JAMA 1999; 282: 1458-1465; Health Professions Education 2003J Am Med Inform 2001; 8(4):398-399N Engl J Med 2003; 348:2635-2645
Healthcare System in Washington State
QI Performance Surveillance
Translation of Research into Practice
Research and Development
• Clinician-led QI using clinical data
• Focus on quality and cost-effectiveness data
• Impacts behavior through:• Benchmarking• Education• Standard orders• Checklists
Why Blood Sugar?• Hypergycemia doubles the risk of SSI
• In some studies 47% of hyperglycemic episodes were in nondiabetics!
• 470 million people worldwide will have prediabetes by 2030
• 35% of US adults older than 20 yrs of age and 50% greater than 65 years had prediabetes in 2005-2008
Latham. Inf Contr Hosp Epidemiol. 2001;22:607Dellinger. Inf Contr Hosp Epidemiol. 2001;22:604Lancet 2012; 2279-22902011 US Department of Health and Human Services
• > 65 years• 1 in 4 will have diabetes• 2 in 4 are prediabetic
2011 US Department of Health and Human Services
Why Blood Sugar?
Why Medications?
• Some medications and herbal remedies increase risk of bleeding• Echinacea, Garlic, Ginkgo, Ginseng, Kava, Saw
Palmetto, St. John’s Wort, Valerian ↑ risk
• Aspirin can be safely continued
Chest 2012; 141:e326S-e350S; JAMA 2008; 300(24):2867-2878; Ann Surg 2012; 255(5):811-819
Why Medications?
• Some medications and herbal remedies increase risk of bleeding• Echinacea, Garlic, Ginkgo, Ginseng, Kava, Saw
Palmetto, St. John’s Wort, Valerian ↑ risk• Aspirin can be safely continued
• Beta-blocker continuation associated with fewer cardiac events and mortality
Chest 2012; 141:e326S-e350S; JAMA 2008; 300(24):2867-2878; Ann Surg 2012; 255(5):811-819; Arch of Surg 2012; 147(5):467-473
Why Nutrition?
• Malnutrition is prevalent in surgical patients• Best determinant of surgical outcome
Why Nutrition?
• Malnutrition is prevalent in surgical patients• Best determinant of surgical outcome
• Modifiable with appropriate intervention• Immunonutrition may improve recovery
SCOAP: Albumin & ComplicationsElective colon/rectal procedures 2011
<2.0 2.0-2.4 2.5-2.9 3.0-3.4 3.5-3.9 4.0+0.0%
3.0%
6.0%
9.0%
12.0%
15.0%
Re-operation Death
Albumin Levels (g/dL)
Adve
rse
Out
com
e Ra
tes
Arginine Depletion
T-Cell Dysfunction
Risk of INFECTION
Surgery and trauma patients are immune suppressed making them more susceptible to infection due to arginine depletion.
Popovich 2006; McClave 2009; Zhu 2010
Arginine Depletion
T-Cell Dysfunction
Risk of INFECTION
Surgery and trauma patients are immune suppressed making them more susceptible to infection due to arginine depletion.
Immune- modulating formulas Arginine + Ω-3 fatty acids + Nucleotides 5 to 7 day regimen, 3 times daily
Popovich 2006; McClave 2009; Zhu 2010
Literature Review• Systematic Review
N=3,43835 studies focused on elective surgeryProcedure types
• Community Engagement• Outreach events• Website content
www.strongforsurgery.org
Publications
OR MANAGER
By Laura Landro
Collaborators
• Washington State Medical Association• Washington State Hospital Association• Washington State Nurses Association• Washington State Academy of Nutrition and Dietetics• Washington Patient Safety Coalition• Washington State Society of Anesthesiologists• Washington St. Chapter – American College of Surgeons• Qualis Health• American Lung Association
Social Media Presence
2014 to date• 2,375 Total Hits• 1,803 Unique
Hits
• 126 “Likes”• Frequency 2-3
posts/week
• Discussion post 1-2/month
www.strongforsurgery.org
Implementation Guide requests 2013: 113 sites, 34 states, 7 countries
• 14.1 K Tweets• 2,678 Followers• 2,495 Following• Frequency
~70/week
@Strong4Surgery@TomVargheseJr
Changing Practice
The SUSP Team
Understands that patient safety culture is LOCAL
Composed of engaged frontline providers who take ownership of patient safety
Includes staff members who have different levels of experience
Tailored to include members based on clinical intervention
SUSP Teams’ Group Processes
Effective Group
Processes
Norms
Role Clarity
Effective Team Communication
Conflict Resolution
Education and
Engagement
Leadership Buy-in and
Support
Site Expectations
• Change team formation and support champion• Commitment through post-implementation• Checklist adoption• Data abstraction and sharing• Stakeholder calls attendance• Feedback for improvement
Site Activities
• Pre-Assessment• Workflow Mapping• Assessment of Resource Needs• Feedback – clinicians and staff• Post-Assessment
For More Information
• Visit the website: http://www.strongforsurgery.org• Review the literature• View our checklists• Request the implementation guide