Implementing an Intervention Project

1
Implementing an Intervention Project
Understanding CHEOs culture

• Piloting Patient Safety Rounds
• Emergency Mental Health Inpatient
• PICU Infant/Toddler Medicine
• Designed by Susan Richardson
• VP Patient Services Allied Health, EXTRA
  Fellowship Candidate
• Presented by Tracy Wrong
• Director, Quality Management wrong_at_cheo.on.ca
• June 30, 2006

2
What we know about Patient Safety

• Reporting systems inadequate
• Limited hospital information on safety problems
• Leadership viewed as Out of Touch
• Staff have knowledge to create safer systems

3
Intervention Project Patient Safety Rounds

• The literature identifies Patient Safety Rounds
  as one approach to address these issues
• Hospital leaders visit units to ask staff about
  their patient safety concerns, and ensure
  follow-up to improve quality of care
• New concept with limited research evidence
  regarding effectiveness
• CAPHC members conducting rounds Calgary
  Childrens, North York General, HHSC, Grey Bruce
• Many American examples, particularly Brigham
  Womens

4
Structure of the Rounds

• Pilot patient safety rounds
• Inpatient Medicine, Mental Health Inpatient,
  PICU and ER
• Participants
• All available staff on unit
• Medical Operations Director
• VP, Chief of Staff and CEO
• Manager of Clinical Risk Patient Safety
• Patient Safety Priority Champion for Units
  Quality Team
• Frequency
• Monthly visits June to November

5
Objectives of Patient Safety Rounds

• Foster open communication among management and
  staff regarding patient safety
• Enhance the patient safety culture within the
  hospital
• Identify clinical risk issues from the
  perspective of staff
• Prioritize and implement actions to improve
  quality and patient safety

6
AHRQ Patient Safety Culture Survey

• Overall perceptions of safety.
• Frequency of events reported.
• Supervisor/manager expectations actions
  promoting patient safety.
• Organizational learning-continuous improvement.
• Teamwork within units.
• Communication openness.

• Feedback communication about error.
• Nonpunitive response to error.
• Staffing.
• Hospital management support for patient safety.
• Teamwork across hospital units.
• Hospital handoffs transitions.

• 51 questions, takes approx 10 minute to complete
• Translation to French approved for the Ottawa
  Hospital
• http//www.ahrq.gov/qual/hospculture/index.html
• Pre and Post surveys planned

7
Rounds Process

• Pilot teams consulted before Rounds started
• VP of Area, Medical Operations Directors,
  Manager, Clinical Risk and Patient Safety and
  team safety champion
• Walk through or group meeting in room on unit
• Includes day and evening shifts
• Specific questions asked

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Patient Safety RoundsQuestions

• Tell me about your concerns from a patient safety
  perspective?
• What recommendations would you make to address
  these safety issues?
• Describe any personal practices you use to ensure
  safe patient care?

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Timeliness is Key
10
Topics Raised

• Classified using Vincents Framework for
  analysing risk and safety in clinical medicine
  (BMJ 19983161154-7)
• Institutional Context
• Organizational Management Factors
• Work Environment
• Team Factors
• Individual (staff) Factors
• Task Factors
• Patient Characteristics

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STAT Team Meetings

• Safety Topic Action Teams
• Review detailed list to prioritize items for
  action
• Top 2 priorities decided
• Just Do Its identified
• Accountability assigned
• Timelines for action estimated
• List to be posted for staff, reviewed before next
  Rounds to assess completion rate

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Learnings from Rounds so far

• Very well received by staff
• Staff are watching for results
• Enormously resource intensive
• Walk Throughs work better than sit down rounds
• Variety of long standing issues and just do its
• The proof will not be in the pudding but in the
  action that results