e1 rapid fire: passing the baton for quality care - t. northway, l. yarske and k. thibault
TRANSCRIPT
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Sustainment of Standardized Cardiac OR
to Intensive Care Unit Transfer of Care
Tracie Northway, RN, MSN, CNCCP(C) & Lisa Yarske, RN, BSN, CNCCP(C)
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Identification of a problem
•Condition of cardiac patients upon receipt was historically unstable
•Cluster/flock care•Chaos•Delays in care•No clear communication•Missed critical information
0
20
40
60
80
100
120
140
160
180
# of
Pat
ient
sSurgical Service
BCCH PICU Surgical Admission Breakdowns (2008)
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Creating change: Take 1
•New additions to CVS team•Questioning of current practice
at BCCH•Review of cardiac program•Team reps to Philadelphia for
review of practices•Team agreed on new approach for admissions•Ideas implemented
http://blog.svconline.com/briefingroom/wp-content/uploads/2008/09/childrens-hospital-of-philadelphia-37.jpg
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Results of Take 1
http://2.bp.blogspot.com
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Take 2: imPROVE with Lean
• Capitalized on region wide Lean improvement process• Appeal of better understanding with prep• 1 week of dedicated collaborative improvement time• Stakeholders wanted change
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What were we trying to improve?
•Decrease barriers (defects in Lean language) to increase clarity within roles for a safe handover between OR & PICU Teams
•Prior to improvement week the following “defects” were observed in cardiac OR to PICU handover
Defects in Cardiac OR to ICU Transfer of care
14
8 7
14 2 1
2
3
5 12
1
3
3
21 2
11
3
3
11
1
3
12
1
2
0
5
10
15
20
25
30
Defect Category
# of
Def
ects
OR Admit #6OR Admit #5OR Admit #4OR Admit #3OR Admit #2OR Admit #1
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RPIW #4 Team & Plan
Team –
Plan for the RPIW #4 week (March 23rd-27th, 2009)1. Determine characteristics of a safe patient handover from OR 4 to PICU 2. Define process, roles & responsibilities (“standard work” in Lean
language) for a safe patient handover3. Create tools to guide & support standard work4. Test standard work tools
PICU RepsAndrea Yuel (RN)Lisa Yarske (CNL)Tracie Northway (Q&SL)
OR #4 RepsBill Cooper (Anaesth Assist)Clayton Reichert (Anaesthetist)Melanie Ganshorn (CRN)Neil Casey (Perfusionist)
External RepsAlecia Robin (imPROVE)Barb Fitzsimmons (VP BCCH)Erin Miller (Executive Assistant Corporate)
Sponsor – Lynn Coolen Program Manager, PICU
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Standard work
•Used past cardiac OR project work, Great Ormond’s Street handover protocol & participants ongoing input to define:–Pre-transfer standard work: •PICU bed preparation•PICU bedspot set-up•Perfusionist’s report & confirmation of PICU admitting team
–Transfer standard work:•Transfer process•Technology transfer process•Handover process
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Support tools
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Support tools
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Support tools (cont’d)
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Measured Outcomes
BCCH PICU & Cardiac OR Pre & Post RPIW Defects per Handover
4.2
2.8
1.5 1.51.2 1.3
0.7
00.3
1.3
0 0 0 00.00.5
1.01.5
2.02.5
3.03.5
4.04.5
Type of Defect
# of
Def
ects
Pre RPIW Average/Handover
Post-Kaizen Average/Handover
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Measured Outcomes
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•Broke down barriers & “sacred cows” between OR & PICU teams
•Developed a better understanding & appreciation for our teams and the work they do
•Determined characteristics of a safe patient handover•Defined standard work for a safe patient handover•Created & tested tools for standard work (Bedside Set-up Visual, Handover Checklist & Interprofessional Handover Protocol)
Sacred
X You actually know what’s going on [with
your patient]!
Quote from PICU CRN after participating in standard work of safe patient handover.
Workshop Summary
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Follow On
•Responsive adjustment of Handover Protocol based on practice changes
•Anecdotal comments support change
•PICU staff have requested change in process for handover with other surgical services teams
http://www.dagami.com/wp-content/uploads/2011/08/big-dog-little-dog.jpg
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Follow On Results: Two Years Post Change
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• Black, J. & Miller, D. (2008). The Toyota Way to Healthcare Excellence: Increase Efficiency and Improve Quality with Lean. Health Administration Press, Chicago
• Catchpole, K., Leval, M., McEwan, A., Pigott, N., Elliott, M., McQuillan, A., MacDonald, C., & Goldman, A. (2007). Patient handover from surgery to intensive care: Using Formula 1 pit-stop and aviation models to improve safety and quality. Pediatric Anaesthesia, 17: pp. 470-478.
• Ohno, Taiichi. (1988). The Toyota Production System: Beyond Large-Scale Production. Portland, Oregon: Productivity Press
References