The Journey To Ariadne Labs Bill Berry, MD, MPH

Chief Medical Officer

Principle Research Scientist

A Little History

• Flight Controls FREE & CORRECT

The Problem

The 3 Central Problems in Surgical Safety Throughout the World

• Unrecognized as public health issue

• Lack of data on surgery and outcomes

• We know what to do, but we don’t do it consistently

Global Annual Procedure Rates

The Safe Surgery Saves Lives

Program

Guiding Principles

• Simple

• Widely applicable

• Measurable

• Addresses serious and avoidable surgical

complications

• Causes no harm

Four Categories for Surgical

Standards:

CONTROL OF

INFECTION AND

CONTAMINATION

ANESTHESIA AND

PATIENT

MONITORING

SURGICAL

OPERATOR

QUALITY

ASSURANCE

London, UK

EURO EMRO

WPRO I

SEARO

AFRO

PAHO I

Amman, Jordan Toronto, Canada

New Delhi, India

Manila, Philippines

Ifakara, Tanzania

WPRO II

Auckland, NZ

PAHO II

Seattle, USA

International Pilot Study

8 Evaluation Sites - Nearly 8,000 Patients

Results – All Sites

Baseline Checklist P value

Cases 3733 3955 -

Death 1.5% 0.8% 0.003

Any Complication 11.0% 7.0% <0.001

SSI 6.2% 3.4% <0.001

Unplanned Reoperation 2.4% 1.8% 0.047

Survey of Attitudes to Checklist Use Among Clinicians at Study Site (n=229)

The checklist was easy to use 78.6%

The checklist improved operating room

safety

79.0%

The checklist took a long time to complete 18.3%

Communication was improved through

use of the checklist

84.3%

The checklist helped prevent errors in the

operating room

78.2%

If I were having an operation, I would want the

checklist to be used.

92.6%

How Does The Checklist Work?

Two Ways

• Assuring critical processes are completed

• Guaranteeing critical conversations take place

Site C

Baseline

(n=524)

Checklist

(n=598)

Abx Given 0-60 Mins

Except Dirty Cases 98.1% 96.9%

Adherence to All Six

Safety Indicators 94.1% 94.2%

SSI 4% 2.0%*

Death 1.0% 0.0%*

Any Complication 11.6% 7.0%*

*p<0.05

What Does It Look Like To Use The Checklist

The Story Of Ariadne Labs

RESEARCH PATHWAY

10. Pull Back

9. Spread

8. Testing

7. Tool / Product Design

6. Convening of Experts

5. Planning

4. White Paper

3. Background Research

2. Idea Fleshed Out

1. Kernel of an Idea

Measurement

HANDOUT 3

This is the Ariadne

Labs destination

Design

Spread

3/16/2015 Retreat Meter_AZ

The Heart Of Ariadne

• Simple

• Critical Moments

• High Leverage

• High Impact

Critical Moments

• Birth

• Surgical Procedures

• End of Life

Challenges Of Standard Academic Research

• Siloed

• Single investigator driven

• Often ending with a publication

• A disconnection between discovery and implementation

The Matrix

Current Projects

• Improving care of mothers and babies in developing countries

• Decreasing caesarian rates

• Helping patients get what they want at the end of life

• Improving primary care globally

• Keep patients safe in the operating room by improving teamwork and communication

AHRQ Safety Program for Ambulatory Surgery

Jeff Durney, MS

Quality Improvement Advisor

How do you spread the checklist in 500+ ambulatory surgery centers

nationwide?

What is an Ambulatory Surgery Center?

• Most are free standing facilities

• Some are attached to a hospital

• Majority are physician owned and operated

• Some are run by management companies

• Most provide multispecialty services

• Wide range of procedures performed

• More procedures are moving to this setting

Program Goals

1. Reduce surgical infection and complication rates within participating ambulatory surgery centers (ASCs)

2. Improve safety culture through improved teamwork and communication achieved through the effective use of:

- Surgical safety checklist

- Proven patient safety practices

The National Program Partners

Partners in ASC

Quality

Program Funding

Program Vitals Duration 12 months with optional 6-month sustainability period

Strategies

Educational webinars

• Infection control and prevention

• Surgical safety checklist implementation

Data collection

• Facility demographic information

• Patient safety culture survey

• Monthly process and outcome measures

Program office hours

Participating Centers*

Cohort 1 - 55

Cohort 2 - 121

Cohort 3 - 73

AAOS Pilot - 12

Cohort 4 – 100

Additional Cohorts Planned

*Goal: Reach 520 Centers in all 50 states including Washington, DC and Puerto Rico

Program Reach

37

Challenges in this Environment

• Limited resources

• Physician ownership

• Same physicians not present every day

• Limited QI/PI capacity

Tremendous variation in all of these areas

Lessons from Cohorts 1 & 2

• Program running on autopilot

• Lack of any direct contact with centers

• No knowledge of local implementation activities

• No follow-up/coaching of implementation teams

• No one holding teams accountable for changes

…and we wonder why nothing changes

Introducing the Quality Improvement Advisor

Why Jeff Durney?

From the Cockpit to Ariadne Labs

Quality Improvement Advisor

• Introduced with Cohort 3

• Goals

– Serve as a coach to centers enrolled in the program

– Connect participants to program resources

– Monitor and encourage local implementation efforts

• Key activities

– Coaching calls

– Learning groups

Coaching Calls

Six calls with each center participating in the program • Initial call

– Relationship building – Readiness assessment

• Follow-up calls – Assess engagement in the program to date – Evaluate implementation activities – Provide coaching on all program content – Collect program feedback

• Over 150 calls completed to date

Learning Groups

• We learned from previous participants that the webinars weren’t enough

• We want to create: – A sense of community – An environment where centers can help each other and

brainstorm to solve problems

• We want to: – Make it easier for centers to get help if they need it – Check-in to assess progress in the program – Learn from one another – Capture feedback

• 10 groups facilitated to date

What have we learned from 150+ phone calls and 10 learning groups?

Initial Impact of the Quality Improvement Advisor

• Coaching Calls – Improved center satisfaction – “a friendly voice bringing a

personal touch” – Increased center engagement – Better center retention in the program – Strengthening implementation capacity through individualized

coaching strategies

• Learning Groups – New ideas shared are being tested in some centers – Networking outside of the groups – Sense of community is developing within the program

The People Side of Change

Why is this work important?

Questions?

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