Surgical Checklist: Debriefing andSurgical Checklist: Debriefing and Tracking

Madigan Army Medical CenterMadigan Army Medical Center

LTC Andrew FosterStaff Anesthesiologist

Agendag

• Review the evolution of our Debrief Process

• Introduce Madigan’s TeamSTEPPSBriefing Tool and Surgical Time-Out g gChecklist

• Review how data generated by the DebriefReview how data generated by the Debrief is then communicated and tracked electronically

2

electronically

Command Directive

• Safety is top priority• Compliance with new regulations is non-p g

negotiable• OR Personnel will attend and implement aOR Personnel will attend and implement a

pre-surgical briefing (TeamSTEPPS)in addition to following all components ofaddition to following all components of MEDCOM Reg 40-54 (Universal Protocol

3

MEDCOM Universal Protocol Regulation 40-54Regulation 40-54

4

Briefing/Debriefing Toolg g

Dept/Div Vision

5

MEDCOM Form 741Procedural Area Time OutProcedural Area Time-Out

6

The Debrief

7

The Dilemma

• How do you capture all of the data included in the Debrief?

• How do you communicate issues or problems identified?p

• How do you track your issues over time so that problem areas can be identified in athat problem areas can be identified in a data driven manner?

8

Electronic Debrief Form

• Desktop icon on all workstations in the OR• All relevant facts gathered during the g g

debrief is captured on this form• Forms are stored on a server so that theForms are stored on a server, so that the

data is all in one central place and accessible at all timesaccessible at all times

• Thus far we have generated over 12000 Debrief FormsDebrief Forms

9

Electronic Debrief Form via Microsoft SharepointSharepoint

10

So, we get the data..how do we track itwe track it

• Our Utilization Management Nurse reviews all Debrief Forms from the previous day and identifies those that have issues

• Issues are then placed into a Debrief pTracker, which is the tool that allows us to follow trends and communicate with those responsible for ensuring loop closure.

11

12

Assigned Personnel Receive an Instant Outlook Messagean Instant Outlook Message

13

What did our data show?

• We were scheduling cases better over time as made that a priority

• We made a concerted effort to address our equipment problems, and saw a drop in q p p , pthose issues

• Compliance with inputting debrief formsCompliance with inputting debrief forms improved over time

• Reduction in delays• Reduction in delays14

Cases Scheduled AppropriatelyAppropriately

Increased from 94.3% to 98.6%

80%

90%

100%

50%

60%

70%

80%

20%

30%

40%

50%NoYes

0%

10%

20%

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Marp y g p

2010 2011

Issue Tracking - 201060

50

40 CMS

Equipment

Instrumentation

20

30preference card

Scheduling

10

0Apr May Jun Jul Aug Sep Oct Nov Dec

OR CASES (Main OR) / DEBRIEF FORMS 2010DEBRIEF FORMS 2010

Month (2010) # # Debriefs  %   Debriefs # Trackers ( )OR Cases Received Completed Generated

April 889 695 78 222May 787 592 75 172June 839 622 74 174Jul 767 545 71 138Aug 861 624 72 166Sep 821 624 76 200Oct 788 717 91 168Oct 788 717 91 168Nov 817 730 89 134Dec 740 688 93 102

Delay Reduction 2010y

18

Q ti ?Questions?