the journey to ariadne labs - boston...
TRANSCRIPT
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?
53