Scaling Safety: The South Carolina Surgical Safety Checklist Experience.

Proven patient safety solutions such as the World Health Organization's Surgical Safety Checklist are challenging to implement at scale. A voluntary initiative was launched in South Carolina hospitals in 2010 to encourage use of the checklist in all operating rooms. Hospitals that reported completing implementation of the checklist in their operating rooms by 2017 had significantly higher levels of CEO and physician participation and engaged more in higher-touch activities such as in-person meetings and teamwork skills trainings than comparison hospitals did. Based on our experience and the participation data collected, we suggest three considerations for hospital, hospital association, state, and national policy makers: Successful programs must be designed to engage all stakeholders (CEOs, physicians, nurses, surgical technologists, and others); offering a variety of program activities-both lower-touch and higher-touch-over the duration of the program allows more hospital and individual participation; and change takes time and resources.

Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.

OBJECTIVE: To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. BACKGROUND: Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program. METHODS: We compared postoperative mortality rates after inpatient surgery in South Carolina utilizing state-wide all-payer discharge claims from 2008 to 2013, linked with state vital statistics, stratifying hospitals on the basis of completion of the checklist program. Changes in risk-adjusted 30-day mortality were compared between hospitals, using propensity score-adjusted difference-in-differences analysis. RESULTS: Fourteen hospitals completed the program by December 2013. Before program launch, there was no difference in mortality trends between the completion cohort and all others (P = 0.33), but postoperative mortality diverged thereafter (P = 0.021). Risk-adjusted 30-day mortality among completers was 3.38% in 2010 and 2.84% in 2013 (P < 0.00001), whereas mortality among other hospitals (n = 44) was 3.50% in 2010 and 3.71% in 2013 (P = 0.3281), reflecting a 22% difference between the groups on difference-in-differences analysis (P = 0.0021). CONCLUSIONS: Despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state. This may indicate that effective large-scale implementation of a team-based surgical safety checklist is feasible.

Determining Barriers and Facilitators Associated With Willingness to Use a Personal Health Information Management System to Support Worksite Wellness Programs.

PURPOSE: To determine the barriers and facilitators associated with willingness to use personal health information management (PHIM) systems to support an existing worksite wellness program (WWP). DESIGN: The study design involved a Web-based survey. SETTING: The study setting was a regional hospital. SUBJECTS: Hospital employees comprised the study subjects. MEASURES: Willingness, barriers, and facilitators associated with PHIM were measured. ANALYSIS: Bivariate logit models were used to model two binary dependent variables. One model predicted the likelihood of believing PHIM systems would positively affect overall health and willingness to use. Another predicted the likelihood of worrying about online security and not believing PHIM systems would benefit health goals. RESULTS: Based on 333 responses, believing PHIM systems would positively affect health was highly associated with willingness to use PHIM systems (p < .01). Those comfortable online were 7.22 times more willing to use PHIM systems. Participants in exercise-based components of WWPs were 3.03 times more likely to be willing to use PHIM systems. Those who worried about online security were 5.03 times more likely to believe PHIM systems would not help obtain health goals. CONCLUSIONS: Comfort with personal health information online and exercise-based WWP experience was associated with willingness to use PHIM systems. However, nutrition-based WWPs did not have similar effects. Implementation barriers relate to technology anxiety and trust in security, as well as experience with specific WWP activities. Identifying differences between WWP components and addressing technology concerns before implementation of PHIM systems into WWPs may facilitate improved adoption and usage.

Postoperative acute care use after freestanding ambulatory surgery.

BACKGROUND: Surgical procedures in the United States are increasingly performed in the ambulatory setting, including freestanding ambulatory surgery centers (ASCs). However, there is a lack of research and tracking of surgical outcomes in this setting. MATERIALS AND METHODS: We analyzed data from a state all-payer claims database to produce a retrospective cohort study on the rate of acute care use (emergency department [ED] visits and inpatient admissions) within 7 d after operations performed in freestanding ASCs in South Carolina. Two-level reliability-adjusted generalized linear mixed models accounting for random facility-level effects were used to adjust for patient-level and facility-level characteristics. RESULTS: A total of 1,328,708 procedures were performed in 86 freestanding ASCs in South Carolina from 2006-2013. The overall rate of postoperative acute care per 1000 procedures within 7 d was 17.3 (95% confidence interval [CI], 15.3-19.5). Patient characteristics associated with the highest postoperative acute care use within 7 d included Medicaid insurance (adjusted odds ratio [aOR], 1.79; 95% CI, 1.70-1.90), lowest median household income (aOR, 1.36; 95% CI, 1.30-1.43), and preoperative Charlson Comorbidity Index (CCI) score 3+ (aOR, 4.14; 95% CI, 3.95-4.34). Total charges for postoperative ED visits (n = 14,682) and inpatient admissions (n = 8945) within 7 d were approximately $51.4 and $361.1 million, respectively from 2006-2013. CONCLUSIONS: Acute care use within 7 d was commonly ≥10 per 1000 procedures performed in freestanding ASCs in South Carolina. These measures may be targets for quality and cost improvement and innovation. Patients at risk for acute care utilization may benefit from improvements in postoperative follow-up after procedures in ASCs.

Priming professionals for a complex communication environment: Findings from a pilot study.

Factors such as time pressure, distractions, and profession-specific jargon can contribute to poor communication in complex working environments such as healthcare. Technical solutions are often sought to improve patient care when simple improvements in communication would suffice. This article describes an icebreaker activity, an interprofessional game, aimed to prime and engage experienced healthcare professionals on the topic of communication, specifically related to care transitions. By using unexpected content from veterinary care, cycling messages rapidly, and by adding distractors, we were successful in creating openness to considering communication needs in new ways. Participants completed an evaluation following this intervention. It was found that the activity was effective at raising awareness of communication problems and the activity caused participants to view care transitions communications in new ways. In particular, it was reported that this activity illustrated opportunities for communication improvement at multiple levels including peer-to-peer and with patients. This interprofessional activity can illustrate communication barriers, both within and beyond healthcare, in an interactive and engaging manner.

Prioritization strategies for patient evacuations.

Evacuation from a health care facility is considered last resort, and in the event of a complete evacuation, a standard planning assumption is that all patients will be evacuated. A literature review of the suggested prioritization strategies for evacuation planning-as well as the transportation priorities used in actual facility evacuations-shows a lack of consensus about whether critical or non-critical care patients should be transferred first. In addition, it is implied that these policies are "greedy" in that one patient group is given priority, and patients from that group are chosen to be completely evacuated before any patients are evacuated from the other group. The purpose of this paper is to present a dynamic programming model for emergency patient evacuations and show that a greedy, "all-or-nothing" policy is not always optimal as well as discuss insights of the resulting optimal prioritization strategies for unit- or floor-level evacuations.

The use of a mobile application to track process workflow in perioperative services.

This article discusses the data collection tool developed to investigate how patient flow is affected by the delivery of different types of care within Perioperative Services. To better understand the Perioperative Services processes, this study tracked staff members as they perform their activities. A challenging aspect of documenting the processes observed while tracking the Perioperative Services staff is to record the specific times and order in which the activities took place. The Perioperative Services is a fast-paced, dynamic environment where the staff members often perform multiple tasks that may also be interrupted, and each staff member may perform these tasks in their own sequence. To meet the needs of accurate data gathering, an iPhone/iPod Touch application was developed. It provides several advantages over the traditional paper/pencil method: (1) time stamps are instantaneous and consistent among the data collectors, (2) activities are entered via swipe-and-click capability, (3) multiple active tasks and interruptions can be tracked, and (4) collected data can be output to Microsoft Excel or Access for analysis. The "app" has proven to be useful in capturing data for our study. This technology can be customized and applied to similar settings at other hospitals.