Quality is Job. 1
In every unit across UF Health, physicians, nurses and other staff members are committing themselves to ensuring patients receive safe, high-quality care. In July, UF Health honored some of these teams for their projects. In this issue of The Q Report, we bring you a snapshot of some of our best practices.
By April Frawley
Surgical Safety Initiative
For patients, there is no greater leap of faith than undergoing a surgical procedure. After slipping into sleep from anesthesia, patients put their health and lives in the hands of total strangers — strangers they trust to help them heal.
In the operating room, where even the tiniest errors can cost lives, communication is not just key; it’s crucial to keeping patients safe. To help improve communication among team members (and patients) in the O.R., a team of UF Health physicians, nurses and experts began working in January to find out what processes were failing and how to fix them.
Their efforts resulted in a new Surgical Safety Initiative, which was established in May and recently earned top honors at the UF Health Quality Retreat’s poster competition in July.
“When I started here, one of the first things I wanted to do was see the quality outcomes to find the risk areas in the O.R.,” said Diane Skorupski, R.N. M.S.N., assistant vice president for perioperative services at UF Health Shands Hospital. “It came up loud and clear that communication was a problem.”
Comprising surgeons, anesthesiologists, nurses, administrators and other staffers, the team devised the Surgical Safety Initiative, which establishes a three-pronged approach to communication in the O.R. The team used the Center for Transforming Healthcare’s Targeted Solutions Tool.
“I think the teamwork was very good, but we knew that there was a part missing,” said Kevin Behrns, M.D., chair of the department of surgery in the UF College of Medicine.
First, the team holds a briefing with the patient before the patient receives anesthesia. The attending surgeon leads the briefing and discusses the plan for surgery, which includes the procedure and things specific to that patient, such as allergies, medication and positioning. Everyone on the team participates.
“It is customized to the patient,” Skorupski said.
“When our physicians round postoperatively, they have found out that patients love the idea of being included in the briefing, in part because the team is introducing themselves to the patient. That has never happened before.”
After this, the team stops again before the first incision to conduct a time-out, a process required by The Joint Commission. This is a chance to ensure they are doing the correct procedure on the correct patient with the correct surgeon before the first incision is made. Afterward, the team conducts a debriefing to discuss how the case went.
“In certain O.R.s with certain teams, communication was outstanding. But in other O.R.s, you just did not know what to expect,” said Laura Davies, M.D., an associate professor of anesthesiology in the College of Medicine. “So one of the real goals of this initiative was
to standardize and make the expectation the same in all O.R.s.”
Audits of the new process have been under way, but positive results are already being seen. The surgical team is closer and all on the same page, Skorupski said.
“It’s really exciting,” she said. “The team is starting to work as a team and not as individuals with their own goals in mind.”
The Access Center
Three years ago, when a patient made a call to a UF Health Physicians outpatient practice, on average it took about 74 seconds before a staff member answered. Sometimes, it took as long as two-and-a-half minutes.
This resulted, on average, in about 164,000 lost calls (12.5 percent), as well as a bevy of patient complaints and difficulty in coordinating appointments across the health system.
To combat this, UF Health Physicians decided to establish one patient access center, where all calls would be taken in one centralized location by a team of people whose sole job was to communicate with patients.
“The goal was to have a better solution for our patients and our physicians and provide a much more patient-centered process,” said Kelly Kerr, M.B.A., UF Health Physicians senior director.
UF Health Physicians began phasing in the new Access Center, practice by practice, in 2011. In Fiscal Year 2013, the average time to answer a call was down to 29 seconds and only 4.5 percent of calls were lost. Now, 80 percent of calls to UF Health Physicians practices are handled by the Access Center.
Led by Kerr, the team was recognized for its efforts in the poster competition at the Quality Retreat.
“It’s still a work in progress,” Kerr said.
“We have taken over 3 million calls since we have been live. We try very hard to do what is right for the patient.”
The Association for Graduate Medical Education has mandated that patient safety and quality education be woven into residency training programs. Leaders within the UF College of Medicine’s Internal Medicine Residency Program recognized they needed to do something to provide formal training in quality to the program’s 96 residents.
“We did a needs-assessment with our residency program to see how much training residents had.
We checked their attitudes and knowledge, and we found that most of them had not had any formal training,” said Nila Radhakrishnan, M.D., an assistant professor of medicine in the UF College of Medicine. “People are realizing we need to train future leaders in this. Every physician will be involved in some sort of quality initiative in the future.”
To change this, the department established a new quality curriculum for residents, which was recently honored during the Quality Retreat.
As part of the curriculum, the residents participate in a monthly morning report to analyze cases and to identify systems issues that need improvement. The residents also participate in two four-hour workshops focused on quality and patient safety. They attend noon conferences where speakers are invited to discuss quality. This year, the residents also are working on a longitudinal project focused on improving discharges from the hospital.
“Ultimately, our goal is to have every resident involved in some sort of quality project in the institution,” Radhakrishnan said.
To view the posters from the Quality Retreat, visit intranet.ahc.ufl.edu/ForwardTogether/qualitycenter/QualityRetreat.