Grant Opportunities. Providence Hood River Memorial Hospital Oregon Rural Healthcare Quality Network OREGON S EXPERIENCE

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4 Grant Opportunities Providence Hood River Memorial Hospital Oregon Rural Healthcare Quality Network West Valley Hospital Mountain View Hospital Grande Ronde Hospital

5 We speak in metaphors and learn by telling our stories Mary Catherine Bateson

6 Our stories will include How we started & why Training Approach Implementation Successes Learnings

7 Providence Hood River Memorial s Story by Becky Kopecky Joanne Johnson Armanda Mason

8 Suzi Bean Will Bean

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10 Immediate Measurable Goal: Improve care of ED patients with chest pain or Acute MI; Aspirin EKG in 10 minutes STEMI -Thrombolytic in 30 minutes OR PCI in 90 minutes NSTEMI -Decrease transfer times to cardiology

11 Long term Goal: Improve communication through the use of TeamSTEPPS in all departments of the hospital.

12 Target group ED Docs and Nurses Respiratory Therapy Lab Imaging Pharmacy Diversify Four 4 hour sessions - 60 caregivers

13 Case #1- STEMI Brief You want to stop? Huddle with team and patient Please check that dose Debrief Success. We Win!!!! Failed huddle (before TeamSTEPPS) Protocol typo

14 100% Percentage of Patients who received ASA 98% 96% 94% 92% 90% 88% 2008 n= n = 13

15 14 Door to EKG M i n u t e s n= n=13 Mean time to EKG Median time to EKG

16 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percentage of Patients who received Thrombolysis within 30 minutes 2008 n= n=1

17 Time to NSTEMI Transfer Mean time Median time

18 Case #2 Double trouble Brief Divide and conquer Huddle How many choppers? What is happening in OB? Debrief Developing the Family Plan

19 Future Planning Train hospital wide Tailored for group Keep it fresh New caregivers Debrief documentation

20 Grande Ronde Hospital s Story Brandie Manuel Brandie Manuel

21 SITUATION: Master Trainer classes in February, Chest Pain Improvement Focus: Improving the care given to patients who present to the ED with the complaint of chest pain that is suspected to be cardiac in origin. Four trainers Quality/Risk Manager ICU Nurse Manager Respiratory Therapy Manager Emergency Department Nurse Manager

22 BACKGROUND: Parallel Hospital-wide Initiatives TeamSTEPPS training in Omaha Groundwork to implement a system wide Electronic Medical Record (EMR) back home Several Nurse Managers were needed to build the new EMR system & train staff The result? A very smooth go-live week for our new EMR; however, TeamSTEPPS training was postponed by several months.

23 ASSESSMENT: Leadership Briefing for the Board of Trustees Quality Committee & securing full support of TeamSTEPPS Training will start after the successful implementation of the new EMR. Initial Training November 19 th -23 rd ED, Laboratory, Radiology, Respiratory Therapy.

24 ASSESSMENT: Fundamentals courses December 1 st and December 3 rd administration, housekeeping, and admitting. Tag Team - Grande Ronde & Mountain View Master Trainers (weekly meetings course development) Department Manager Course Overview President s Report featured TeamSTEPPS to all staff

25 RECOMMENDATION: Gain the full support of your Leadership team before implementing TeamSTEPPS. Educate your managers who will sell it to front line staff. Timing is CRITICAL! Other projects, such as a new electronic medical record, should be considered when deciding how and when to implement TeamSTEPPS.

26 West Valley Hospital Joyce Wilder, Sharon McVey, Julie Fontanilla

27 Super trainers ED Physician, Nurse Manager, EPIC/Trauma/Case Manager and Director of Nursing Hospital-wide training April 19, 2009 based on need to focus on a Just Culture

28 Culture of Patient Safety Survey % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

29 Training OREGON S 4 hour Fundamental TeamSTEPPS training for clinical staff including ED physicians 2 hour Essentials TeamSTEPPS training for non-clinical staff and community physicians 90% West Valley Staff trained to date Quarterly Training Sessions started for new employees

30 Morning Briefs

31 Patient Safety Issues Lateral red mark through orders Scanning patients and medications No verbal orders 2 patient identifiers on EKGs Include Med-Surg RN in observation report 2 patient identifiers for transports Script for people calling in for medical advice SBAR blanket warmer SBAR pre-packs

32 Huddles Acute Chest Pain Trauma Med-Surg Admissions Surgery ED

33 Process Improvement ED Throughput Rapid Cycle Improvement Model Identify Trigger Points Visual Management Standardize Work Care Team expectations & Accountability

34 2009 Month Averages 02:36 Time in Minutes 02:18 02:01 01:44 01:26 01:09 00:52 00:35 00:17 00:00 LOS: Dispo within 2hrs LOS Arrvl to RM Arrvl to Doc Arrvl to Doc within 30min Month

35 Patients Left Without Being Seen Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

36 Improved Revenue Billing Capture Trauma revenue/ed visit = 13% increase since Trauma Huddle initiated Savings Pre-pack reduction - $25,487 Prevent Lost Revenue $28,000 lost from incorrect admission status

37 What have we learned? OREGON S 2 hour training session too short for material Adaptability/flexibility (rapid cycle improvement model/lean Plan-Do-Check-Act) Expecting and preparing for resistance Focus is ALWAYS patient first and patient safety

38 Date Arrive to Arrive to RN Dr to Arrive to DR PT Rm to DR Rn to DR Dr Assign Rm Asgn Reg. Assign Assign Assign Discharge LOS Wednesday, October 07, :09 0:16 0:24 0:21 0:12 0:10 1:24 1:45 Thursday, October 08, :09 0:23 0:32 0:27 0:17 0:18 1:25 1:53 Friday, October 09, :21 0:33 0:30 0:40 0:18 0:37 1:42 2:22 Saturday, October 10, :45 0:51 0:28 1:03 0:16 0:18 1:47 2:43 Sunday, October 11, :25 0:31 0:45 0:33 0:14 0:12 1:34 2:05 Monday, October 12, :09 0:20 0:58 0:25 0:15 0:17 1:36 1:35 Tuesday, October 13, :32 0:42 0:30 0:41 0:10 1:25 1:40 2:22 0:21 0:31 0:35 0:36 0:15 0:28 1:35 2:06 Team Leader presence needed for change processes ED thru put flow changes Keeping staff on track with change, don t let fall back to the way we have always done it that way Standardize Work Modeling of tools Pilot Study Bedside Triage & Registration

39 What have we learned? Change is constant Success of TeamSTEPPS is because of the focus on Patient Safety and practical strategies for the Health Care Team. This focus provides for success despite internal and external change/crisis

40 Hardwiring Approaches Hospital-wide training all staff including ED physicians and members of medical staff Implementation of Tools Briefs, Huddles, Communication Tools OREGON S Utilization of TeamSTEPPS language huddle, mutual support, situation monitoring etc. TeamSTEPPS MONTHLY NEWSLETTER This contains reminders about tools, their usage and success stories.

41 Hardwiring Approaches OREGON S Posting of Commitment Statements - Each department manager received a list of the tools their employees choose to use. This list is posted in each department. TeamSTEPPS Orientation - WVH has created a hospital orientation that includes the 4-hour TeamSTEPPS training for new hires or those who have not yet been trained. Goal: training offered quarterly. One member of the TeamSTEPPS steering committee will visit each department meeting quarterly to review tools, get success stories and answer questions

42 Hardwiring Approaches Consistent Senior Leadership Commitment Training of new leadership members OREGON S Including expectations of use of TeamSTEPPS strategies in job performance appraisal. Magic Wand Actions Posting of actions and of the corrective measures taken Holding leadership responsible for corrective action.

43 There is no power for change greater than a community discovering what it cares about Margaret Mead Join us in our TeamSTEPPS Campaign!