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Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair AAOS Orthopaedic Surgery Safety Summit AAOS Patient Safety Committee.

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Presentation on theme: "Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair AAOS Orthopaedic Surgery Safety Summit AAOS Patient Safety Committee."— Presentation transcript:

1 Fall Meeting AAOS Orthopaedic Surgery Safety Update 2012 William J Robb III MD Chair AAOS Orthopaedic Surgery Safety Summit AAOS Patient Safety Committee

2 Disclosure Consultant – Blue Cross Blue Shield Association Consultant – Blue Cross Blue Shield Association TJR - Centers of Distinction Program Consultant (Unpaid) - Smith and Nephew Consultant (Unpaid) - Smith and Nephew Investor – emmi Solutions Investor – emmi Solutions Chair – AAOS Orthopaedic Surgery Safety Summit Chair – AAOS Orthopaedic Surgery Safety Summit Chair – AAOS Patient Safety Committee Chair – AAOS Patient Safety Committee

3 Is there an Orthopaedic Surgery Safety Problem 2012? Media ABC News Report - Maryland 2012 Report on Surgical Errors Report on Surgical Errors CMS - only 14% errors reported in hospitals CMS - only 14% errors reported in hospitals Advised patients ask about checklists Advised patients ask about checklists Report Report SSIs shoulder surgery SSIs shoulder surgery Wrong site pediatric eye surgery Wrong site pediatric eye surgery

4 Is there an Orthopaedic Surgery Safety Problem 2012? HealthGrades >350,000 patient safety errors/year >350,000 patient safety errors/year Cost $9B Cost $9B 1/10 safety errors results deaths 1/10 safety errors results deaths >100,000 surgical error deaths/year >100,000 surgical error deaths/year Top 5% Hospitals – only 43% reduction safety incidents Top 5% Hospitals – only 43% reduction safety incidents Wrong Site Surgery (WSS) rates - 1/20,000 surgeries Wrong Site Surgery (WSS) rates - 1/20,000 surgeries Hospital SSI rates 2-3% Hospital SSI rates 2-3% NO evidence safety/quality improvement NO evidence safety/quality improvement

5 Is there an Orthopaedic Surgery Safety problem 2012? JC Wrong Site/Procedure/Patient Surgery (WSS) Wrong Site/Procedure/Patient Surgery (WSS) Mandatory State –bsed WSS Reporting Mandatory State –bsed WSS Reporting Minnesota (48 - WSS) Minnesota (48 - WSS) Pennsylvania (58 - WSS) Pennsylvania (58 - WSS) 35.4 WSS/wk. in US (estimated) 35.4 WSS/wk. in US (estimated)

6 JC Sentinel Events Data Base Orthopaedic WSS

7 Is there a Orthopaedic Surgery Safety Problem 2012? Hospital Data JC >7 wrong site/side/level/implant/procedure/patient surgeries /day >7 wrong site/side/level/implant/procedure/patient surgeries /day System errors – NOT Surgeon errors System errors – NOT Surgeon errors Most frequent causes: Most frequent causes: inadequate/missing surgical information inadequate/missing surgical information scheduling discrepancies/errors scheduling discrepancies/errors irregularities in pre-op holding process irregularities in pre-op holding process inadequate/absent surgical site marking inadequate/absent surgical site marking poor communication poor communication distractions in OR distractions in OR inadequate/absent OR process/time-out inadequate/absent OR process/time-out Mark Chassin MD, MPP, MPH

8 Is there an Orthopaedic Surgery Safety problem 2012? ABOS Certification/Recertification Data Base – 2011 ABOS Certification/Recertification Data Base – 2011 WSS Rate - 1/30,000 orthopaedic surgeries WSS Rate - 1/30,000 orthopaedic surgeries NO CHANGE NO CHANGE

9 Surgical Safety/Quality/Value Timeline AAOS - Program - (safety) AAOS - Sign Your Site Program - (safety) IOM Report - To Error is Human: Building a Safer Health System – (safety) (44-88,00 deaths in hospitals/year from medical errors) IOM Report – Crossing the Quality Chasm: A New Health System for the 21 st Century (quality) VA National Directive to reduce Risk WSS (safety) JCAHO – Universal Protocol (safety/quality) SCOAP** (safety/quality) voluntary hospital-based surgical safety/quality – Washington voluntary hospital-based surgical safety/quality – Washington

10 Surgical Safety/Quality/Value Timeline SCIP* (quality) mandated national surgical quality standards mandated national surgical quality standards WHO Safe Surgery-Saves Lives (safety/quality) Checklist Manifesto –Atul Gwande MD (safety and quality) Berwick*** CMS Administrator (safety/quality/value) CMS payments - financial penalties for Never Events CMS payments - financial penalties for Never Events CMS/PQRS payments – financial incentives for quality reporting CMS/PQRS payments – financial incentives for quality reporting 2012 – CMS Public Quality Data Reporting Program (safety/quality/value) Hospital SSI Rates Hospital SSI Rates Surgical Re-admission Rates Surgical Re-admission Rates * Surgical Care Outcome Assessment Program – Washington State Hospital Association * Surgical Care Outcome Assessment Program – Washington State Hospital Association ** Surgical Care Improvement Program – US Department of Health and Human Services ** Surgical Care Improvement Program – US Department of Health and Human Services *** Former President and CEO, Institute for Healthcare Improvement (IHI) *** Former President and CEO, Institute for Healthcare Improvement (IHI)

11 Evidence Surgical Safety/Quality/Value Programs are Effective 2006 – Central Line Checklists – Peter Pronovost MD Reduction central line infections - 40% to <1% Reduction central line infections - 40% to <1% 2008 – WHO Safe Surgery - Saves Lives - Atul Gwande MD 50% reduction surgical mortality/complications (multi-nation study) 50% reduction surgical mortality/complications (multi-nation study) 2010 – Surgical Care Outcomes Assessment Program (SCOAP) Universal Protocol (UP) adopted in all Washington ORs Universal Protocol (UP) adopted in all Washington ORs < Complications - appendectomy, colectomy, bariatric surgery < Complications - appendectomy, colectomy, bariatric surgery < Hospital Costs < Hospital Costs

12 Evidence Safety/Quality/Value Programs are Effective 2010 – Northern New England Cardiovascular Disease Study Group Group improved Cardiovascular surgery outcomes - participating medical centers improved Cardiovascular surgery outcomes - participating medical centers 2011 – VA Surgical Safety Program reduced surgical errors 25% reduced surgical errors 25%

13 AAOS Orthopaedic Surgery Safety/Quality Survey 2011 Survey Goals Survey Goals Assess safety/quality in orthopaedics Assess safety/quality in orthopaedics Evaluate differences by: Evaluate differences by: sub-specialty sub-specialty length of practice length of practice practice type practice type Evaluate orthopaedic leadership attitudes regarding safety/quality Evaluate orthopaedic leadership attitudes regarding safety/quality Assess orthopaedic safety practices/culture /errors Assess orthopaedic safety practices/culture /errors Identify opportunities/barriers for change Identify opportunities/barriers for change

14 Survey Participants

15 Participating Practice Types

16 Participating Orthopaedic Sub-Specialties

17 Participant Surgical Settings

18 Results Positive Findings >90% use Universal Protocol (UP) in Hospital ORs >90% use Universal Protocol (UP) in Hospital ORs 82% Believe UP Improves Surgical Safety/Quality 82% Believe UP Improves Surgical Safety/Quality No differences in utilization/understanding UP by: No differences in utilization/understanding UP by: Years in practice Years in practice Sub-specialty Sub-specialty

19 Results Negative Findings Surgical errors reported ALL orthopaedic settings Surgical errors reported ALL orthopaedic settings Most undereducated safety science Most undereducated safety science <50% UP use in surgi-centers - rare in office/procedure rooms <50% UP use in surgi-centers - rare in office/procedure rooms Few surgeon safety leaders/champions Few surgeon safety leaders/champions Younger surgeons < team communication knowledge Younger surgeons < team communication knowledge

20 Model Safe Orthopaedic Surgical Care

21 Historical Orthopaedic Surgery Culture Surgical Processes Highly variable surgical techniques Surgeon specific care plans Surgeon-centric care Data Experience/ Memory driven Limited systematic data collection Communication Top-down surgical hierarchy Limited shared decision making

22 Model Orthopaedic Surgery Culture of Safety Surgical Processes Standardized techniques Reliable evidence/ consensus-based care plans System-centric care Data Systematic data collection and analysis Active data management demonstrating improvement/s Communication Shared authority team model Delegated responsibilities Transparency

23 Definition Safe Orthopaedic Surgical Care Safe surgical care is: Safe surgical care is: surgical care delivered with a highly reliable surgical system surgical care delivered with a highly reliable surgical system designed to reduce, with a goal of eliminating, designed to reduce, with a goal of eliminating, preventable harm/s preventable harm/s continuously monitored through safety data collection continuously monitored through safety data collection effectively integrating interfaces between surgical: effectively integrating interfaces between surgical: patient and family patient and family physicians, surgeons and staff physicians, surgeons and staff suppliers and equipment suppliers and equipment and environments.* and environments.* * Modified from Dev Raheja - Safer Hospital Care

24 Definition Quality Orthopaedic Surgical Care Quality Surgical Care is: Quality Surgical Care is: standardized surgical care based upon standardized surgical care based upon medical evidence and/or medical evidence and/or consensus-based best surgical practices consensus-based best surgical practices continually improved through innovation continually improved through innovation validated through surgical quality data collection and analysis validated through surgical quality data collection and analysis achieving optimal composite surgical outcomes achieving optimal composite surgical outcomes

25 Definition Value Orthopaedic Surgical Care Value in surgical care: Value in surgical care: focused on patient-centered outcomes focused on patient-centered outcomes evaluated continually with surgical benchmarking evaluated continually with surgical benchmarking supported by only essential resources ($$$) supported by only essential resources ($$$) effectively coordinated through the entire surgical care episode* effectively coordinated through the entire surgical care episode* * Modified from Michael Porter – Redefining Healthcare

26 Relationship Safety, Quality and Value Value Optimal Outcomes with ONLY Essential Resources Quality Reliable Care Improvement Systems Safety Organized Error Elimination

27 What is needed to improve Orthopaedic Surgical Safety? Change historical orthopaedic surgical behaviors Change historical orthopaedic surgical behaviors Implement surgical safety science and behaviors into ALL orthopaedic settings Implement surgical safety science and behaviors into ALL orthopaedic settings Shift focus from surgeon to team performance Shift focus from surgeon to team performance Establish sustainable culture of surgical safety Establish sustainable culture of surgical safety Build and maintain orthopaedic safety/quality data bases Build and maintain orthopaedic safety/quality data bases Validate safety programs in orthopaedic settings Validate safety programs in orthopaedic settings Collaboration with other safety stakeholder organizations Collaboration with other safety stakeholder organizations

28 Key Elements Orthopaedic Surgical Safety 6 Cs 6 Cs (1) Communication – effective surgical team communication (1) Communication – effective surgical team communication (2) Consent – accurate timely informed consent (2) Consent – accurate timely informed consent (3) Confirmation – proper surgical site marking/identification (3) Confirmation – proper surgical site marking/identification (4) Checklists – use validated standardized processes (4) Checklists – use validated standardized processes (5) Concentration – focused team without distraction (5) Concentration – focused team without distraction (6) Collection – systematic safety/quality data collection (6) Collection – systematic safety/quality data collection Submitted to CORR 10/2012 – Kuo, Robb

29 AAOS Surgical Safety Program Fall Board Workshop 2011 Fall Board Workshop TeamSTEPPS TeamSTEPPS 80 Hospital/Surgicenter training sites Hospital/Surgicenter training sites Spring Board Workshop 2012 Spring Board Workshop Develop orthopaedic checklists Develop orthopaedic checklists Establish/collaborate orthopaedic safety data bases Establish/collaborate orthopaedic safety data bases Surgical Safety Board Oversight Work Group Surgical Safety Board Oversight Work Group Chair - Dr. Fred Azar Chair - Dr. Fred Azar Orthopaedic Surgery Safety Summit Orthopaedic Surgery Safety Summit Chicago – 2012 Chicago – 2012 Orthopaedic Surgery Sub-Specialty Pilot Programs Orthopaedic Surgery Sub-Specialty Pilot Programs Validate Pilot Safety Programs Validate Pilot Safety Programs

30 Orthopaedic Safety Summit Goals Unify orthopaedics regarding safety Unify orthopaedics regarding safety Reduce errors/ preventable harm/s Reduce errors/ preventable harm/s wrong site/side/level/procedure/implant/patient surgery wrong site/side/level/procedure/implant/patient surgery surgical complications surgical complications readmissions readmissions Establish surgical safety as a specialty priority Establish surgical safety as a specialty priority Improve orthopaedic outcomes Improve orthopaedic outcomes Collaborate with other surgical safety stakeholder organizations Collaborate with other surgical safety stakeholder organizations

31 Participating/Presenting Organizations 1. American College of Surgeons (ACS) 2. Surgical Care Outcomes Assessment Program (SCOAP) 3. Centers for Disease Control and Prevention (CDC) 4. Centers for Medicare and Medicaid Services (CMS) 5. Agency for Healthcare Research and Quality (AHRQ) 6. The Joint Commission (TJC) 7. Ambulatory Surgical Center Association (ASCA) 8. Accreditation Association for Ambulatory Healthcare (AAAH) 9. Association of Operating Room Nurses (AORN) 10. Webster Healthcare Consulting 11. Pascal Metrics

32 Participating Orthopaedic Organizations 1. American Academy of Orthopaedic Surgeons (AAOS) 2. American Association for Hand Surgery (AAHS) 3. American Orthopaedic Foot and Ankle Society (AOFAS) 4. American Association of Hip and Knee Surgery (AAHKS) 5. American Orthopaedic Society for Sports Medicine (AOSSM) 6. American Shoulder and Elbow Society (ASES) 7. American Society for Surgery of the Hand (ASSH) 8. American Spinal Injury Association (ASIA) 9. Arthroscopy Association of North America (AANA) 10. Cervical Spine Research Society (CSRS) 11. Hip Society (HS) 12. Knee Society (KS)

33 Participating Orthopaedic Organizations 13. Limb Lengthening and Reconstruction Society (LLRS) 14. Musculoskeletal Tumor Society (MSTS) 15. North American Spine Society (NASS) 16. Orthopaedic Trauma Association (OTA) 17. Pediatric Orthopaedic Society of North America (POSNA) 18. Scoliosis Research Society (SRS) 19. Society of Military Orthopaedic Surgeons (SMOS) 20. American Academy of Orthopaedic Surgeons (AAOS) Board of Directors (BOD) Board of Specialty Societies (BOS) Board of Councilors (BOC) Council on Research and Quality (CoRQ) Patient Safety Committee (PSC)

34 Summit Work Group Safety Projects Hand/Foot Ankle – Opioid Abuse Hand/Foot Ankle – Opioid Abuse Hip/Knee/Tumor – SSI Prevention Bundle Hip/Knee/Tumor – SSI Prevention Bundle Pediatrics – Peds Patient/ Family Checklist Pediatrics – Peds Patient/ Family Checklist Spine – Wrong Level Spine Surgery Spine – Wrong Level Spine Surgery Sports – UP in Surgicenters Sports – UP in Surgicenters Trauma – Hip Fracture Trauma – Hip Fracture

35 Patient Safety Summit Next Steps Next Steps Develop Pilot Projects Develop Pilot Projects Explore data relationships Explore data relationships ACS, SCOAP ACS, SCOAP Explore Global SSI Prevention Program Explore Global SSI Prevention Program CDC, AHRQ, AAOS CDC, AHRQ, AAOS Unified Orthopaedic Safety Information Statement Unified Orthopaedic Safety Information Statement Explore BOS Safety role Explore BOS Safety role

36 Safety Barriers Surgeon resistance to change Surgeon resistance to change Inadequate surgeon knowledge Inadequate surgeon knowledge Limited utilization of surgical team safety science Limited utilization of surgical team safety science Limited surgeon data contribution and benchmarking Limited surgeon data contribution and benchmarking Inadequate surgeon leadership Inadequate surgeon leadership

37 Orthopaedic Surgical Safety Journey Safety is no Accident AAOS Sign Your Site Program 1997

38

39 Paradigm Shifts Orthopaedic Safety Programs Education Orthopaedic education programs Orthopaedic education programs New focus/balance safety, quality and value science in all New focus/balance safety, quality and value science in all orthopaedic education programs/products orthopaedic education programs/products Orthopaedic Quality InstituteOrthopaedic Quality Institute Safety SummitSafety Summit Standardization system-based focus vs. implant/surgical technique focus Standardization system-based focus vs. implant/surgical technique focus

40 Paradigm Shifts Orthopaedic Safety Programs Data New safety/quality data programs New safety/quality data programs CMS Public Reporting (PACA) CMS Public Reporting (PACA) national benchmarkingnational benchmarking regional benchmarking (by state)regional benchmarking (by state) HVHC - Dartmouth Institute – private benchmarking collaborative HVHC - Dartmouth Institute – private benchmarking collaborative System performance vs. surgeon performance System performance vs. surgeon performance System focus prevention harm vs. good results System focus prevention harm vs. good results Deming – count bad light bulbs not good light bulbsDeming – count bad light bulbs not good light bulbs Patient outcomes vs. surgeon outcomes reporting Patient outcomes vs. surgeon outcomes reporting Multi-center vs. single center trials reporting Multi-center vs. single center trials reporting

41 Paradigm Shifts Orthopaedic Safety Programs Clinical New standardized system-based interdisciplinary surgical New standardized system-based interdisciplinary surgical care programs Geisinger ProvenCare Geisinger ProvenCare Patient contractPatient contract Intermountain Health System Intermountain Health System ACOs ACOs Bundled Care products Bundled Care products NorthShore University HealthSystem NorthShore University HealthSystem Care reliability (LOS, Costs)Care reliability (LOS, Costs) Complication preventionComplication prevention Readmission managementReadmission management

42 AAOS Orthopaedic Surgery Safety Summit Chicago, Ortho Sub-Specialty Work Groups 6 Ortho Sub-Specialty Work Groups Conference Calls. April - July Conference Calls. April - July Safety Webinar Safety Webinar Tuesday, July 31 Tuesday, July 31 Safety Summit Safety Summit Sunday, August 5 - Monday, August 6 Sunday, August 5 - Monday, August 6

43 Hand – Foot/Ankle Work Group Opioid misuse/abuse Opioid misuse/abuse Orthopaedic prescribing practices Orthopaedic prescribing practices Orthopaedic education Orthopaedic education Build consensus standards Build consensus standards Collaboration – national organizations/federal government/advocacy Collaboration – national organizations/federal government/advocacy

44 Is there an Orthopaedic Surgery Safety Problem 2012? Orthopaedic Evidence Orthopaedic surgical outcomes highly variable - by surgeon/hospital/healthcare system/region Orthopaedic surgical outcomes highly variable - by surgeon/hospital/healthcare system/region Limited local, regional, national orthopaedic safety/quality data Limited local, regional, national orthopaedic safety/quality data Slow adoption Safety/Quality communication and process Slow adoption Safety/Quality communication and process Few recognized surgeon safety leaders/champions Few recognized surgeon safety leaders/champions

45 Hip, Knee, Tumor Work Group SSI Prevention bundle SSI Prevention bundle Pre-op checklist Pre-op checklist Diabetic optimizationDiabetic optimization smoking cessationsmoking cessation OR checklist OR checklist Skin PrepSkin Prep Antibiotic optimizationAntibiotic optimization Post-op checklist Post-op checklist Wound care optimizationWound care optimization PIM/OKO modules PIM/OKO modules Collaboration – AHRQ, AAHKS, HS, KS, MSTS, CMS, AORN Collaboration – AHRQ, AAHKS, HS, KS, MSTS, CMS, AORN

46 Pediatric Work Group Patient/Family Checklist Patient/Family Checklist elective procedures elective procedures Focus – patient safety, quality, value Focus – patient safety, quality, value Collaboration – POSNA, SRS, Peds Hospitals Collaboration – POSNA, SRS, Peds Hospitals Pilot Study Pilot Study

47 Spine Work Group Wrong-level Surgery Prevention Wrong-level Surgery Prevention Sign Mark and X-ray Sign Mark and X-ray(SMaX) OR Checklist OR Checklist Confirmation with imaging Confirmation with imaging Pilot Study Pilot Study Develop PIM Develop PIM Collaboration - NASS Collaboration - NASS Educate Educate

48 Sports Work Group Universal Protocol (UP)- Surgicenters & Offices Universal Protocol (UP)- Surgicenters & Offices Pilot Project Pilot Project Scheduling Scheduling Pre-op Holding Pre-op Holding OR OR Patient focus Patient focus Collaboration – AOSSM, Collaboration – AOSSM, AANA, JC

49 Trauma Work Group Hip FX Quality Pathway Hip FX Quality Pathway Checklists/order-sets Checklists/order-sets Pilot Study Pilot Study SSI Prevention SSI Prevention New SSI Quality bundle New SSI Quality bundle Pilot study Pilot study Hip FX PIM/s Hip FX PIM/s Collaboration - CDC, AHRQ, OTA, AGS Collaboration - CDC, AHRQ, OTA, AGS

50 AAOS Safe Orthopaedic Surgical Programs Surgical Team Communication Surgical Team Communication effective patient and surgical team communication effective patient and surgical team communication TeamSTEPPS TeamSTEPPS human factors supporting a Culture of Safety human factors supporting a Culture of Safety distraction-free/focused OR environment distraction-free/focused OR environment Standardized Surgical Processes Standardized Surgical Processes accurate timely patient-centered informed consent accurate timely patient-centered informed consent proper marking and confirmation of: proper marking and confirmation of: site - side - level - implant - procedure - patient site - side - level - implant - procedure - patient regular use standardized surgical checklists regular use standardized surgical checklists Surgical Data Surgical Data Systematic surgical data collection and analysis Systematic surgical data collection and analysis

51 Orthopaedic Safety Summit Ortho Sub-Specialty Work Groups Hand/Foot-AnkleDavid Ring MD Hip/Knee/TumorMark Froimson MD PediatricsKit Song MD SpinePaul Huddleston MD SportsLaurence Higgins MD TraumaSteve Olson MD

52 CMS NorthShore THR/TKR All-Cause Readmissions consensus building among surgeons consensus building among surgeons collaboration hospital administration collaboration hospital administration surgical team communication surgical team communication patient-centered care with optimized outcomes patient-centered care with optimized outcomes reducing/controlling unnecessary costs reducing/controlling unnecessary costs validate innovation improvements validate innovation improvements surgeon self reporting - safety/quality/value data surgeon self reporting - safety/quality/value data

53 Thanks

54 HistoricalUnsafe Surgical Behaviors Process - surgical techniques/care plans - highly variable Process - surgical techniques/care plans - highly variable surgeon-unique surgeon-unique Data -surgical care experience-based Data -surgical care experience-based little/no surgical data collection/analysis little/no surgical data collection/analysis Communication - surgical authority hierarchal Communication - surgical authority hierarchal surgeon top down to surgical team surgeon top down to surgical team

55 Model Needed forSafe Surgical Behaviors Process - surgical techniques/care plans standardized and evidence/consensus-based best practices Process - surgical techniques/care plans standardized and evidence/consensus-based best practices consistent/reliable consistent/reliable Data - surgical data systemically collected and analyzed Data - surgical data systemically collected and analyzed improvements data/active management driven improvements data/active management driven Communication - Surgeon authority shared in team model Communication - Surgeon authority shared in team model surgeon as leader supporting transparency and authority surgeon as leader supporting transparency and authoritydelegation

56 Model Orthopaedic Surgical Safety

57 How? Introduce OR behaviors benefitting entire surgical team Introduce OR behaviors benefitting entire surgical team Embrace safety science in orthopaedic practices Embrace safety science in orthopaedic practices Own orthopaedic surgical safety data and errors Own orthopaedic surgical safety data and errors Shift focus surgeon to surgical care system improvement Shift focus surgeon to surgical care system improvement Celebrate improvements Celebrate improvements Partner with patient, stakeholder and safety organizations Partner with patient, stakeholder and safety organizations

58 Safety Summit No! No! cultural change resistance cultural change resistance other industries safety change > decade other industries safety change > decade Options Options embrace change – improve care embrace change – improve care resist change – accept regulatory mandates/financial penalties resist change – accept regulatory mandates/financial penalties Safety Summit designed to Safety Summit designed to expand safety practices introduced by AAOS in 1997 expand safety practices introduced by AAOS in 1997 build new orthopaedic specific safety tools build new orthopaedic specific safety tools affirm orthopaedic leadership/commitment affirm orthopaedic leadership/commitment

59 Safety Summit Summary Overview Participant Recognition: Prioritize Safety for ALL orthopaedic settings Participant Recognition: Prioritize Safety for ALL orthopaedic settings 6 sub-specialty work groups : PILOT new orthopaedic safety programs 6 sub-specialty work groups : PILOT new orthopaedic safety programs Safety collaboration - CMS, AHRQ, JCAHO, ACS, SCOAP Safety collaboration - CMS, AHRQ, JCAHO, ACS, SCOAP Unify Orthopaedic community : Unify Orthopaedic community : UNIFIED Orthopaedic Safety Information Statement UNIFIED Orthopaedic Safety Information Statement BOS and AAOS collaboration new safety programs /products BOS and AAOS collaboration new safety programs /products

60 Summit Safety Outcomes Summary Unified Position Statement on Orthopaedic Surgical Safety Unified Position Statement on Orthopaedic Surgical Safety Develop funding support for Work Group pilot safety programs Develop funding support for Work Group pilot safety programs Continue communication CMS, JCAHO, AHRQ Continue communication CMS, JCAHO, AHRQ Explore partnering with ACS/SCOAP for surgical safety data Explore partnering with ACS/SCOAP for surgical safety data Explore ongoing support and coordination of the Orthopaedic Safety programs Explore ongoing support and coordination of the Orthopaedic Safety programs ? new BOS Safety Committee ? new BOS Safety Committee Collaborate with AAOS Surgical Safety TeamSTEPPS Communication Program (80 Centers/3 years) Collaborate with AAOS Surgical Safety TeamSTEPPS Communication Program (80 Centers/3 years)

61 Safety Recommendations Trauma Work Group Recommend to AAOS - SSI Prevention Guideline Recommend to AAOS - SSI Prevention Guideline Develop SSI Prevention Checklist (Bundle) Develop SSI Prevention Checklist (Bundle) Antibiotic managementHbA1C/Hypergylcemia Management Antibiotic managementHbA1C/Hypergylcemia Management Surgical warming (>35c.)Albumin/Nutritional management Surgical warming (>35c.)Albumin/Nutritional management Smoking CessationBlood manageent Smoking CessationBlood manageent Pilot a Standardized Hip Fracture Patient Care Pathway Pilot a Standardized Hip Fracture Patient Care Pathway Standardized Order Sets Standardized Order Sets Pre-op Pre-op Post-op Post-op Discharge Discharge Hip Fracture PIM Hip Fracture PIM Goals: decreased LOS, decreased costs and improved Fx outcomes Goals: decreased LOS, decreased costs and improved Fx outcomes

62 Safety Recommendations Sports Work Group Develop a Surgical Safety Program for Ambulatory Surgery Centers Develop a Surgical Safety Program for Ambulatory Surgery Centers Collaborate with JCAHO, ASCA Collaborate with JCAHO, ASCA Develop training modules Develop training modules Collaborate with AAOS TeamSTEPPS training program Collaborate with AAOS TeamSTEPPS training program Currently only 50% of orthopaedic surgicenters use Universal Protocol Currently only 50% of orthopaedic surgicenters use Universal Protocol

63 Safety Recommendations Spine Work Group Recommend to AAOS - SSI Infection Prevention Guideline Recommend to AAOS - SSI Infection Prevention Guideline Pilot - Wrong Level Spine Surgery Checklist Pilot - Wrong Level Spine Surgery Checklist Define imaging requirements Define imaging requirements Define wrong level surgery Define wrong level surgery Define exception/outlier management – obesity, retained implants Define exception/outlier management – obesity, retained implants

64 Safety Recommendations Pediatric Work Group Pilot a Family/Patient Focused Peri-operative Checklist Pilot a Family/Patient Focused Peri-operative Checklist Pre-op Pre-op Care team review Care team review Consent, Consent, Team huddle Team huddle Surgical Surgical Post-op surgeon review Post-op surgeon review Post-op Post-op Care plan review Care plan review Discharge Discharge Follow-up appointment Follow-up appointment pilot centers identified pilot centers identified Potential funding sources identified Potential funding sources identified

65 Safety Recommendations Hip/Knee/Tumor Work Group Recommend to AAOS - SSI Prevention Guideline Recommend to AAOS - SSI Prevention Guideline Develop SSI Prevention education products Develop SSI Prevention education products OKO OKO PIM PIM With AHRQ pilot Pre-op Optimization SSI Prevention With AHRQ pilot Pre-op Optimization SSI Prevention Checklist (Bundle): Checklist (Bundle): Obesity (BMI>40 counseling) Obesity (BMI>40 counseling) Smoking Cessation (Pre-op counseling/cessation) Smoking Cessation (Pre-op counseling/cessation) Diabetic Management (Optimize Pre-op HbA1C <7) Diabetic Management (Optimize Pre-op HbA1C <7) Anemia Assessment (for pre-op Hb<10) Anemia Assessment (for pre-op Hb<10)

66 Results Wrong Site/Procedure Errors Wrong Site/Procedure Surgeries Wrong Site/Procedure Surgeries Hospital ORs - 0.4/yr. Hospital ORs - 0.4/yr. Surgi-Center ORs /yr. Surgi-Center ORs /yr. Office Procedure Rooms – 0.05/yr. Office Procedure Rooms – 0.05/yr. Career - Wrong Site/Procedure Surgeries Career - Wrong Site/Procedure Surgeries Hospital ORs – estimated -1/20,000 surgeries Hospital ORs – estimated -1/20,000 surgeries Surgi-Center ORs – estimated -1/80,000 surgeries Surgi-Center ORs – estimated -1/80,000 surgeries Office Procedure Rooms – insufficient data (rare) Office Procedure Rooms – insufficient data (rare)

67 Safety Recommendations Hand/Foot-Ankle Work Group Develop an comprehensive opioid drug misuse/abuse Develop an comprehensive opioid drug misuse/abuse management and education program to: decrease peri-operative opioid drug events, decrease peri-operative opioid drug events, improve orthopaedic outcome satisfaction improve orthopaedic outcome satisfaction reduce opioid dependency/abuse reduce opioid dependency/abuse 80% of worlds opioid drugs consumed in US 80% of worlds opioid drugs consumed in US Opioids - #1 cause of accidental death in young adults in US Opioids - #1 cause of accidental death in young adults in US


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