MHA Keystone: Surgery
Background: There are 329,000 surgeries in Michigan each year; with national estimates of complications at 25 percent, that may result in up to 82,320 surgical complications. In addition, literature shows that mortality rates as a result of surgical complications have reached 5 percent (including infections and other post-surgical complications), giving rise to significant costs estimated at about $250 million.
In fall 2007, the MHA Keystone Center launched MHA Keystone: Surgery in partnership with the Johns Hopkins University Quality and Safety Research Group. This collaborative now includes more than 100 Michigan hospitals that are voluntarily participating to improve perioperative patient safety.
The goals of MHA Keystone: Surgery are:
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Intervention 1: Eliminate surgical-site infections by ensuring that at least 90 percent of patients receive evidence-based interventions for infection prevention
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Intervention 2: Eliminate the mislabeling of specimens
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Intervention 3: Prevent defects in care, in particular focusing on the National Quality Forum’s serious adverse events (wrong-site surgery and retained foreign bodies
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Intervention 4: Achieve positive safety and teamwork climate reports from surgery staffs (these reports affirm improvements in the “culture of safety” at participating hospitals)
Collaborative interventions focus on methods to improve communication among the surgical team. Briefings are conducted before surgery to confirm that the correct patient is in the operating room, to verify the surgical site, to ensure the proper equipment is accessible and to outline possible complications. Debriefings are conducted by the surgical team immediately following the procedure to identify defects and to discuss the patient’s future needs, ensuring a smooth transition to postoperative care.
Lean/Six Sigma1
is another method used to identify process gaps and eliminate the
mislabeling of specimens removed during surgery.
The MHA Keystone: Surgery collaborative has included October 2008 and May 2009 face-to-face workshops, monthly conference calls with surgical teams and MHA Keystone Center leadership to share measurement tools, and other forms of communication.
Results: Since the fall of 2007, more than 84,000 surgical briefings have been completed by participating hospitals.
Future: To further facilitate surgical improvements, a new intervention to prevent the mislabeling of specimens began in 2009, with data collection beginning statewide in the fall of 2009.
1Lean/Six Sigma is a balanced business improvement methodology that seeks to identify and remove the causes of errors within a set period of time. The process uses a set of quality management methods, including statistical methods; creates a special infrastructure of people within the organization who are experts in these methods; and defines quantified financial targets for the project.
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