No Resting on Laurels Where Safety Is Concerned
No Resting on Laurels Where Safety Is Concerned
On Wednesday, Aug. 23, at 7 am, Perioperative Services took a department-wide timeout for the 13th annual Frederick C. Ryckman Surgical Safety Stand Down. Surgeon-in-Chief Dan von Allmen, MD, welcomed everyone who attended the in-person and livestreamed presentation in the Sabin Auditorium where staff gave a progress report on safety improvement initiatives and outcomes.
“This is a special year,” said Dan. “The banner out front says we were named the number-one children’s hospital in the country by "U.S. News & World Report." While that’s a fantastic honor, we don’t teach to the test. More importantly, being number one doesn’t mean that we stop trying to improve. Rather, we continue our mantra of being the best at getting better and maintain our relentless focus on the safety of our patients.”
Rolanda Clark, a parent of five, shared the story of her son’s treatment at Cincinnati Children’s, reminding the audience why safety is so important (see sidebar below).
Then several Periop leaders presented the work their teams have been doing in FY23. This includes:
- Strengthening our processes for preventing unintentional retained foreign bodies, empowering everyone to call a timeout when something isn’t right, marking surgical sites, getting consents, holding Periop huddles, and conducting safe handoffs to the Post Anesthesia Care Unit. We have 100-plus Safety Culture champions who completed more than 6,900 observations and provided coaching, especially for individuals who were new to the team.
- Taking care of each other by reducing OSHA-recordable injuries, such as bloodborne pathogen exposures and incidents of workplace violence, while fostering an environment of psychological safety. The team hosts periodic safety talks about integration and collaboration to build trust and transparency. Having a more robust Operational Excellence structure is helping to streamline communications. The next step will be to decentralize decision-making so that frontline staff feel empowered to act without waiting for approval from a director, manager or the OR front desk.
- Flagging OR patients for acuity to help staff prepare for potential notable events. When patients are designated as “watchers” (yellow or orange), the Periop team goes on high alert for conditions like hypotension or broncospasms, which can be addressed as they come up.
- Creating a comprehensive system that evaluates the medical, behavioral and social complexities of patients to proactively assess and optimize care prior to surgery—called the Periop SHOPPE (Perioperative Surgical Home for Optimal Patient Planning and Experience). This is a coordinated, multidisciplinary care plan that is developed with the patient, family and other key partners ahead of surgery. The goals are to reduce significant delays or cancellations by making sure all labs and screenings are completed, and to give patients and families an opportunity to ask questions and voice concerns. So far, 551 cases have been reviewed, and there have been zero cancellations.
Other benefits of the Periop SHOPPE include:
- Improved awareness of special needs of complex patients
- Increased and more consistent use of the OR
- Better employee experience, e.g., workload predictability, avoiding last-minute workups
- Improved patient/family experience, e.g., less stress associated with delays or changes in the plan of care, lost wages and academic disruption.
What’s Ahead
The Periop team has been excited to work with other teams across multiple sites of care this past year, and they look forward to collaborating more in FY24 as patient volume and acuity increases. Specifically, they hope to focus on our health equity networks to ensure that all patients have equitable access to the Periop system by identifying and removing barriers.
Regarding employee experience, Periop is kicking off a program called “Beyond the Scrubs,” aimed at helping staff get to know each other better by celebrating successes and pausing to offer support when unplanned events happen.
As the Surgical Stand Down came to a close, Steve Davis, MD, MMM, president and CEO, praised the Periop team, saying, “What really impresses me is that your area is probably our highest risk area, and you have an absolutely outstanding track record for keeping patients and employees safe. No matter how good you are, every year, you’re focused on getting better. Thank you and your team for the incredible leadership and keep up the good work.”
The Power of Human Connection
My name is Rolanda Clark. I am a wife and mom to five children, ages 10 through 24. My story is about Christian, my baby.
He started experiencing debilitating headaches about a year and a half ago during the first week of March. This guy is just as active as all get-out, so if he tells you he’s going to take a nap, you know something’s wrong.
We got a call from his school. They said that Christian was in a bad way and that it was imperative that I come immediately. Eleven days later, after three trips to the ED, my husband and I found out that our son had a sinus infection that had gone awry. He would be admitted to Cincinnati Children’s and given aggressive antibiotics. Timing was of the essence.
Thirty minutes passed, and we received an update that Christian would not receive aggressive antibiotics until after he had a craniotomy, during which they would excise the abscess that had formed. The surgery was necessary to save my son’s life.
Before Christian went in for the procedure, my husband and I held hands with the neurosurgeon, the anesthesiologist and the otolaryngologist and prayed for his quick recovery, that the procedure would be a success and that God would supply whatever the doctors needed.
There’s a value to human connection. We were all so different. But at the same time, we connected and were of one accord.
Following the five-hour procedure, the otolaryngologist found my husband and me. By then, it was 5 or 6 am, and everybody was just tired. The poor doctor was on his knees talking to us—not because he was tired but because he wanted to connect with us and make sure we understood the information he was providing. He looked in our eyes and told us that if there was anything he could do, to please speak to him. He was there for us.
In all, it was probably an eight-minute conversation, but it was so valuable. It was a balanced form of communication that I will never, ever take for granted. And I ask that it informs your decisions on how you treat your patients—just listen to them.
Christian was taken to the PICU, and as always at Cincinnati Children’s, we have very good experiences. But human error and oversight does happen. About three days in, my son was recovering so well, we were going to transition to a regular hospital floor. During that transition, a nurse and her trainee came in to change out Christian’s IV. Although he exclaimed that he was in pain during and after the switch, the nurse decided to wait and see what happened instead of trying to figure out what the issue was. When she came back 10 minutes later, his arm was swollen. Unfortunately, we experienced an infiltration, and the medication was going into his muscle. Several nurses, including the charge nurse, came in and offered lots of apologies.
I kept wondering what I could have done differently to advocate for my child. What information could have possibly informed the nurse’s decision to come back, take out the IV and start over?
Once we got to the regular floor, our bedside nurses, with their energy, compassion and empathy, superseded all the trauma we’d experienced. There’s some value to human connection, to having a balanced style of communication, being collaborative, partnering with your parents, your caregivers and your patients. There’s value in being compassionate, and I urge you to lean into that.
With that said, I’d like to share a small poem that speaks to the culmination of our experience:
Nurturing safety through compassionate care
Amidst challenges, my tale unfolds, A parent’s journey, as life’s story molds. Through medical trials and paths unknown, Collaboration and care brightly shone. Debilitating headaches, a battle to fight, ER visits, days blending into night. A CT scan revealed, a critical sight, A brain abscess discovered in the light. From antibiotics to a sudden change, A craniotomy, emotions rearrange. Chaplain, surgeon, prayer in range, Human connection’s power, our hearts exchange. Communication’s thread, woven with care, The ENT surgeon’s words, a lifeline to bear. Clarity and compassion, a bridge we share, Building trust and confidence in the medical air. Lessons learned in moments so stark, Empathetic listening, a healing spark. Sensitivity to history, in shadows and arc, Patient-centered care, a bright new embark. Emotions unveiled, compassion the guide, Nurturing nurses by my son’s bedside. Healing in kindness, emotions can’t hide, A patient’s well-being, in care they confide. As days unfolded, with quality in sight, The healing power of care, a radiant light. Patient-centered approaches, pure and bright, Advocating for safer healthcare with all our might.
—Rolanda Clark