Monday, January 22, 2018
Health

How lessons from auto racing are helping with patient safety

Even if you're not a fan of auto racing, a pit crew at work is a marvelous sight. Moving with practiced precision, the team changes tires, refuels, adjusts, repairs and gets the driver back on the course — in seconds.

After a 12-hour heart transplant surgery some years ago, two British physicians relaxing in front of a break room TV saw a Formula One crew in action and had a revelation:

"Why can't we do it like this?'' transplant surgeon Martin Elliott said to Allan Goldman, the head of intensive care at London's Great Ormond Street Hospital for Children.

"It'' was one of the most common, yet potentially perilous, events in any hospital: The handoff of a patient from one caregiver or team to another. The Joint Commission, which accredits U.S. hospitals, has estimated that 80 percent of serious medical errors can be traced to communication failures during handoffs or transfers. Health care organizations everywhere are stressing safety.

The British doctors knew their surgical and ICU teams were outstanding. Yet their communication was chaotic compared to the pit crew's.

The doctors invited a top racing team manager to watch video of a handoff and suggest improvements. That was the genesis of the "Ferrari Formula One'' approach that institutions, including All Children's Hospital Johns Hopkins Medicine in St. Petersburg, are using to help protect patients.

This month, the journal Pediatrics published a study on how 23 U.S. children's hospitals, including All Children's, are improving handoffs. All Children's, which was among the top performers in the study, focused on handoffs from cardiac surgery to intensive care.

(By the way, Elliott is a familiar presence at All Children's, as he has been a frequent speaker at its annual International Congenital Heart Conference.)

Last week, the center's executive director, Susan Collins, and Dr. Brigitta Mueller, the hospital's chief safety officer, walked me around the cardiac ICU and talked about the study, how the results are changing care at All Children's, and why they want parents and even kids to help look out for safety.

The study started in 2012 by analyzing how handoffs were being performed.

"Everyone knew what had to be done, but it wasn't necessarily efficient,'' Collins said. "It's a noisy environment.''

Equipment whirs and wheezes, alarms buzz and ring. Doctors and nurses talk to one another — all at once. Everyone's in motion.

"I'm a nurse,'' Collins said. "We're compulsive about moving and doing things all the time. It's hard to stop and really listen.''

So one change was requiring everyone to take a break and focus as each of their colleagues spoke — one at a time.

That must have slowed things down, I said.

"It sped things up,'' Collins replied. Orders and vital facts weren't missed and didn't have to be repeated.

Another example: Setting up equipment on the same side of operating rooms as in patient rooms means IV lines are more easily — and safely — transferred when a child leaves surgery.

After months of refining, staff surveys showed the system to be a success worth applying around the hospital. Although 60 percent of the study participants were "very satisfied'' with the quality of handoffs before the changes, that figure shot to 92 percent afterward.

Even beyond surgery and intensive care, even with top-notch medical staff, serious errors can happen. But alert observers can help.

"I want parents to be part of the safety team,'' said Mueller, who encourages people to speak up if they have questions.

For instance, properly cleaning central line hubs is vital to preventing infection. Mueller, an oncologist, told me about a program to teach kids and parents to watch the clock, making sure the task gets the full time prescribed. Collins likes to have parents in care conferences because they "might think something isn't important until they hear us in a handoff,'' she said.

Mueller and Collins know that the very notion of standardizing care raises hackles among those who complain about "cookbook medicine.'' They see it differently.

A firm routine "takes care of the easy stuff so we can focus on the complex things,'' Mueller said. "That's immensely helpful.''

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