Patient Safety Checklist – RIE

Last Friday I had a chance to hear the results of some work by several Operational Effectiveness Teams.  Effective and impressive quality improvement work continues at McLeod to provide more efficient delivery of health care for our patients physicians, and staff.

Based on the work of those involved at the operating room table, notable achievements were made to improve the flow in the Operating Rooms through a Rapid Improvement Event (RIE) targeting Surgical Safety.  I wanted to take this time to highlight the team’s activities and thank our physicians and staff for their industriousness and dedication.

The Institute of Healthcare Improvement (IHI) introduced the Surgical Safety Checklist at its 2008 National Forum in December. The Surgical Safety Checklist is a tool, sponsored by the World Health Organization, designed to standardize and improve the safety of patients by fostering clear communication and behavior between members of the surgical team. The New England Journal of Medicine published a study in January on 2008 outlining the benefits to patients as a result of implementing a similar checklist. This specific study found an overall 36% reduction in postoperative complication rates in the testing hospitals throughout the world. During the National Forum all hospitals were encouraged to implement the Surgical Safety Checklist in at least one Operating Room.  Operating Rooms in Darlington, Dillon and Florence are beginning to pilot the use of this safety checklist.

The Operating Room chose to use the Operational Effectiveness model of the Rapid Improvement Event (RIE) to Plan, Test & Implement this tool in the OR.  OR Management Council decided to set the first phase to include the surgeons and OR staff on the Orthopedic Service Line. The week-long RIE began on Monday June 15th and ended with a report out to the Leadership Council on Friday June 19th. The team was composed of members from the OR including Jill Caulder RN, Ann Moore RN, Richard Hobbs CST & Erin Ivey CST. The team also included ‘Fresh Eyes’ in the form of Jean Broughton from Human Resources and Zach Coward a Summer Medical Student Intern.

The RIE team began by analyzing the current conditions of the “As Is” state and brainstorming characteristics of the “future state”. The map below identifies the “As Is” steps in Yellow and the “Future State” in green. This exercise allowed the team to identify any gaps or additions to the proposed Patient Safety Checklist.


Future State Characteristics
Good Communication:
- Respectful and Unthreatening between surgeon and entire team
- Interactions with Patient and Patient’s family are professional
- Individuals who have a need to know, KNOW!
Fosters Teamwork:
- Shows respect for all individuals
- Team is all working towards a common (stated) goal
- Everyone gives full support (goes the extra mile for the team)
- Brief
- Timely
- Cover the right amount of information (not too much/not too little)
Ownership of Key Functions:
- Known owners for processes are held accountable to the team
- Visual evaluation of success
- 2 way feedback including surgeons

The Team then added three additional areas for discussion to the Checklist:

- PRIOR TO ROOM – Is the room ready to receive the patient?
- PRIOR TO PROCEDURE – Team Validated Patient Identify, Side & Site marked, Procedure, Consent
   and Position!
- END OF PROCEDURE – Are there special concerns and needs for the next patient?

Next, the team conducted Rapid Experiments by testing the Checklist in the OR with Dr. Denton and Dr. Clark. These test included discussion with the surgeons and team members regarding specific items contained in checklist, benefits of the checklist to the patient / team and gathering their feedback. These test allowed the group to refine the form and discuss issues such as Follow-up and communication.

More on Rapid Improvement Events
Operational Effectiveness at McLeod began by working on two value streams.  The selected streams are “Patient Flow” and “Revenue Cycle.”  The process is designed so that these areas are divided into smaller segments called Rapid Improvement Events (RIE). A RIE is a multidisciplinary team that meets for a week to analyze a particular area within the Value Stream. These teams plan small test of changes, implement or test these changes, study the results, and make final the changes. People directly engaged in the specific work and “fresh eyes” from other departments work hand-in-hand to create these changes. 

Clinical Effectiveness
In 1998, McLeod Regional Medical Center embarked on an initiative called Clinical Effectiveness. This initiative focuses on “doing the right thing, for the right patient, at the right time, by the right health care provider, using the right resources.” In essence, it furthers the McLeod mission by ensuring medical excellence.

Clinical Effectiveness is a physician-led, data-driven process that takes the best information and practices that the medical literature has to offer and applies that information to the local health care setting.

Clinical Effectiveness is achieved through a process that applies specific components. Those components include physician leadership, quality care – both technically and clinically, best practice, evidence-based medicine, and measurable outcomes and results.

Clinical Effectiveness is a quality improvement process for medicine. It is unique because it’s led by physicians with strong administrative support, nursing personnel, analysis and data collection. Clinical Effectiveness is unlike anything else in medicine because we’re actually taking business models and applying them to a clinical setting.


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