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Surgery is an area of high impact to your hospital—and of high potential harm to patients. Aside from its inherent risks, such as surgical site infections and deep vein thrombosis, the perioperative environment is complex, involving multiple teams of caregivers and transitions of care. Communication breakdowns and poor teamwork in this environment can lead to harmful medical errors, less efficient operating rooms, longer hospital stays and increased costs.
Our Approach to Perioperative Safety
At Johns Hopkins, we have developed a suite of tools and strategies for improving perioperative safety. Our efforts include:
- Fostering a culture of safety in the operating rooms and other perioperative settings.
- Introducing preoperative briefings—essentially extended time-outs—in which surgical team members introduce themselves by first name, discuss the procedure, and have the chance to raise issues that might come up during it.
- Reducing surgical site infections by consistently following evidence-based practices for preventing them.
- Following evidence-based guidelines for eliminating complications of care, such as deep vein thrombosis.
- Developing dashboards to display performance on key measures and encourage frontline workers and managers to seek improvement.
- Improving transitions of care from the OR to the intensive care unit through a structured handoff process that helps ensure that care teams exchange vital information about the patient.
- Using simulation to help improve teamwork and communication among caregivers, and also to help them practice new procedures on mannequins.
Our Track Record
- Compliance with national best practice guidelines for VTE prophylaxis is now in the upper 90th percentile across the entire hospital, and significantly higher than national and state averages. We have seen our VTE rates fall concomitantly. In one year, these efforts are estimated to have prevented more than 80 DVTs from occurring—which translates to eight fewer deaths and avoiding costs of more than $650,000.
- By increasing compliance with evidence-based measures for patients undergoing surgery—such as proper selection, timing and redosing of antibiotics, using the correct skin preparation methods and maintaining perioperative normothermia—The Johns Hopkins Hospital has been able to decrease these stubborn infections. Year over year since 2007, surgical site infections at the hospital have been reduced by about 20 cases.
- Through teamwork and communication training, we have improved collegiality in the operating rooms, flattened hierarchies that make some caregivers hesitant to raise their concerns, and improved on-time case starts.