OS1-139
Redesigning the Intraoperative Emergency Response
Caruso T, Darling C, Munshey F, Chen M, Gonzalez R, Knight L, Sharek P
Stanford, Stanford, CA, USA
Introduction
Given the acuity and relatively rare incidence of intraoperative arrests, it is important that the pathway triggered by these events reliably result in an appropriate response to maximize the chance of a favorable outcome. At our institution, the intraoperative code response was redesigned to improve patient safety by delineating the emergency response activation, defining perioperative code team members and their roles, and educating staff regarding these processes.
Methods
Beginning April 2016, quality improvement lean methodology was utilized to approach a redesign of the intraoperative emergency response systems at Lucile Packard Children’s Hospital Stanford. The background and current state were identified through retrospective analysis of intraoperative arrests and operating room staff interviews. Although a standard method for activating an intraoperative code did exist, multiple homegrown pathways were identified during the current state analysis, resulting in confusion during practical application and subsequent suboptimal patient care. These problems were analyzed by people, processes, and equipment and technology involved, and countermeasures were developed. The code activation process was simplified to a dichotomous system, the staff involved in code response were truncated and given clear roles, and the new system was summarized and clearly publicized in the hospital intranet. Members of the response team included a small number of intensive care physicians and nurses to ensure adequate code role coverage on nights and weekends. Outcomes measures were evaluated with a competency assessment for all circulating nurses and staff anesthesiologists. Follow-up and maintenance of these efforts occurs with monthly perioperative simulation sessions and teaching with competency assessments administered to all new intraoperative employees.
Results
Outcomes measures involved administration of an assessment to perioperative staff using this system. After education and simulation sessions were conducted, the average score on the assessment was 96% by all OR staff. In addition, 100% of participants indicated that they felt comfortable performing their designated role during a perioperative code, and individual reports of subsequent perioperative codes indicate that the process has subjectively become much smoother. Perioperative staff continue monthly simulations to ensure familiarity and understanding with the emergency response system.
Discussion / Conclusions
Quality improvement methodology was utilized to assess and redesign the perioperative emergency response systems. This was accomplished by improving clarity of response system activation, standardization of downstream pathways, defining roles for emergency response personnel, and improving staff understanding of these processes. Staff competence and patient safety has been optimized.
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