227 - Creating a Pre-op Huddle to Improve Patient Safety
Description: Brighton Center for Specialty Care (BCSC) opened in September 2018 and is the newest ambulatory surgery center (ASC) at Michigan Medicine. Within six months of opening, a disconnect between the perioperative team verifying and confirming that the patient was ready for transport to the operating room (OR) was identified. There were instances where the patient was transferred to the OR without an updated consent, updated history and physical, missing armband, and in one case the incorrect patient was brought to the OR. Perioperative leadership; including anesthesia, the OR nurse supervisor, and pre-op nurse supervisor met to discuss these concerns and identify ways to improve the quality and safety of patient care. The idea of a pre-op huddle was introduced. This huddle would include the pre-op nurse, anesthesia, and the OR circulating nurse. All three would meet at the patient’s bedside in pre-op to go over a checklist to ensure all necessary documentation, orders, site marking, patient understanding, etc. were addressed. Prior to piloting the huddle, a small group of front line staff from all three areas met to discuss this initiative. Through open, honest dialogue all necessary items to address at the bedside were identified and a one-page checklist was created. Team meetings were held with all staff to share the patient safety concerns that had occurred and the idea of the pre-op huddle. While some staff were hesitant to change due to the pre-op huddle drastically altering their routine, all staff were onboard with the pilot and all services agreed to participate. A six-month pilot began in April 2019. During the pilot, leadership routinely met with their respective teams to check in. Additionally, an anonymous survey was sent to all nursing and anesthesia staff to gain their feedback. From this feedback, small modifications were made to the checklist, including adding defined roles for each person participating, identifying a white board for pre-op RN assignments, and adjusting the room readiness dialogue. A ‘good catch’ binder was also created allowing staff to quickly document and track areas of concern that were identified and corrected at the huddle. Staff who were part of that huddle receive a certificate and candy as a way to encourage reporting. There have been 20 documented ‘good catches’ since rolling out the huddle. No case delays, increases to room turnover or room ready times have been noted. Feedback from staff has been overwhelmingly positive. Many find that they have an improved relationship across disciplines, that it closes the loop, has prevented errors and increased patient safety. Patients have commented that they feel a sense of comfort with the huddle showcasing a team centered approach. With the success of the pilot, it has officially been adopted into practice at BCSC. There are plans to roll it out to all ASCs across Michigan Medicine as well as presenting this work to the inpatient sites for implementation.