University Health Network (UHN) has embarked on a patient safety transformation following the principles and approaches that are used by high reliability organizations.
Known as Caring Safely, the approach focuses on four pillars, one of which aims to reduce hospital-acquired conditions (HACs) to zero over time. Six HACs, chosen because they are the ones with the most impact on patients, are being addressed first: surgical site infections, central line infections, Clostridium difficile (C. diff), pressure ulcers, falls and adverse drug events.
UHN is participating in the National Surgical Quality Improvement Program (NSQIP), to evaluate its performance and benchmark against other U.S. and Canadian hospitals. This is helping them evaluate their surgical site infections. Developed by the American College of Surgeons, NSQIP enhances a hospital's ability to zero in on preventable complications. UHN has also joined Health Quality Ontario's Ontario Surgical Quality Improvement Network, a community of surgical teams across the province who are working to achieve long-term surgical quality improvement goals. The program is designed to deliver better patient outcomes, shorten hospital stays, and reduce the number of surgical complications per year.
Last February, UHN also participated in the Safer Healthcare Now! Canadian Surgical Site Infection (SSI) Prevention Audit, which provided a snapshot of the current state of its practice related to surgical site infection prevention.
"The Safer Healthcare Now! SSI Audit provided a baseline granular view of where we have gaps in data collection and practice," says Wing-Si Luk, Director, Hospital Acquired Conditions Prevention & Management, UHN. "We did not have a robust ongoing mechanism to collect data on the status of practice related to surgical site infection prevention at UHN. The audit was really helpful in terms of providing a snapshot of what we are doing well and where we need to improve. It created a current state for us and an opportunity to compare our data with other healthcare organizations across Canada."
Patient care coordinators and nurses in the surgical program at both the Toronto Western (TWH) and Toronto General Hospital (TGH) sites of UHN participated and were tasked with reviewing 270 paper-based patient charts for the SSI audit. These clinicians recorded data on all components of the Safer Healthcare Now! SSI bundles, which included temperature, glucose levels, hair removal and perioperative antimicrobial coverage, and trailed the patient's journey from pre-op to the operating room to recovery, to collect relevant information.
"The audit was a lot of work, but the information is so valuable," says Laura Corman, Patient Care Coordinator in Perioperative Services at TGH. "We found gaps in the way we document across sites and the audit showed where we have work to do. By extracting the data, we can now give valuable feedback to the direct caregivers."
Joe Brubaker, Nurse Manager on the 9B Surgical Unit at TWH, adds: "We are now looking at trends and feeding information back to groups and managers of those areas so that they can take that information back to the staff, to look at how and what they are documenting. Our clinicians have gathered a great deal of knowledge from the audit and we will be involving them to recommend changes in our processes."
The audit results are being review by UHN's Surgical Quality Review Committee and the Surgical Divisions at both TWH and TGH.