The Innovations in Patient Safety Education (IPSE) Awards recognize organizations, groups and individuals that demonstrate exemplary practices in patient safety and quality improvement using the Patient Safety Education Program – Canada (PSEP – Canada). Patient safety trainers from healthcare organizations across the country are eligible for awards in three categories: the Power of One, the Power of an Organization and the Power of a System.
The 2016 IPSE Power of One award recipient is Dr. Irene McGhee, Anesthesiologist, Sunnybrook Health Sciences Centre for her commitment to improve patient safety through the development and use of a communication tool, I-START-END.
I-START-END is an engagement process for an ad hoc or transitory group of people who come together in an event to provide episodic care.
"Often anesthesiologists are called outside of the operating room to assist with resuscitations," says Dr. McGhee. "These resuscitations can be anywhere in the hospital, from the cafeteria to the trauma room. When you go to these resuscitations, it is a very stressful situation. The patient is in critical condition and there are so many unknowns. You don't know the patient and you look around and you don't recognize any faces and you don't know what their skill set is or who to ask for help. When you look for equipment you expect to have at your fingertips, it isn't there."
"The group that gathers for a particular task may not have anything to do with each other again. If a cardiac or code event occurs an hour later, there will be a new group of people. I thought, there has to be better way to do this. I looked at all of the well-established principles of crisis resource management and because you don't know who your team is, I started looking at the individual. That is where I came to the power of one. Everyone has their own view of their world in terms of their own experience and judgement. It is like seeing different parts of the elephant. We only see the whole elephant if people are sharing information in the moment."
I-START-END is not a script, rather it is a framework that encourages engagement and communication. As soon you arrive on the scene, ask, 'who is in charge'. If no one is in charge, that is the first item of business. Second, tell the leader what your specialty is and what level you are at. That is useful information for the leader in terms of delegating appropriately to the people at hand. The END part of the tool addresses the importance of the transitions of care. Let the leader know you are leaving, what you have done and what you think will happen next. Leave information on how to contact you specifically about an item that could come up. In the next hour the pager may be carried by someone else who may not have that information at hand, so it is important to make connections reliable and robust.
Dr. McGhee has been using the tool for about four years and the feedback has been very positive. When she presented the tool to Sunnybrook's Interprofessional Committee, they recognized how valuable it could be for patients and families. Nurses like the tool because it opens up a space to communicate and helps people speak-up and share information. Residents say it applies to many areas of their practice as they move from place to place and work with various teams. They report that the tool has really helped them to connect with others and communicate more effectively as well as increasing their awareness of what else was happening beyond their own task. The I-START-END tool is versatile – it is not bound by context. It sets out a process which can be applied in diverse situations.
Dr. McGhee is currently studying the effectiveness of the tool with 50 anaesthesia residents in a simulation setting where they are presented with an ad hoc scenario and then learn how to implement the tool. Six months later, they look at sustainability and retention to see if they are using the tool and if in fact it is impacting positively on communication. She has also done a number of workshops and communication seminars with the residents at Sunnybrook and the University of Toronto Anaesthesia program.
"The paradigm has changed in medicine and so the way we communicate must also change," says Dr. McGhee. "We are now delivering care to patients in a more episodic and transient fashion. The I-START-END framework fosters active engagement in the moment. This results in key information, managerial and relational elements of patient care plans to be set out in detail before the team disbands. In this way seamless patient care transitions are ensured going forward. A read-back, opportunity for questions, debriefing with all present, and documentation complete the encounter."
"The PSEP – Canada training really resonated with me and I am so thrilled to receive the Power of One award," says Dr. McGhee. "What I loved about the PSEP – Canada program most was that it was not physician-centred, rather it is patient- and healthcare worker centred. It was a rich experience with such a diverse group at the table. I learned so much and I have tried to take that forward."