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Working with vendors, OR nurses and scrub techs reduced the number of trays and instruments needed per case by one-third, decreasing the time allocated to opening instrument packs Scheduled nurses on the team to arrive earlier Metrics Adopted a mechanism to track causes of delay Tracked time spent in each phase of the OR using swimlanes with timestamps Results Average time of late start was reduced by 96% over a two-year period, with a current average of less than one minute Total time to making the incision was reduced by 21% from 102 minutes in 2015 to 81 minutes in 2017 35% improvement in OR efficiency versus 2015 2017 Report on Clinical and Scientific Innovations | 5 Average Time of Late Start Average Time of Anesthetist Ready Average Time of Surgeon Ready Average Time of Incision Ready 0 Minutes Significant Improvement in OR Efficiency for Pediatric Spine Using CUSP Applying CUSP enabled the Department of Orthopedics to increase OR efficiency for adolescent idiopathic scoliosis surgery in 2016 by 35%versus 2015. 6 | NewYork-Presbyterian Orthopedics NewYork-Presbyterian Orthopedics Quality and Patient Safety Initiatives Optimizing Best in Class Outcomes Requires Examination of the Entire System of Care Host System Procedure/Indications Communication Problem/ Complication Patient Characteristics Staffing Institutional Work Environment Organizational/ Management Team Environment Task-Related An Alternative Application of the Mortality and Morbidity Conference In the reorganization of the quality infrastructure for the department, an opportunity materialized to use the monthly Mortality and Morbidity (M&M) conferences of each orthopedic service as a vehicle for department-wide adoption of new practices. “Medical error is rarely the result of a single, sharp-edge problem and much more often a result of a combination of host, systems, culture, and technique issues,” says Dr. Vitale. “Our M&M conferences are now presented in that structured light. In other words, we use a fishbone process where every suboptimal result or situation that occurs in the department is looked at with a lens of what we could have done differently from the point of view of systems, optimization of host, culture, and technique. When you do this you truly realize how complex the healthcare system is, but it also reveals the many opportunities for improving care that go far beyond the intervention and extend to the entire episode of care.” NewYorkPresbyterian Orthopedics A high reliability organization caring for the most complex adult and pediatric patients while having much lower rates of adverse outcomes than the national average 2017 Report on Clinical and Scientific Innovations | 7 30-Day readmission rates for every orthopedic service at NewYork-Presbyterian/Columbia are below the national average. 3.36% 4.73% Adult Spine* 1.60% 2.50% Foot and Ankle 3.90% 0.00% Hand/Microvascular Surgery 1.10% 2.50% Pediatric Spine 1.60% 2.30% Shoulder/Elbow 2.80% 4.00% Trauma 30 Day Readmission Rates – Related 2016 Source: Academic Medical Centers Data: Re ects data compiled from Columbia Orthopedics NewYork-Presbyterian Academic Medical Centers 30 Day Readmission Rates – Related 2016 Source: Academic Medical Centers Data: Re ects data compiled from Columbia Orthopedics NewYork-Presbyterian Academic Medical Centers * All Readmissions Source: Academic Medical Centers Data: Re ects data compiled from Columbia Orthopedics 8 | NewYork-Presbyterian Orthopedics NewYork-Presbyterian Orthopedics Quality and Patient Safety Initiatives 60% 70% 80% 90% 100% Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Foot and Ankle Hand 60% 70% 80% 90% 100% Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 60% 70% 80% 90% 100% Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Preoperative Timing Preoperative Dose Preoperative Timing Preoperative Dose Preoperative Timing Preoperative Dose Source: NewYork-Presbyterian Data: Re‚ects data compiled from Columbia Orthopedics 60% 70% 80% 90% 100% Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 60% 70% 80% 90% 100% Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Preoperative Timing Preoperative Dose Preoperative Timing Preoperative Dose Shoulder, Elbow, and Sports Medicine Spine Hip and Knee Antibiotic Usage Q3 2015 - Q4 2016 Constant attention and continuous quality improvement allow the Department of Orthopedics at NewYork-Presbyterian/Columbia to function with near 100% reliability. Meeting the Challenges of SSIs 2017 Report on Clinical and Scientific Innovations | 9 Spine Fusion SSI Prevention Measures Q1 - Q4 2016 *Antibiotic compliance includes timing, weight-based dosing, and re-dosing Source: United Healthcare Pay-for-Performance Program (AAOS 2016); Based on Best Practice Guidelines authored at NewYork-Presbyterian/Columbia University Medical Center Data: Re‹ects data compiled from Columbia Orthopedics 0% 20% 40% 60% 80% 100% Baseline Q1 2016 Q2 2016 Q3 2016 Q4 2016 (n=124) (n=99) (n=113) (n=83) (n=116) Total Bundle Compliance 40% 54% 84% 94% 92% Antibiotic Compliance* 60% 61% 85% 94% 92% Preoperative CHG Use 65% 95% 100% 100% 97% Intrawound Vancomycin Compliance 78% 91% 99% 100
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