November 10, 2016

TeamSTEPPS Team Presentation

Temecula Valley Hospital

Hospital Information

• Hospital opened October 2013

• 5 Story Building-140 Beds

– All Private Rooms

– 20 ICU Beds

– 120 MST Beds

– 21 Bed ED

• Expansion plans for a second patient tower for total of 320 beds

TVH Team

• Over 700 Employees

• 300 Physicians

• Over 150 Volunteers

Mission, Vision and Values

• Mission: To deliver exceptional and compassionate patient care

• Vision: To transform the healthcare experience

• Values: Compassion, Trust, Courage and Innovation

• Patient safety is Priority

– Just Culture

– Transparency

– Staff/patients, family encourage to identify and report safety concerns

Key Programs

• TJC accredited as Primary Stroke Center

• Chest Pain Accredited as STEMI Receiving Center

• Open Heart Program

Why we are Glad to be Here!

• Our Hospital’s Unique Challenges

– New Hospital

– New Staff/Physicians

– Rapid growth

– Creating and maintaining intentional culture based on safety

• Introduction to TeamSTEPPS• Periop Education 2015

• BOG presentation

Area for Improvement

• ED Throughput– 80% of patients admitted through ED

– ED throughput involves every department in hospital

– Baseline data showed there were admission delays from the ED to the hospital

• Patient and staff/provider dissatisfaction

• Potential safety issue

– How we decided our area of focus: • Issues with ED handoff from ED to nursing floors

– Not timely

– Incomplete patient information/communication

Intervention

• TeamSTEPPS tools/strategies – Handoff

– SBAR Communication

– Face to Face Communication

– Advocacy and Assertion

• Small Tests of Change – Developed Admit Checkoff List

– Includes what should be done for patient before leaving ED and Face to Face Handoff

– Transport by RN

• Low Hanging Fruit– Developed flowchart of options when ED nurse not available

to transport patient

How We Implemented the Changes

• Key Individuals– ED and Hospitalist MDs

– Jacquelyn Ramirez, Director of ED

– Jackie Simon, ED Staff RN

– Lori Ohringer, Director of Med/Surg/Tele

– Med/Surg/Tele Staff Nurses

– Amber Gollogly, Director of Clinical Programs, Education and Training

– Kate DiDonato, CNO

• Key Strategies– Identify Risk Points

– Involvement of frontline staff

– Setting clear expectations

– Education and reinforcement of communication

– Follow up and follow through for accountability

Process Changes

• Specific Changes – Re-defined process for communication between ED and

nursing units

– Expectation for SBAR communication

– Face To Face Handoff

– Reinforced expectation for teamwork in transporting

patient

• Minor adjustments– Follow up on process when it didn’t go well

– Based on real time feedback

– Audit of process

Audit Tool

Face to Face Hand-off Validation:

Signature is Acknowledgement of Face to Face handoff only

ED RN handing off patient Face to Face signature:

Signature:______________________Time:____________

RN Receiving Face to Face handoff on floor:

Signature:___________________Time:____________

Barriers & Strategies

• Barriers Identified– Time challenges and conflicting priorities

– Inconsistency in team membership (2 key members left organization)

– Work load

• Strategies– Communication and collaboration between directors

and team members: staff were the drivers

– Cross-monitoring and feedback

– New team members were needed and committee restructured

What we found out?

• The new process could actually work!

• Needed to reframe our thinking – not focus on– what’s been done in the past

– why it can’t be done

• Surprises – Early buy in and adoption of the new process

– Staff started coming up with what they could do to improve

the process for each other and how they could support

each other

How did it go?

• Staff feedback

• New employee comment

• Medication reconciliation improved

• Eliminated patients being brought to floor without staff

awareness

• Staff Satisfaction

• Teamwork

• Opportunity to validate patient condition upon arrival on unit

Patient Satisfaction scores

• Patient admitted to floor more promptly

Next STEPPS

• Patient Safety Hero

• Annual Culture of Safety Survey

• Speak up campaign

• Monthly safety report to Board of Governors and annual TeamSTEPPS training

• Incorporated TeamSTEPPS concepts into annual Culture of Safety/Patient Experience/Service Excellence training for all employees and volunteers

• Corporate appointed physician leader for TeamSTEPPS

The Value of Participating in the IE TeamSTEPPS Collaborative

– Relationships improved between ED and Nursing

impacting team performance

– Mutual trust developed

– Improved patient safety & staff teamwork

– TeamSTEPPS was the system that helped us pull

it all together!

Something BIG is happening in the IE!

• We are glad to be a part of it!

• Happy to collaborate and share lessons learned:

Amber Gollogly

(951) 331-2270

amber.gollogly@uhsinc.com