Institute for Healthcare Improvement: Learning and Innovation Community: Reducing Surgical Complications

Overview

Available through the IMPACT network or on a direct-enroll basis, IHI’s most intensive front-line improvement work happens in Learning and Innovation Communities. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area. NOTE: This Community is for current members only; we are no longer accepting new participants in it.

Listen to an informational call on this topic.

Download a brief description of this Community.

Participation in Reducing Surgical Complications is available either through membership in the IMPACT network or through direct enrollment in the Community. Learn more about IMPACT.

The Challenge

The Solution

According to the Surgical Care Improvement Project (SCIP), there are nearly 30 million operations performed annually in the United States and a significant percentage result in preventable complications, some of which can be life-threatening. [Surgical Care Improvement Project. "Improving Surgical Care." Online information available through MedQIC.]

A 1992 study reported that reviewers had analyzed 15,000 patient records and discovered over 9,000 preventable adverse events, of which 40% were related to operative procedures. The most frequent preventable events were: technical (44%), wound problems other than infection (35%), and bleeding (31%). [Brennan TA, Leape LL, Laird NM, et al. The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II. New England Journal of Medicine. 1991;324(6):377-384.]

There are many barriers to reducing harm to patients, including but not limited to: the complexity of the core processes designed into our care delivery systems; a punitive approach which inhibits reporting and open discussion of events, and the tradition of focusing corrective action on individuals rather than on the underlying systems failures. However, adverse events can be significantly reduced by the implementation of known safety measures such as standardizing and simplifying core processes in known high-risk areas; redesigning delivery systems using proven human factors principles; partnering with patients; creating safety cultures that minimize blame and maximize communication and teamwork; and using technologies appropriately.

The emphasis of this Community is to create systems of care that dramatically improve the safe delivery of care — ultimately, systems that are safer by a factor of ten. Our goal is to assist organizations in achieving at least a 50%, if not tenfold, reduction of harm in at least one high-risk population selected at each institution.

Areas of Focus

Cardiac events
Emboli
Post-operative bleeding
High-risk events such as operative fires and wrong site surgery
Simulation
Teamwork

Aims

The aim of this Community is to significantly reduce the occurrence of some of the most serious surgical complications in one year, including infections, cardiac events, emboli, post-operative bleeding, and low-frequency, high-risk events such as operative fires and uncontrolled hemorrhage.

Specifically, in a designated population of focus we will decrease applicable perioperative adverse events as measured by a Surgical Trigger Tool by at least 50% by the end of April 2008. We will explore the use of simulation as a key tool for achieving the following goals:

>95% in an all-or-nothing measure for surgical site infection prevention (antibiotic prophylaxis, hair removal, glucose control for cardiac and normothermia for colorectal)
>95% compliance with DVT prophylaxis for high-risk patients
>95% compliance with providing intraoperative and post-operative Beta blockade to patients already receiving it pre-operatively
A reduction of the FMEA-derived Risk Profile Number by 50% for one of the following high-risk events: operative fires, wrong-site surgery, retained objects, or uncontrolled bleeding