Day 1 Speaker Presentation - Emma Joynes
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The document details a health partnership between Lifebox and Kilimanjaro Christian Medical Centre (KCMC) aimed at promoting safe anaesthesia and improving surgical efficiency through the implementation of a surgical safety checklist. Compliance with the checklist showed significant improvement, leading to decreased cancellations and enhanced theatre efficiency. Challenges included communication barriers and the need for ongoing education and empowerment for local faculty.
Day 1 Speaker Presentation - Emma Joynes
- 1. Sustainable change Lifebox KCMC Dr E Joynes THET conference London October 2017
- 2. Background • Kilimanjaro Christian Medical Centre (KCMC) • Referral hospital for Northern Tanzania • Health partnership between Lifebox and KCMC • Projects to promote safe anaesthesia
- 3. Sustainable projects – Equipment – a little yellow box – Education – National nurse curriculum – Efficiency and safety in theatre
- 4. How to maintain this partnership? – Lifebox fellow – Education and empowerment of local faculty – Pulse oximeters and Lifebox training – Funding
- 5. How to maintain this partnership? – Regular follow up of quality improvement (QI) projects – Communication and good relationships
- 6. Successful projects The Surgical Safety Checklist • Multiple attempts to roll out checklist at KCMC • A needs assessment was carried out • Surgical heath care staff education • Checklist was implemented
- 7. Theatre efficiency • Theatre cancellations before and after checklist • Number of operations • Cancellations • Reasons for cancellations • Start/finish times
- 8. Checklist • Audited: – Sign in – Time out – Handover to recovery • We assumed improved compliance would result in improved – Safety – Efficiency – Reduced cancellations
- 9. Findings: Checklist • Morning team brief 59% • Sign-in 87% • Sign-out 67% • Recovery handover 35%
- 10. Table 1: Compliance with checklist First audit cycle Second audit cycle Sign-in 41% 87% Sign-out 0% 67%
- 11. Table 3. Operations and cancellation rate Theatre After checklist Ops planned Ops done Ops cancel Start Time earliest Start time latest Finish time latest 1 207 189 18 (9%) 9.30 12.45 20.00 2 270 189 81 (30%) 9.00 16.20 20.00 4 366 280 86 (23%) 8.30 13.00 20.00 5 235 190 45 (19%) 9.15 16.00 21.00 average 269 212 20% Before checklist 1 509 401 108 (21%) 8.40 12.50 2 449 278 171 (38%) 9.15 16.15 4 826 514 312 (38%) 8.55 13.40 5 525 350 175 (33%) 9.00 13.30 average 577 386 33%
- 12. Table 4: Reason for cancellations Surgical Anaesthetic Patient Theatre (delay/chan ge/ Out of time) Not paid Before Checklist 10.5% (76) 0.5% (4) 24% (126) 57% (402) 8% (59) After Checklist 8% (21) 2% (6) 41% (111) 39% (103) 10% (25)
- 13. Discussion: Checklist • Compliance improved after implementation. – ENT (100%) – Ophthalmology (0%) • Sign-in 87% • Sign out 67% • Pre-operative assessment: recognise/prevent problems • Sign-out improved following critical incident • Development of safety culture
- 14. Discussion: Checklist • Barriers: – Lack of seniors – Lack of ownership in theatre – Communication – Extra work – Paper checklist (not in notes) versus wall laminate – Lack of compliance - sign-out and recovery handover – Improved compliance during audit week
- 15. Discussion: Efficiency • Cancellations decreased – 39% • Improved efficiency
- 16. Discussion: Efficiency • Cancellations due to theatre efficiency – 57% – 39% • Patient factors increased after implementation – 24% – 41% • Patient problems highlighted in pre-op assessment
- 17. Recommendations 1. Education/awareness 2. Satellite theatres 3. Introduce to obstetrics and emergencies 4. Champion/fellow 5. Handover to recovery
- 18. Conclusion • Successful healthcare change through a sustainable partnership between KCMC and Lifebox • Barriers – lack of fellow, more work, lack of communication and structure
- 19. 5.19
- 20. References • The Lancet commission on Global Surgery, 2015. Accessed 7/4/2017 at www.lancetglobalsurgery.org • Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AHS et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine 2009; 360: 491-499.