Quality award winner takes 'STEPPS' to improve

Hospital uses TeamSTEPPS philosophy

Exeter (NH) Hospital has already demonstrated its ability to improve quality and patient safety, but it's nowhere near finished. The facility, which has been named to Harvard Pilgrim Health Care's 2009 Hospital Honor Roll in recognition of its excellence in clinical quality and patient safety, is launching a new initiative based on the TeamSTEPPS program jointly developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD). (Honor Roll designees are those adult, acute-care hospitals whose performance was among the top 25% nationally, as reported by the Centers for Medicare & Medicaid Services.)

"We are proud of the recognition but far from satisfied," says Barbara Hughes, DNP, RN, vice president of system quality for Exeter Hospital.

The TeamSTEPPS program incorporates many of the most effective safety tools developed from the airline industry, national defense programs, and other highly safety-focused organizations and applies them to care settings such as the emergency department, operating rooms, and obstetrical services.

First released in 2006, TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

TeamSTEPPS seeks to provide higher-quality and safer patient care by:

  • producing highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients;
  • increasing team awareness and clarifying team roles and responsibilities;
  • resolving conflicts and improving information sharing;
  • eliminating barriers to quality and safety.

TeamSTEPPS has a three-phased process aimed at creating and sustaining a culture of safety with:

  • a pre-training assessment for site readiness;
  • training for onsite trainers and health care staff;
  • implementation and sustainment.

"This program has the ability to revolutionize the way we work together as a team and communicate during challenging patient encounters so that we provide our patients with the safest environment and best clinical outcomes," says Hughes.

Project goals clear

Hughes is very clear on her goals for the program. "We are looking at preventing errors and improving patient safety," she asserts. In fact, she says, the program has grown out of Exeter's own patient safety initiative. "Basically, we did a culture of safety survey a couple of years ago," Hughes recalls. "We were pleased overall, but we felt there were still opportunities for improvement — especially in high-risk areas like communications and handoffs."

One of the reasons TeamSTEPPS was chosen, she continues, is that it helps identify preventable errors. "They've been doing training for the last couple of years for health care organizations, and there is no charge," says Hughes. (There are Five Team Resource Centers at Duke Medical Center, Durham, NC; Carilion Clinic, Roanoke, VA; University of Minnesota Fairview Medical Center, Minneapolis; Creighton University Medical Center, Omaha, NE; and University of Washington Medicine, Seattle.) "The only thing you have to pay for is to send folks to the training. You complete a readiness assessment, they evaluate you, and you get accepted." (To apply for eligibility for training, call 877-6STEPPS.)

The TeamSTEPPS National Implementation Project also will provide support and guidance for the Team Resource Centers and their trainees through a user support network. This network will ensure proper implementation of TeamSTEPPS principles by offering channels of communication through webinars, a toll-free telephone line, and a web site. Trainees also will receive continuing education through new tools and measures that are researched, developed, and validated to supplement the curriculum.

Exeter sent six individuals to the three-day "Master Training" course — the chief of surgery, head of the ED, the quality coordinator and director of accreditation, one of the nurse leaders in the ED, and two family practice physicians from obstetrics. "Now the facilitators have come back and developed a project plan," says Hughes. "They've also developed a scope for training and project goals; clinical and team goals; team assessment evaluation; and are now creating a training plan for all staff in the OR, the ED, and labor and delivery. We have a couple hundred folks who will go through training, which is just now being rolled out."

Department goals customized

In terms of team goals for the various departments, they are customized for each specific area, Hughes explains. "In the OR, we will be using specific tools and techniques they learned in the TeamSTEPPS training program," she says. "These include the interdisciplinary briefs, where you stop and evaluate the situation and take a 'time out.' We are also looking to consistently sustain the goals of the Surgical Care Improvement Project [SCIP] at greater than 95% compliance; one of the ways we hope to do that is by using some of the teamwork tools and techniques." SCIP is a national quality partnership of organizations committed to improving the safety of surgical care through the reduction of postoperative complications.

In the ED, on the other hand, the focus will be on handoffs, in particular between the department and inpatient units. "There we will use the SBAR [Situation-Background-Assessment-Recommendation] tool and focus on core measures for conditions such as pneumonia and medication events related to handoffs," says Hughes. "So, you decide what is significant for your particular area."

The chief of surgery is the lead for the project, says Hughes, while she is providing administrative oversight.

[For additional information, contact:

Barbara Hughes, DNP, RN, vice president of system quality, Exeter Hospital. Phone: (603) 778-7311. Web site: http://teamstepps.ahrq.gov/.]