Update on ongoing departmental safety, quality initiatives

By Andrea Vannucci, M.D.

Sara Robertson, Newsletter editor asked me to provide an update on what's happening in our department from the patient safety and quality improvement standpoint.

I believe there are several ongoing initiatives that can be of general interest and are being developed thanks to the active participation and effort of a large number of our members.

Before providing a brief review on these ongoing projects, I would like to underscore that a common denominator of many of these initiatives is the active role that our Department has been playing to establish interdisciplinary collaborations with several other UMMC Departments and Units to the goal of designing new, safe, and more effective clinical processes.

Another important feature common to several of these projects is the requirement of a close collaboration with the informatics team. In fact, their implementation is critically dependent on updating the electronic medical record to support those best practices by driving consistent workflows and appropriate documentation.

At an Institutional (A) and departmental (B) level the following initiatives have recently been completed or are currently well on their way:

A. Multidisciplinary collaborations:

1) We have revised the UMMC Policy for Moderate and Deep Procedural Sedation. In addition we have redesigned the training and assessment of competences of clinicians requesting procedural sedation privileging.  In collaboration with the colleagues at the Simulation Center, we are currently working on establishing a calendar for the sessions to be held during the academic year 2018-2019.

Of note, the revised Sedation Navigator, the Epic tool used to document procedure performed under moderate and deep sedation by non-anesthesiologists, will support an electronic auditing process for all procedures performed under procedural sedation.

2) We have initiated an interdisciplinary collaboration with colleagues from Pharmacy, Infection Prevention, Surgery, Allergic Diseases, and Perioperative Nurses to develop an institution-wide guideline on Antibiotic Surgical Prophylaxis. The guideline is based on national standards, but also on the prevalence of pathogens and of their antibiotic resistances at UMMC.

The goals of these projects are two fold: 1) to decrease surgical infection rates; 2) to promote antibiotic stewardship and evidence-based practices.  

The full implementation of this project still requires approval by appropriate UMMC committees and the resolution of some significant issues in the electronic record to include the antibiotic orders in the surgical case requests. This IT upgrade is considered a crucial step to promote the timely and consistent implementation of these guidelines in daily patient care.

3) In collaboration with Pharmacy, and colleagues from adult Medical and Surgical ICUs and ER, we have launched an initiative for Drug Infusion Standardization (volume, concentrations and units of measurements) infusions across all adult locations.  

4) We are working with our Radiology and Infection Prevention colleagues to revise the Workflow of MRI cases under Anesthesia Care to enhance good clinical practices, like adherence to isolation precautions in patients with airborne diseases; timeout before anesthesia induction; verification of the appropriateness of the requested study by radiologists for all elective cases; and discussion and documentation of informed consent for anesthesia care.

5) Several of our clinicians have been collaborating with our surgical colleagues to design and implement Enhanced Recovery after Surgery (ERAS) Protocols. Among those protocols, I would like to name a clinical care pathway for patients undergoing colo-rectal surgery and an opioid-sparing protocol in major liver and pancreatic resections that have recently been rolled out.

6) Our group is working on instituting a Quarterly Joint Morbidity and Mortality of the Departments of Anesthesiology and Surgery. The first date is scheduled for October 3^rd, 2018: the conference will focus on the Intraoperative Use of Massive Transfusion Protocols. Speakers will include representative of both Departments as well as representatives of UMMC Blood Bank.

B. Within the Department of Anesthesiology:

1) We have launched a Case Review Committee including residents, nurse anesthetists, and faculty with the goal of assuring the timely and transparent review of adverse events and near misses, so that as a group we can learn from those events and improve our clinical practice.

2) We have redesigned the Morbidity and Mortality Conferences to increase their education value, while trying to prevent the mistake of blaming individuals for complications that are often the consequence of larger and systemic issues. 

3) We have renewed a contract with the National Anesthesia Clinical Outcomes Registry (NACOR-AQI) and we plan to start submitting data to this registry as soon as the EPIC team has completed the necessary interface. This collaboration will allow the department to compare our performance in several clinical domains at a national level.

In addition, interested members of our department will have an exciting opportunity to pursue research endeavors mining the data contained in the largest national database of anesthesia quality data.

4) Members of the Department with an interest in research, have just launched a new Research Forum.  This group will meet every 2^nd Tuesday of each month in Room S123 at 5 pm to review basic and advanced research topics, as well as to provide advice on individual research projects. The goals of this project are to support the education in clinical and translational research and to promote the pursuit of original investigations by members of our Department.

Our chair, Dr. Bacon and UMMC Chief Medical Office have strongly encouraged and supported these quality initiatives. UMMC as an institution is deeply committed to improve patient safety and quality of care and we, as a department, have been working on aligning our goals and priorities in these areas with the Institution at large. In these difficult times for health care financing, taking advantage of synergy and interdisciplinary collaborations is the best way to face challenges and to advance the academic mission of our department: to provide the best education to the next generations of health professionals, to generate new transferable knowledge, and to improve the medical care of Mississippi patients.

Currently the Patient Safety and Quality Improvement team is focusing on other problems that have been detected through self-analysis and case review, or that have been brought to our attention by other Departments and the UMMC leadership. We anticipate that new projects will soon be deployed as part of our continuous quality improvement efforts. All Individual interested to participate in PS and QI initiatives are welcome: our team is looking forward to receiving new collaborators and new ideas.