FOCUS Update

Bruce D. Spiess, MD
Chair, FOCUS Committee

The FOCUS team, together with our research collaborators, the Quality and Safety Research Group at Johns Hopkins University, continue to forge ahead. The data collected during the literature review, analysis of the National Learning Reporting System, and observations at the five FOCUS sites, are being prepared for publication. Three publications, with joint authorship between SCA and QSRG members, have been submitted, with 5 additional manuscripts in preparation. The next phase of FOCUS is well underway, with QSRG developing tools to enhance teamwork and safety in cardiac surgery. FOCUS sites that indicated a primary interest in the Learning Collaborative are participating in the development of these tools, and will be pilot testing them in the near future.

The FOCUS team continues to seek participation and collaboration with the key societies involved in the cardiac operative setting. On Sept 16, a Society Summit was held in Boston, and was attended by the Presidents of the Society of Thoracic Surgery (Dr. Doug Mathisen), the American Society of Extra-corporeal Technology (Susan Englert), and the Society of Cardiovascular Anesthesiologists (Dr. Sol Aronson, President Elect). Dr. Bruce Spiess presented the history of FOCUS, and Dr. Elizabeth Martinez presented the work done to date, as well as the planned work. Although the FOCUS Steering Committee includes thoracic surgeons, perfusionists and nurses, participation and collaboration at the society level will enable the innovations and teamwork improvements of FOCUS to be disseminated and adopted more broadly

The FOCUS team attended the Lucian Leape/ National Patient Safety Foundation Forum in Boston on the afternoon and evening of September 16, 2010. A number of speakers reported on progress and recommendations from work groups within the Lucian Leape Institute. It was clear from listening to these reports that FOCUS is now and will be providing a vital research/interventional force to the movement to make medical care safer.

As a result of attendance at the Lucian Leape Forum, FOCUS has secured Paul O’Neill as the keynote speaker for the SCA Annual Meeting, in Savannah, Georgia, on May 2, 2011. Mr. O’Neill will talk on: “Leadership in High Reliability Organizations: Methods to Reduce Human Error. “ This keynote address will dove tail to the FOCUS session, held from 3:30 pm - 5:15 pm on May 2, 2011, where Mr. O’Neill will again appear on the panel to answer questions and provide discussion regarding FOCUS data and future programs.

Paul O’Neill has had an important career in private industry as well as public service. Mr. O’Neill served as the 72nd Secretary of the Treasury under George W. Bush (first term). Prior to this service, he had been CEO of Alcoa Corporation and the Rand Corporation. His experience from these leadership positions will form the basis for his address to the SCA and his participation in FOCUS. We hope as many members as possible will attend his address and hearing him speak is itself a reason to come to Savannah for the SCA Annual Meeting.

FOCUS Presentation at the ASA Meeting

by Bruce Spiess, M.D.

The FOCUS Initiative is a part of the program of the ASA Annual Meeting. Join us on Sunday, October 17 at 10:00 am -12:00 noon pacific time at the San Diego Convention Center, room Upper 1A for the presentation, “Patient Safety in the Complex Environment of the Cardiac Operating Room. “

Panelists for the presentation include Joyce A. Wahr, MD, Jeffrey Cooper, MD, Elizabeth A. Martinez, MD, Alan F. Merry, MD and Bruce D. Spiess, MD.

FOCUS previewed in American Heart Association newsletter

The Vol 8., No. 1 spring 2010 issue of the American Heart Association newsletter, Connections, features an excerpt from the article Spiess, BD, Wahr, JA, Nussmeier, NA. Bring Your Life into FOCUS! Anesth Analg. 110:283-7, 2010.

Pronovost Interviewed by New York Times

Dr. Peter J. Pronovost, 45, is medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore, which means he leads that institution's quest for safer ways to care for its patients. He also travels the country, advising hospitals on innovative safety measures. The Hudson Street Press has just released his book, "Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out," written with Eric Vohr. An edited version of a two-hour conversation follows.
http://www.nytimes.com/2010/03/09/science/09conv.html?em

Anesthesia & Analgesia Spotlights the FOCUS Initiative

January 26, 2010

John Melleky, SCA Foundation Executive Director

Anesthesia & Analgesia Spotlights the FOCUS Initiative

An introduction and update on the FOCUS initiative appears in two special articles, “Bring Your Life Into FOCUS “and “The Society of Cardiovascular Anesthesiologists' FOCUS Initiative: Locating Errors Through Networked Surveillance (LENS) Project Vision” in the February 2010 issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS) and the SCA.

"Preventing humans from making mistakes may be nearly impossible, but the SCA FOCUS initiative is predicated on the strong belief that making an error-free medical environment can be achieved," comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia.

Read the full article in Anesthesia & Analgesia.

FOCUS Sets Priorities

December 1, 2009

FOCUS Sets Priorities

By Bruce Spiess, M.D. and Joyce A. Wahr, M.D.

In 2009, the first year of the FOCUS research project, Dr. Peter Pronovost and the Quality and Safety Research Group (QSRG) at Johns Hopkins Hospital (JHU). completed an extensive review of the cardiac patient safety literature and reviewed the National Heath Service (United Kingdom) error reporting database, focusing on cardiac surgical errors. From this rich background, QSRG developed an in-depth, two-day observational process to research operating room factors that contribute to human errors. This observational process was conducted in cardiac operating rooms at five separate hospitals. At each of the five sites, surgeons, anesthesiologists, nurses, perfusionists, surgical technicians and hospital executive management personnel participated. Each individual completed extensive surveys on motivation and patient safety culture, and observations were conducted over several days at each site. The surveys and observations have been coded into a database and used to create a taxonomy of errors and to develop interventions. The data collected are both informative and distressing. For example, errors were made in nearly every skin preparation procedure, and in nearly every programming of the “smart” intravenous pumps. These errors were made despite the high level of motivation to provide flawless care by the OR staff who were surveyed. The data are currently being analyzed and will be presented in a series of publications over the next 6-12 months.

Although the full analysis of the observations will not be complete for some time, the FOCUS Steering Committee and QSRG have identified three priorities for interventions to improve patient safety.

1. Develop a learning collaborative within the cardiac surgical teams to enhance patient safety. This process will use the Michigan Keystone model developed by Dr. Pronovost and the QSRG team that has been so successful in eliminating catheter based infections in the ICU setting. The FOCUS learning collaborative will use reduction in wound infections as the metric that will inform us of how we are doing.

2. Develop a peer-to-peer assessment tool that can be used by operating room teams to assess their own safety performance, or be used by an invited visiting team to provide feedback regarding areas for improvement in safety. This non-judgmental, for-internal-use-only peer-to-peer assessment tool will be based on the highly successful WANO (World Association of Nuclear Operators) process that has made the nuclear industry a “highly reliable” industry.

3. Design the operating room of the future. Tackle the issues of equipment and OR design to improve the interfaces between humans and the machines they use to deliver patient care in the operating room.

The FOCUS committee is looking for more sites and individuals to get involved in the project, whether it is on a committee, on a workgroup of the three priorities above, or as a site for one of the workgroups. Committees that you can be involved in include Data, Fundraising/Grants, Public and Society Relations, Patient Safety Initiatives Liaison, Publications, Site Selection, Speaker’s Bureau, and Summit Planning. To get involved and for more details, contact the SCA Foundation at foundation@scahq.org or call John Melleky, Executive Director at 804-565-6324.

A FOCUS Update

By Bruce Spiess, M.D.

The FOCUS Initiative is making strong progress through the summer months. At the SCA Annual Meeting in San Antonio, the curtains were pulled back for a slight peek into the initial data regarding human errors in the cardiac operating rooms. At that meeting the data was described as “robust”, meaning a number of problems had been uncovered. We are happy to report that since the Annual Meeting, the remainder of site visits and follow-up questionnaires have all been completed. The Johns Hopkins University Center for Innovation in Quality Patient Care (JHUIQPC) is now hard at work collating the data and inputting it into computers for analysis. That process is huge. As part of their analysis, JHUIQPC has undertaken a review of the data using the National Reporting and Learning System from the United Kingdom, which is the largest known error reporting system in the world.

FOCUS will convene a meeting in Baltimore at JHUIQPC on August 13, 2009 for an initial review of data. At this meeting a number or representatives from the FOCUS leadership, data management committee and consultants will be present as well as the JHUIQPC team. Importantly, leadership from the Society of Thoracic Surgeons and AORN are expected to attend. Enthusiasm from other associations is growing so that we can all work together to improve patient care. Letters and phone contacts have been completed to AMSECT and we hope to solicit their participation/sponsorship of FOCUS in the future.

The committees within the FOCUS Initiative have been formed and their charges have been given to them. Notably, the publications committee is moving forward with a written process with regards to authorship and participation in publications from FOCUS data. This process should be available to all for review through our FOCUS web site. Once our August meeting is complete, we will develop our next steps based on the data obtained at our initial sites. To become involved as a volunteer with FOCUS, you can contact the SCA Foundation via email at foundation@scahq.org.