Identification of Local Problem
There was a need to strengthen surgical safety practices and team engagement at Walter Reed National Military Medical Center (WRNMMC) to reduce patient safety risks and ensure consistent adherence to national safety standards. Variability in surgical brief processes and incomplete discussion of critical safety points posed potential patient safety concerns.
Context of the QI Activity
The project was carried out within a large military medical center that aligns its practices with The Joint Commission (TJC) National patient Safety Goals, the Defense Health Agency’s Ready Reliable Care framework, and Leapfrog surgical safety standards. The initiative required a team-based approach, leadership engagement, educational development and sustainment training in a high-stakes surgical environment.
What were the interventions?
Development of a whiteboard magnet that could be visualized by the surgical team and an optional written surgical brief checklist tool to address both standard patient/procedure details and highlight key patient safety issues (e.g., long procedure times, DVT prophylaxis, specialty equipment, projected specimens, ASA class). Incorporation of Team STEPPS principles into conducting in-person training, with targeted education sessions for surgical staff, hands-on coaching during surgical brief, and in person audits using visual checklists and audit tools to measure compliance.
Costs and Funding Sources
Resources came from existing WRNMMC operational budgets and staff training was done during clinic education days.
Overall Results and Analysis
Achieved a 14% increase in adherence to all surgical safety elements. WRNMMC became one of only 9 military treatment facilities to earn an “A” Leapfrog Patient Safety Grade. The structured checklist, reinforcing the use of the whiteboard, and Team STEPPS based training have been effective in improving compliance and fostering a just culture in the Operating Rooms.
Limitations
Inability of clinical auditors to attend Surgical briefs for every case performed in the main operating room to monitor compliance and provide hands-on coaching support. The high turnover rate of staff at a military training facility puts knowledge at risk of being lost when experienced staff rotate out.
Lessons Learned
A well-designed checklist visible to the surgical team can significantly enhance communication and safety during surgical procedures. Face-to-face coaching during the Surgical Brief was instrumental to team engagement and the Team STEPPS process, while auditing reinforced adherence and sustain improvements. Leadership engagement and a just culture empowering staff to speak up are critical for success. Closed loop communication on audit performance allowed for feedback from surgical team and reinforced adherence to surgical safety practices. Aligning local practices with national safety standards supports measurable outcomes and external recognition.
