LEAN SIX SIGMA WORLD CONFERENCE
Keeping Children’s Hearts Precious: Providing Exceptional Care While Fighting Infections
Presenter: Jamie MacLaren, Continuous Improvement Specialist, Michigan Medicine, Ann Arbor, MI, USA
Co-Presenter: Mandy McKay, Project Manager, Michigan Medicine, Ann Arbor, MI, USA
Keywords:Healthcare, Quality, Value Stream Mapping, Root Cause Analysis, Sustainment
The Congenital Heart Center (CHC) at Michigan Medicine
C. S. Mott Children’s Hospital is one of the largest and top performing pediatric heart programs in the United States. In fiscal year ‘19, the CHC performed 519 surgeries on children with complex congenital heart disease, which is more than nearly every other program in the nation. Though our clinical outcomes are reputable, patients in this population are susceptible to hospital acquired conditions (HACs), including surgical site infections based on the complex nature of these procedures. As clinical teams strive for continuous improvement, the CHC identified an opportunity seeing that their surgical site infection (SSI) rate was higher than national benchmarks. Based on data gathered and shared by our Infection Prevention & Epidemiology (IPE) department, the CHC SSI rate for fiscal year ’18 was 2.3%, which was 15% higher than other ‘like’ institutions. In an attempt to close this gap, the CHC teamed up with members of IPE and Clinical Design and Innovation (CDI) to understand potential opportunities. A multidisciplinary team was formed including, nurses, cardiologists, surgeons, techs, Child Life Specialists, call center staff, environmental services, anesthesiologists, respiratory therapists, perfusion, IPE, administrators and patient advisors. This team took on the challenges surrounding surgical site infections by using current state process mapping, root cause analysis, prioritization, and countermeasure development to implement and sustain successful interventions. The continuum of care through the system for CHC patients was an area of focus, based on identified opportunities during the gap analysis phase.
Patient education and the day of surgery were targeted as areas of high impact on patient outcomes, primarily SSIs. The current state of patient education included all necessary information, however, the team identified there was no standard process in which it was provided to patients.
Involving patient advisors also revealed that the education material did not convey the importance of infection prevention, nor did it encourage patients to take ownership of and be personally involved in preventative measures that help to avoid potentially negative outcomes. A four-page standardized education document was created that gives an overview of the importance of infection prevention as well as critical steps that can be taken by the patient and their family to improve the outcomes of their care. While the involvement of the patient in their own care is important, the CHC also had process gaps in the preparation for surgery. Through value stream mapping, the team identified that although most infection prevention steps were taken, it was hard to identify at what point during the continuum they were competed and what role performed them. This led to partnering with our Information Technology group and creating standard documentation within the Electronic Medical Record (EMR) that can be accessed by the entire care team so everyone is able to be on the same page about what tasks still need to be accomplished before the patient is properly prepared for surgery. The day of surgery is the most critical time to guarantee all steps are taken to keep the patient safe from preventable harm, especially SSIs. Several opportunities were identified by the team and countermeasures were developed to close the gaps. Instead of relying on staff to notify environmental services of soiled areas in the pre-operative and waiting room areas, there are now standard schedules for what needs to be cleaned and when the cleaning should occur. Anesthesia representatives identified the need to separate the intravenous (IV) lines from the ECHO probe to avoid saliva transferring from the mouth to the line access points, this led to a standard set up of IV lines that all anesthesia faculty now use. Nursing staff have also adopted standard set up practices for the instruments and machines that they use during the case. This prevents possible contamination of the sterile field during the procedure. These countermeasures, along with many others, were identified and implemented through various methods over the course of the 1.5-year program. The team is now in a sustainment phase where a control plan has been developed, data is being monitored, and process owners are taking over the facilitation of continuous improvement. Through this initiative with CDI and the partnership with IPE, the CHC has seen a reduction in their SSI rate from 2.3% in fiscal year ’18 to 1.5% in fiscal year ’19!