15 Health Care Standardization (Dikis 2024).pdf

Health Care Standardization Ashley M. Dikis, DPM, FACFAS Objectives 01 02 Identify the role of Recall the role of checklists in standardization in providing safe, high health care outcomes quality and cost-...

Health Care Standardization Ashley M. Dikis, DPM, FACFAS Objectives 01 02 Identify the role of Recall the role of checklists in standardization in providing safe, high health care outcomes quality and cost- effective care  “…the process of developing, agreeing upon and implementing uniform technical specifications, criteria, methods, processes, designs or practices that can increase compatibility, interoperability, safety, repeatability and quality…” —Standardization in patient safety: the WHO High 5s project Introduction Standards or standardization? Competing theories of standardization versus customization Humans are prone to error due to many underlying factors (i.e. fatigue, stress, interruptions, production pressure, etc) Introduction What we’ve learned from other professions/sectors… Standard Sub-Types: Timmermans and Epstein Design Performance Explicitly define the properties and features 01 02 Set outcome specifications for of products or services to service delivery ensure uniformity and compatibility Procedural Terminological Specify how Support stability of meaning (i.e. ICD) 03 04 processes are to be performed and the steps to be taken  01 Role of Standardization in Health Care Outcomes Federal Level - Overview President Department of executive DHHS branch overseeing federally controlled healthcare Surgeon Agency for Healthcare General FDA Research & Quality Patient Safety Organizations CDC and Network of Patient Safety CMS Databases AHRQ Recommend various screening exams, coverage of services PSOs NPSD  Standardization A growing body of literature demonstrates that when patterns of care are widely divergent, clinical outcomes suffer ○ Patient safety may be compromised ○ Example: Sliding-scale insulin protocol 6 week trial 3.85% vs. 1.49 (p500ML BLOOD LOSS CONFIRMED? ARE THERE EQUIPMENT (7ML/KG IN CHILDREN)? ISSUES OR ANY CONCERNS? NO YES, AND ADEQUATE INTRAVENOUS ACCESS HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN AND FLUIDS PLANNED WITHIN THE LAST 60 MINUTES? YES NOT APPLICABLE IS ESSENTIAL IMAGING DISPLAYED? YES NOT APPLICABLE THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED. WHO Safe Surgeries Save Lives program 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery Primary end point was rate of complications, including death, during hospitalization within the first 30 days after the operation Results: ○ 1.5% mortality prior to checklists ○ 0.8% after checklist (p=.003) Checklists Physicians have a tendency to push back against any rules/restrictions that threaten to diminish their autonomy in practice ○ Data shows us that checklists and standardization decrease morbidity and mortality Checklists: Origins Popularized through studies funded by the WHO, led by Dr. Atul Gawande Some subsequent studies lacking the same promising outcomes ○ Role of implementation strategy Presentation by administration Checklists: Development Multidisciplinary work group ○ Evaluate and understand the needs of users ○ Understand the environment ○ Detailed review of the existing literature Short, concise and useful information is included ○ No extraneous information to distract ○ Easy and efficient ○ Clear as to the “who, when and why” Rigorous pilot testing and revision based on results Checklists: Types Static Parallel ○ One person read and perform ○ Grocery list, anesthesia machine checklist Static Sequential with Verification ○ Two person read and verify (challenge & response) ○ Airline take off Static Sequential with Verification & Confirmation ○ Team based challenge & response ○ Pre-surgical checklist Dynamic ○ Flow charts and algorithms to guide complex decision- making ○ ACLS pathways Checklists What does this look like for us as podiatric physicians and surgeons? OR Time Out Everyone quiet No activity Typically performed by the circulating nurse All present in agreement Checklist Electronic order entry ○ No need to memorize order sets ○ Static and dynamic checklists ○ Hard stops prevent error or omission ○ Can use same order set for each procedure ○ Benefit demonstrated compared to traditional paper charting Checklist - Examples Checklist - Examples Checklist - Examples Checklist - Examples Checklist - Examples Checklist - Examples Checklist - Examples Summary Role of standardization in outcomes ○ Majority of published data supports improved outcomes ○ Implementation plays a role Role of checklists ○ Decreases human error ○ Accountability for all team members ○ Ease with use of EMR ○ Hard stops ○ Types of checklists References Dalhke et al. The Case for Standardizing Cesarean Delivery Technique. Obstet Gynecol 2020;136:972–80. Drs. Nelson, Dayton and Pehde. Lecture Material. Des Moines University, last updated 2020. Haynes et al. A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. N Engl J Med 2009;360:491-9. Rozich et al. Standardization as a Mechanism to Improve Safety in Health Care. Joint Commission Journal on Quality and Safety. 2004; 30(1): 1-14. Winters et al. Clinical review: Checklists – translating evidence into practice. Critical Care 2009, 13:210. Young M, Smith MA. Standards and Evaluation of Healthcare Quality, Safety, and Person-Centered Care. [Updated 2022 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK576432/  Thanks Copyright Notice: This presentation may contain copyrighted material used for educational purposes under the guidelines of Fair Use and the TEACH Act. It is intended only for use by students enrolled in this course. Reproduction or distribution is prohibited. Unauthorized use is a violation of the DMU Integrity Code and may also violate federal copyright protection laws. Please keep this slide for attribution