by Candi Helseth
Most medical errors are caused by communication breakdowns among health care teams—so the best way to improve patient safety is to improve communication and teamwork skills among health care professionals. That is the goal of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), an evidence-based teamwork system designed for health care professionals by the Department of Defense’s Patient Safety Program and the Agency for Healthcare Research and Quality.
By implementing TeamSTEPPS, Grande Ronde Hospital, a Critical Access Hospital (CAH) in northeast Oregon, has reduced patient complaints in the Emergency Department by 21 percent and the number of patients leaving ER without being seen by 37 percent.
TeamSTEPPS encourages hospitals to begin with manageable projects, addressing one issue or department at a time. Grande Ronde, located in La Grande, Ore., began by targeting improvements in STEMI (“ST segment elevation myocardial infarction,” a type of heart attack) care in ER. Their data indicated only one-third of patients with STEMI received the recommended administration of an EKG within 10 minutes and thrombolytic medication within 30 minutes of arrival. Using TeamSTEPPS’ tools, Grande Ronde developed a multi disciplinary STEMI team, which pulled together the city-owned emergency medical services and hospital staff from various departments. Now EMS does patient assessments in the field and notifies ER in advance when a patient meets STEMI team activation criteria. The STEMI hospital team assembles in ER, ready to begin treatment as soon as the patient arrives. Current data indicates all STEMI patients receive an EKG within 7 to 10 minutes and thrombolytic administration within 30 minutes or less.
“We have a defined plan of action with people inside and outside the hospital working together, and it’s amazing to see how well it works using TeamSTEPPS communication tools,” Quality/Risk Manager Brandie Manuel said. “It sounds so simple but we had gotten really frustrated trying to find a solution on our own.”
Providing Greater Flexibility and Accessibility
Following a hospital-wide survey of nurses, McCune-Brooks Regional Hospital, a city-owned CAH in Carthage, Missouri, implemented TeamSTEPPS to improve nursing handoff-related events such as medication and intravenous therapy errors. Handoff errors generally occurred between shift changes or when patients were transferred to other floors.
“We’ve decreased handoff events by 8 percent since beginning a year ago,” Chief Nursing Officer Sherry Lopez said. “Our biggest change has been implementing point of care documentation for nurses. We utilize a piece of the patient’s electronic medical record for a patient summary now. All nurses can immediately access that patient information. We have computers in every patient room and nurses do documentation immediately at the bedside. That makes it less likely that medication or procedural related errors happen. It also puts our nurses at the patient’s bedside more rather than in a workroom doing patient records.”
Manuel and Lopez praised the program’s ability to take global terms like leadership and communication and associate them with concrete behaviors and skills in its training materials. Each institution receives a flexible curriculum and training kit they can adapt and modify to fit their particular needs. While basic concepts are uniform, implementation can be different for each organization.
Intensive training is another key to the program’s success. Hospitals send teams to any of five Team Resource Centers for what TeamSTEPPS calls a “train the trainer” approach. These individuals, who become certified as Master Trainers, return to their communities to train others. Trained coaches also mentor and reinforce changes made within hospitals.
Grande Ronde, a member of the Oregon Rural Health Quality Network (ORHQN), collaborated with two other ORHQN CAHs to obtain grant funding that covered training costs at the University of Nebraska Medical Center in Omaha. Primaris evaluated McCune-Brooks’ survey results, provided TeamSTEPPS training at the hospital, and offered additional support in enhancing the patient safety culture, Lopez said. McCune-Brooks completed a hospital-wide survey of staff perception related to patient safety and culture, identified improvement opportunities and presented their findings to hospital leadership to garner support before implementing TeamSTEPPS.
“TeamSTEPPS’ proven tools and its easiness to use encourage administrative and staff buy-in throughout the hospital,” Lopez said.
After an F5 tornado devastated Joplin, Missouri, in May, the Centers for Medicare and Medicaid Service (CMS) granted McCune-Brooks a waiver to accommodate an additional 27 patients and open a third Operating Room. The hospital’s Operating Room volumes almost tripled and the daily census more than doubled from 16 to 37 patients. Lopez said McCune-Brooks operated with existing staff until the end of June when the Talent Share Agreement was implemented with another hospital. Lopez said having the TeamSTEPPS hand-off tool in place helped McCune-Brooks accommodate the increased volumes.
“Under Talent Share, we obtained approximately 150 employees, most of those in the nursing department,” she said. “Their orientation included instruction in TeamSTEPPS tools and the bedside report we are using. We haven’t had an opportunity to do any specific data collection; however, I do believe that if this mechanism were not in place with the increased patient load and new staff, we would have seen an increase in adverse events.”
Influence of TeamSTEPPS Widening
Grande Ronde is developing a 2012 curriculum that encompasses employees in all departments. Manuel said the hospital’s efforts have shifted as they’ve progressed, relying more on coaching and mentoring as needed. “We feel strongly that our entire organization has benefited and it’s important to give all our employees these tools,” she added. “Our non-clinical areas have given us such positive feedback. They feel the training empowered them in ways they didn’t have previously. They really took hold of these tools and changed their processes for the better.”
TeamSTEPPS’ programs are being used in hospitals of all sizes in rural and urban settings. According to Battle, about 2,000 individuals from 700 hospitals have completed training at the five national training centers. The ripple effect has extended the program in immeasurable ways. For instance, with additional funding supplied by the Oregon Office of Rural Health and ORHQN, Manuel said the three CAHs that initially applied for grant funding have since trained staff in 12 additional Oregon CAHs.
A June 2011 policy brief released by the Maine Rural Health Research Center, Improving Hospital Patient Safety Through Teamwork: The Use of TeamSTEPPS in Critical Access Hospitals, concludes that TeamSTEPPS improves processes and reduces errors. “TeamSTEPPS builds a foundation for teamwork that is critical to improving safety and quality,” stated James Battles, PhD, an analyst for AHRQ patient safety who heads the TeamSTEPPS program. “In many community based hospitals, communication lapses or lack of teamwork are underlying factors in adverse events because there is no definitive core team in residence at the facility. Physicians and emergency medical services may be independent from the hospital and, particularly in CAHs, hospital staff may be pulled from different departments for situations such as trauma cases because many CAH emergency rooms do not have 24-hour staffing.”
“The value of TeamSTEPPS is confirmed every day when we hear and see people using these tools,” Manuel said. “At Grande Ronde, we’re going broader now to improve patient safety culture across the entire organization.”
Back to: Fall 2011 Issue