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Mr. Potato Head teaches surgical teams to communicate

Mr. Potato Head teaches surgical teams to communicate

Rebecca Brooke (left), Dr. David Schramm and Brigitte Skinner used Mr. Potato Head to help train hospital surgical teams on how to work better in teams to improve the surgical site infection rate.


Picture 120 surgeons, anesthesiologists, nurses, support staff and quality improvement specialists huddled in teams of five in a conference room, assembling Mr. Potato Heads – yes, the children’s toy.

Each team member had a role: time keeper, assembler, instructor, observer or note taker, explained Dr. David Schramm, who purchased the toys to help train hospital surgical teams on how CUSP works. They assembled the same Potato Head several times to make improvements in how they worked as a team – faster, more efficiently, more effectively.

“I thought it was a great exercise,” said Dr. Schramm. “It was about perfecting communications and teamwork. It has direct implications for nurse-doctor communications or resident-surgeon-anesthesiologist communications.”

CUSP – the Comprehensive Unit-based Safety Program – is a model for gathering wisdom, from the people who work on the frontlines with patients, to make quality improvement and safety changes. Developed at The Johns Hopkins Hospital, CUSP was brought to The Ottawa Hospital in 2013 to tackle the problem of surgical site infections.

The hospital now has 200 staff members on 19 CUSP teams, including urology, general surgery, colorectal surgery, patient warming and glucose management. Team members include frontline staff who have experience with patients, as well as a quality improvement coordinator to support and guide changes, and a Senior Management Team member to pave the way administratively. They all have their roles – just as on the Potato Head teams. And communications across professions is key to their success.

Together, they define problems, develop solutions, test solutions, evaluate results, gather data, fine-tune solutions and expand solutions to other units or campuses. Some of those surgical site infection solutions so far include:

  • Pre-warming patients before surgery, because warm bodies can better fight infections
  • Improved wound-care management, with new dressings
  • Automatic timers in the operating room to remind staff to give the patient more antibiotics during long surgeries
  • Managing patients’ blood sugars before surgery, because patients with high blood sugar (and diabetes) have a much higher risk of infection

At first, many team members were uncertain about the impact CUSP could have, said Rebecca Brooke, one of the Quality Improvement Coordinators working with the teams. For example, timers for antibiotic redosing had been tried years ago but ultimately the change did not stick. This time, people knew the decision was based on team discussions, and that encouraged the use of redosing timers. “This time it really worked.”

“This is the first time in the history of The Ottawa Hospital the surgical teams have been able to sit together with colleagues to find solutions,” said Brigitte Skinner, also a Quality Improvement Coordinator.

“It takes time,” added Dr. Schramm. “They now realize they have a voice and are being included. They have a seat at the table.”


Surgical site infection rate is coming down

As of January, the year-to-date average surgical site infection rate had fallen to 4.18 percent from 4.8 percent in 2012-2013 – meaning 200 fewer patients a year developed an infection. The goal is 4.0 percent.

“The trend is quite clear that there’s been an improvement,” said Dr. David Schramm, who chairs the committee that oversees the teams working to improve surgical site infections.

The improvement means better patient experiences and it saves the hospital money through shorter lengths of stay and fewer readmissions. It’s also good news as we move towards Quality-Based Procedures under the new provincial health funding reforms.


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