New program lifts UTMB above national norm for patient safety

For immediate release: March  14, 2007

GALVESTON, Texas - How do you take a hospital with a good safety record and make it so safe that nurses and doctors would not think about having their family members anywhere else when a medical need arises? To find a solution, the University of Texas Medical Branch at Galveston took to the air 14 months ago and they've landed with a new safety philosophy.

It's called crew resource management (CRM) - a checklist-based communications system that the FAA mandated for the aviation industry in the 1980s, after a series of airline disasters caused by human error. Before taking off, pilots and crews now have to complete a highly detailed checklist and agree to aggressively raise "red flags" whenever some part of the process does not feel or look right. In recent years, inspired by an Institute of Medicine report which found that up to 98,000 patients die annually because of medical errors, the medical industry began to look at CRM as a guide to safety improvement. UTMB is an early adopter of a program, which could become the standard for patient safety.

The program was introduced in the Department of Surgery and now includes Obstetrics and Gynecology. Eventually everyone will be trained in the new safety protocols, and the hospital expects its safety record to fly high.

Dr. Dennis Gore thinks he knows why, about a year ago, his supervisor, Dr. Courtney Townsend, UTMB chairman of surgery, asked him to serve as the "physician champion" for the new CRM program that UTMB was about to implement.

"My boss said I needed it more than anybody even though I thought it looked like a colossal waste of time," says Gore, who is a surgeon, a professor of surgery - and a sometimes-impatient man. "He knew that if I was a convert I'd be less likely to complain about it."

The "lost time" that Gore dreaded comes from the mandatory briefings, or "timeouts," that the entire surgery team has to participate in, along with the still-awake patient, before any operation. The timeouts looked like bureaucratic time-wasters - until Gore began his training.

Each timeout, which in the operating room consists of around 10 steps, begins with all members of the team and the patient introducing themselves and explaining the role they're about to play. (For example, the patient might talk about possible allergies.)  They end with the surgeon reading the following statement, "If anyone has any concerns or sees anything they think is unsafe, or not in the best interest of the patient, I expect you to speak up."

"People are speaking out," says registered nurse Jennifer Baer, administrator for health care quality and patient safety, and a member of the original UTMB team that trained in CRM. Baer credits nurses with getting the program rolling in the O.R. "Nurses stood their ground about performing the checklist," Baer said. "They encouraged physicians to participate."

According to Gore, physician resistance began fading fast as it became clear that CRM led not only to increased patient safety, but also to less wasted time. For example, CRM practices require that all necessary equipment be on hand before a procedure starts. This makes surgery go much more smoothly. Previously, nurses often didn't know beforehand if a surgeon was going to require "a laparoscope or an endoscope," and the surgeon often wouldn't call for the tool until he needed it. This led to nurses "having to go to Mars" to find the instrument while the surgeon stewed.

Gore says now that the safety checks "are actually a ‘mother and apple pie' kind of thing." That is, the practice represents a basic virtue. Gore has become an enthusiastic spokesman for CRM, and helped spread the word throughout the O.R. No one claims that every single UTMB surgeon is a CRM enthusiast, but hospital leadership is so impressed with the outcomes achieved that UTMB policy now forbids anyone, from surgeon to housekeeper, from setting foot in the O.R. if they don't have CRM training.

Hospital leadership actually led the way in taking CRM training. Five leadership members, including Karen Sexton, vice president and CEO of hospitals and clinics, participated in a three-day "boot camp" given by LifeWings, a CRM-consulting firm based in Memphis, Tenn. Baer says hospital leadership was not responding to a specific problem, and that UTMB was in fact "pretty safe." But, Baer says, leadership was well aware of the IOM report, and "patient safety was near and dear to their hearts, and needed to be a priority."

"This program does require time and commitment but we knew it was the right thing to do," says Sexton.

When the leadership members returned to UTMB, they immediately ordered LifeWings training for all O.R. personnel - including housekeepers. It's difficult to prove how big an impact CRM has had on avoiding miscues, since, as Baer says, "It's hard to prove that something didn't happen." But in the year since the training began, patient survey results have improved.

Nine percent more patients than the previous year credit their surgery team with having "good teamwork across areas." This response total, at 65 percent, is 9 percent higher than the industry norm. Seventy-three percent of O.R. personnel have also reported having efficient teamwork, 14 percent higher than the industry norm.

CRM training has also led to some UTMB-specific innovations. Now, before beginning any surgery, a surgeon can watch a short training video detailing the state-of-the-science tools and procedures for the specific operation. "It's a great new educational tool, built as a direct result of the training," Baer says

With encouragement and financial support from hospital leadership, the Women and Infants Unit is currently working now to adapt the new philosophy to their practices. The plan is to eventually require all UTMB clinical personnel to take CRM training.

"The ultimate goal, says Sexton, is to make UTMB "the safest hospital in the country."

Now UTMB is leading the way for other hospitals to learn how to keep their patients safer," she said. For that, I am extremely proud." 
The University of Texas Medical Branch at Galveston
Public Affairs Office
301 University Boulevard, Suite 3.102
Galveston, Texas 77555-0144