The implementation of the ROP correlated with a decrease in mean response time from 190 minutes to 105 minutes, and an increase in mean quality of response from 3.25 to 3.6. Qualitative data suggests that the ROP could be applicable to other highly complex contexts with fluctuating team membership. This session will describe how quality improvement tools were coupled with human factors principles to develop a tool to improve frontline ability to detect and react to patient deterioration. The complexity of the context of emergency abdominal surgery, and the systems problems which challenge effective responses to postoperative deterioration will be explained. The potential value of a “Safety 2” Human Factors approach based on the concept of resilience rather than standardization will be explained, and the use of this approach combined with Quality Improvement techniques in our study will be explained.
Problem: Timely response to patient deterioration after emergency abdominal surgery is associated with decreased morbidity and mortality and reduced transfer to higher care levels. Systems issues are the main source of suboptimal response performance. The challenges involved are complex and require a highly flexible approach rather than a standard operating procedure
Measurement: We analyzed systems for detection and response to deterioration using focus groups, process maps, Hierarchical Task Analysis, FMEA and FRAM methodology. We measured response quality on a 5-point Likert scale (assessed by independent review of case records) and response time (from first notification of deterioration to beginning definitive treatment)
Analysis: Data on response time and quality was displayed using an annotated run chart to identify reasons for any significant changes based on improvement efforts and staff feedback. Overall before-after comparisons used Mann-Whitney U tests and ANOVA
Implementation: A Resilient Operating Procedure (ROP) card was co-developed with staff. This served as a memory aide, listed essential tasks, provided advice for common problems and suggested different options for reaching the overall objective. The card was iteratively improved using a PDCA approach