New safety strategies reduced serious surgical events in children

Ann & Robert H. Lurie Children’s Hospital of Chicago achieved more than a 13-fold improvement in surgical safety after implementing a series of interventions based on high reliability principles across its operating rooms. The hospital went from experiencing a serious safety event about every 2,977 surgical cases to a stretch of 39,654 cases over 585 days without a single serious safety event, according to the study published in Pediatrics.

Operating rooms are among the highest-risk environments in healthcare due to their complexity, pace and high-stakes nature. We are immensely proud of our entire team in the Department of Surgery for adopting key safety practices that resulted in this dramatic accomplishment, even as our surgical cases increased.”

Thomas Inge, MD, PhD, Co-author, Surgeon-in-Chief and Chair, Department of Surgery at Lurie Children’s, and Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine

“There is very limited published evidence on system-level safety interventions specifically in pediatric perioperative settings – our study helps fill that gap,” he added.

Three main safety interventions were implemented:

• Surgical Safety Stand-Downs: The Department of Surgery paused all non-essential operations for a dedicated hour, twice a year, to bring the entire perioperative team together to transparently review safety data, hear from a patient’s family and reset expectations around safety culture.

• Error Prevention Training: Frontline staff were taught practical tools for speaking up, asking questions, focusing on details and communicating clearly. Mandatory education modules were completed by 87% of staff in the first year.

• Safety Coach Program: Frontline safety coaches were trained and embedded to provide real-time, peer-to-peer feedback and model safe practices in the operating rooms every day.

“These safety interventions are practical, feasible, and replicable at other institutions,” said senior author Derek Wheeler, MD, MMM, MBA, Executive Vice President and Chief Operating Officer at Lurie Children’s. “Essential to our success is our ongoing commitment to a culture of safety and continuous improvement. Importantly, our study shows that safety reporting actually increased, which is a sign that people felt safer speaking up when they noticed something amiss, so that appropriate steps could be taken to achieve safe patient care.”