Strategies and Tools
to Enhance Performance
and Patient Safety
OWL # U:INSV727
Objectives
 Describe the TeamSTEPPS training initiative
 Describe the impact of errors and why they occur
 Describe the TeamSTEPPS framework
 State the outcomes of the TeamSTEPPS framework
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 How we communicate and work together can make
the difference between life and death. This video
exemplifies this impact.
 TeamSTEPPS is about reducing the likelihood of
these stories recurring..
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Sue Sheridan
Sue Sheridan. 76 MB (Click camera to watch. Windows Only)
Please wait patiently while movie is downloaded.
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Patient Safety Movement
“To Err
is Human”
IOM Report
DoD
MedTeams®
ED Study
1995
JCAHO
National Patient
Safety Goals
Institute for
Healthcare
Improvement
100K lives
Campaign
Executive
Memo from
President
1999
2001
TeamSTEPPS
2003
2004
Patient Safety
and Quality
Improvement
Act of 2005
2005
2006
Medical Team Training
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Length of ICU Stay After Team Training
OR Teamwork Climate and Postoperative Sepsis Rates
Avg. Length of Stay (days)
2.4
(per 1000 discharges)
18
2.2
16
50
2
1.8
%
14
Re
du
cti
on
12
Group Mean
AHRQ National Average
10
1.6
Low Teamwork
Climate
8
1.4
Mid Teamwork
Climate
6
4
1.2
High Teamwork
Climate
2
1
June
July
August
Sept
Oct
Nov
Dec
Jan
Feb
March
April
0
May
Teamwork Climate Based on Safety Attitudes Questionnaire
(Sexton, 2006)
Johns Hopkins
(Pronovost, 2003)
Johns Hopkins
Journal of Critical Care Medicine
Adverse Outcomes
Low

High
Indemnity Experience
Pre-Teamwork Training
Post-Teamwork Training
25
20
50%
Reduction
20
15
50%
Reduction
11
10
5
(Mann, 2006)
0
Beth Israel Deaconess Medical Center Malpractice Claims, Suits, and Observations
Contemporary OB/GYN
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Why TeamSTEPPS For Us?
45 Staff = 1
million possible
team combos
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72% of medical
errors directly
linked to lack
of clear
communication
$8 million
settlement……
$8 million
settlement……
•1 family affected
forever
•15 more RNs on 1
unit for next 10
years
7
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We know that communication is not
straightforward. The following video clip
exemplifies this reality.
What happened in this video?
It is a question of communication and
assumptions.
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 Another example of lack of communication
resulting from assumptions is contained in this
video.
 We may chuckle at this honest
miscommunication, but what can we do to make
sure such a miscommunication does not happen
while we are caring for our patients?
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Flowers. 8.7 MB (Click camera to watch. Windows Only)
Please wait patiently while movie is downloaded.
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 Let’s review our TeamSTEPPS tools and
see how we can effect patient outcomes like
other organizations who have improved
patient outcomes.
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Huddle
Problem solving
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
Hold ad hoc, “touchbase”
meetings to regain
situation awareness

Discuss critical issues
and emerging events

Anticipate outcomes
and likely
contingencies

Assign resources

Express concerns
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The second tool is CUS, an acronym that helps us remember three key
signal words which include: concerned, uncomfortable and safety.
Signal words, such as “danger,” “warning,” and “caution” are common
in the medical arena. They catch the reader's attention. “CUS” and
several other signal phrases have a similar effect in verbal
communication. When they are spoken, all team members will
understand clearly not only the issue but also the magnitude of the
issue. This is a way of getting someone’s attention without yelling or
using unprofessional language. It has the advantage of not alienating
others and perhaps reducing the likelihood they will contact you the
next time an emergency occurs.
First, state your Concern.
Then state why you are Uncomfortable.
If the conflict is not resolved, state that there is a Safety issue.
Discuss in what way the concern is related to safety. If the safety
issue is not acknowledged, a supervisor should be notified.
Regardless of which word is used, if we hear a someone use any CUS
word, it is our cue to stop what we are doing and pay attention because
patient safety is at risk.
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CUS
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Call-Out is…
A strategy used to communicate
important or critical information

It informs all team members simultaneously
during emergency situations

It helps team members anticipate next steps

Important to direct responsibility to a
specific individual responsible for carrying
out the task

Avoid Thin Air Commands
…On your unit, what information
would you want called out?
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Read-Back is…
Closing the loop
on information
exchange!
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Handoff
 The transfer of information
and authority/responsibility
during transitions in care.
 Includes SBAR information,
giving an opportunity to ask
questions, solicit a readback/check back of
information shared.
Great opportunity for
quality and safety!
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Situation – What is going on with the
patient?
“I am calling about Mrs. L’s fetal heart rate
tracing.
SBAR
Background – What is the clinical
A technique for
communicating critical
information that requires
immediate attention and
action concerning a
patient’s condition.
background or context?
She is a primigravida who is being induced
Assessment – What do I think the
problem is?
I think she is having late decelerations. I
have stopped the Pitocin, and she is on her
left side with oxygen on.
Recommendation – What would I do to
correct it?
I am concerned. I would like you to come
evaluate her tracing. When can I expect
you?
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Vig3alg001parathyroidbad.mpeg : 26 MB (Click camera to watch. Windows Only)
Please wait patiently while movie is downloaded.
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How could this be prevented?
With better communication as shown in
the next video.
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parathyroidgood.mpeg : 53 MB (Click camera to watch. Windows Only)
Please wait patiently while movie is downloaded.
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How we communicate and work together can make
a difference in the care of our patients.
Thank you for taking time to view this
TeamSTEPPS presentation.
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