193 - Heart Center Performance Rounds : Team Learning in Complex, High Volume Environments

Poster Number: 193
Publication Number: 193.143

Shreya S. Sheth, Baylor College of Medicine, Houston, TX, United States; Felicia Cooper, Texas Children's Hospital, Houston, TX, United States; Jenna Wells, Texas Children's Hospital, Houston, TX, United States; Judson Moore, Primary Children’s Hospital/University of Utah, Salt Lake City, UT, United States; Gary Stapleton, Baylor College of Medicine, Houston, TX, United States; Tiffany S. Wrenn, Texas Children's Hospital, Houston, TX, United States; Jordana Goldman, Pediatrix, San Antonio, TX, United States

Background:
Excellent care requires team resilience, complex decision-making, identification of threats, and analysis of errors. Effective communication and detection of near misses remains a challenge.

Objective:
We describe our Heart Center Performance Rounds (HCPR), which focuses on addressing gaps, promoting Safety II concepts, outcomes transparency, education, and improvement work.

Design/Methods: HCPR is a weekly review of prior surgical and catheterization cases. Each case is reviewed against benchmarks, such as length of stay (LOS) and intubation time. Additional attention is devoted to cases that deviate from expected course, exemplify team resilience, or are valuable for team learning. Our approach underwent multiple adjustments over the first year.  The current iteration has been stable for 11 months. We focus on psychological safety by employing a moderator and establishing discussion ground rules. We leverage conferencing technology to assist with moderation and inclusion. A review committee meets to identify actionable items and track trends in discussion. This committee organizes methods for further investigation or follow up, and arranges monthly presentation back to the Heart Center.

Results: We measured improvements in psychological safety by monitoring conference participation. Median attendance was 108 persons per meeting. We noted an increase in participation over 11 months, from a median of 10 distinct voices per meeting in the first 8 weeks, to 16 distinct voices per meeting 7 months later (p-value 0.4, Fischer’s exact). A total of 42 action items originated from HCPR discussions, 28 (66%) of which have been completed. These include: new care process guidelines, operational changes, outcomes presentations, and related educational topics. As we increased awareness of quality improvement efforts, participation in these projects improved, leading to decreased overall length of stay for studied surgical repairs. Interviews demonstrated increased awareness of outcomes, and reductions in siloed conversations. Follow up topics are summarized and archived online for future reference.Conclusion(s):
HCPR has improved psychological safety, identified improvements, and promotes clinical transparency. A team approach is necessary to pursue evolving priorities. Structure for addressing threats and analyzing trends is essential for ongoing improvement. Challenges include ensuring inclusive engagement of audience participants, resources for preparation, and triaging cases in a high-volume setting.

Distinct Voices During Performance Rounds ConferenceWe noted an increase in participation over 11 months, from a median of 11 distinct voices per meeting in the first 8 weeks of this iteration, to 16 distinct voices per meeting over the last 8 weeks tracked (p-value 0.4, Fischer’s exact).