Transitions to new teams are common during healthcare, esp. perioperative care, and are a potent source of error. How do we reduce this source of problems?

1. A/Prof. Douglas Fahlbusch, MBBS, FANZCA, GDM,
GAICD
Reimagining Healthcare Transitions in Care
Calvary Adelaide Hospital Grand Round, 6 MAY 2021

2. What this talk is about
❖ Handover of data
❖ Human element of healthcare
❖ Making sense of healthcare complexity
❖ Examples of success
❖ Examples for possible improvement

3. You’re a Patient
❖ Health data with GP
❖ Health data with Surgeon/Specialist
❖ Health data with Hospital
❖ Process repeated in admissions,
holding bay, theatre, ward, discharge

4. Grocott et al. Perioper Med (Lond). 2017; 6: 9. (Open Access - Creative Commons Attribution 4.0 International
License)
Data Siloes - repeats in
hospital
Largely inaccessible
Repeated data entry
Minimal cross-checking

5. The Case for Better Use of Healthcare Data
What Do People Want?
Patients
- Information
- Know we care
(Not forms)
Healthcare Workers (HCW)
- Helping patients
- Enjoyable/Meaningful work
(Not forms)

6. Source: Australian Institute of Company Directors
Has healthcare kept
up?
Not everything has evolved at
the same rate

7. Healthcare is complex
How do we pursue
this?
Identify things that matter to:
- Patients
- HCW
Typically:
- Safety
- Efficiency
- Great Patient/HCW Experience

8. www.ichom.org - patient & HCW-centred care - worldwide
Over 80 Disease Sets

9. Data Sharing
Accessible data
Singular data entry
Cross-checking

10. Pre-operative (preflight) check
What can we do
Adapt safety/compliance initiatives to
local - our - conditions

11. Case Example
Team Time Out
Von Willebrand’s Disease
- preop Factor VIII
Spinal Cord Stimulator
- switch off in theatre
No mechanism to ensure this critical information handed
over - even though appropriate actions had been taken

12. Post-operative (Pre-landing) Check
Team Sign Out
Previous Case Example applies:
- no mechanism to ensure critical data handed
over
- no mechanism to gather team input to potential
problems and improvements
What about preparing for the next case?
- time-saved by alerting relieving staff member

13. Putting it into practice
Reinventing Healthcare
How do we achieve this
Find a process: something that matters to patients
and/or HCW
Organise a team: critical for innovative ideas
Don’t reinvent the wheel!
Document variations: some necessary, some not
so much
Hypothesise an improvement - to test
13

14. What this talk was about
❖ Handing over data is important
❖ Humans in healthcare are important
❖ Improve something meaningful
❖ Follow a process

15. –W. Edward Deming
“94% of failure is a result of the system … Not people.”
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