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Skagit Valley gets checklist on board with physician champion
Joyce Cardinal, RN, MBA, director of quality at Skagit Valley Hospital in Mount Vernon, WA, says she was lucky. One of Skagit's surgeons is on the SCOAP data committee, and after she attended a meeting about the surgical checklist, she already had a physician champion on board to get it started.
That surgeon started it first in his own OR and then worked on implementing it with other specialties. "At the same time, we got anesthesia on board so they could really help us promote it," she says. Copies were placed in all of the anesthesia charts and posted in rooms. Copies also were placed on the hospital's PACs, a computer system used to display X-rays and other medical images. The checklist became the screensaver on all the PACs monitors. "So it's right there in front of everyone. That helped promote it, too," Cardinal says.
After starting in a few rooms, the nurses started reminding the physicians to do it, and the anesthesiologists on board reminded them, too. Because it's voluntary and not regulated, Cardinal says having a physician champion is essential to get willing participation. The nurses are embracing the checklist, and because most staff know each other in the 137-bed rural hospital, the OR team started adding little-known facts about themselves when they introduce themselves. "So it's really a team-building thing," Cardinal adds.
Staff particularly like that the checklist always reminds them about film so if an X-ray is needed, it's already there. They also like having the anesthesia plan at hand.
The question she always hears from other quality improvement directors is: How did you get your doctors on board? "First and foremost," she says, "physicians want to know how it benefits the patients." Using anecdotes helps them to see the value. "So if you've got some things that have happened in the past, you can use that when you're discussing it with the physicians. Like, 'Do you remember the time we almost operated on the wrong limb?'" If doctors can see the benefit to the patient, they're more likely to buy in and not beleaguer the fact that it takes time to do it.
Cardinal has seen dramatic results from using bundles for central-line infections and ventilator-associated infections and sees the checklist, in essence, as another bundle-type approach. "When you think about just the simple thing of marking the surgical site and what a difference that has made in wrong-site surgery. And that's a checklist, even if it's one box. It makes a difference, and that's where we have to get. We have to get to more and more of doing that. There's too many variables in health care."
Using the checklist also has helped Skagit in its compliance with regulatory requirements. "The pieces of the surgical checklist, like making sure everyone's on the same page, making sure everyone knows the plan, making sure all the right equipment and the things you need for surgery are there does make a difference, even though it's not regulatory. For hospitals that might be struggling with regulatory [components] if they adopt the checklist, I think it probably will help them."