Organizational Culture Changes Result in Improvement in Patient-Centered Outcomes: Implementation of an Enhanced Recovery Program for Surgical Patients at Johns Hopkins Hospital and Health System

Program/Project Description, including Goals: In 2010, we piloted the comprehensive unit based safety program (CUSP) in the operating room with the goal of preventing harm and improving teamwork and safety culture, and a specific focus on addressing higher than expected rates of surgical site infections in patients undergoing colorectal surgery. The team included surgeons, anesthesiology providers, nurses, surgical technicians with local leadership (surgeon, anesthesia provider and nurse). To reduce preventable harm, optimize patient outcomes and experience, and reduce waste, the team used the model for translating research into practice as well as specific tools (staff safety assessment, learning from defects, optimized briefings and debriefings for each procedure) combined with patient engagement strategies to develop, implement, and optimize a bundle of SSI-related interventions over two and half years. These included 1) focused infection related pre-operative education, 2) mechanical bowel preparation with oral antibiotics, 3) pre-operative bathing with chlorhexidine washcloths, 4) use of forced air warming devices in the pre-operative area, and 5) standardized skin preparation with chloraprepTM. The group’s efforts resulted in a significant and sustained reduction of SSI rate from 27% to 18% over three years, yet SSI rates remained higher than comparable hospitals and the hospital leadership’s goal of 10%. In addition to persistently high SSI rates, VTE and UTI rates continued to be higher than expected, length of stay for colorectal procedures exceeded comparable institutions and patient satisfaction was low.