Staff Coordination Project at St.Vincent's Medical Center
Our team at KimKaps thanks Kimberly Knowles, Joseph Brown, and the TAVR team at St.Vincent's Medical Center in Bridgeport, CT for the following write up, photos, and allowing us to be a part of their Staff Coordination Project.
Last fall I was hired by St. Vincent's Medical Center in Bridgeport, CT to serve as the project manager for the launch of their Transcatheter Aortic Valve Replacement program known as TAVR. The TAVR procedure is one of the first in medicine that requires at least seven different clinical service lines to work together in a new operating environment-the Hybrid OR. As a commercial airline pilot and patient safety consultant I knew early on that this was no small challenge. The scope of the project was not unlike putting a brand new aircraft into passenger service for the first time.
One of our first project tasks was to assemble the Structural Heart Team in the Hybrid OR to establish team member positions, equipment locations, etc. The Structural Heart Team consisted of 25 members from Interventional Cardiology, Vascular Surgery, Cardiothoracic Surgery, Anesthesia, Echocardiology, Radiology, Perfusion, and a compliment of OR/CATH Lab circulating nurses. The scene in the Hybrid OR on "mark your turf" day could be described as Grand Central Station at rush hour.
As I scanned the OR it immediately became clear that I had no idea who was who. For that matter, many others felt the same way, too. As an outsider to heath care, all I could see were lots of very smart people walking around in the same color scrubs. It quickly became apparent that this would need to change! In an effort to establish a visual reference point, I decided to assign the team color-coded surgical caps.
After our inaugural day we proceeded to conduct team simulations of the TAVR procedure each Thursday morning in the Hybrid OR. Every week the team diligently arrived and worked together to practice the standardized sequence of the procedure.
Over time the team began to gel from their coordinated use of new checklists and standard phraseology to employing room specific configuration diagrams. Team members not only understood their roles but the roles of their teammates and most importantly what everyone's role was in an emergent condition. It was truly amazing to watch a set of people that had never worked together in a new operating environment transform from a disjuncted group a cohesive, cooperatively functioning team. Then our color-coded surgical caps arrived.
You could almost hear the gasp from the team members as they put their caps on for he first time in the OR. The sea of people instantly turned into an organized, unified team of professionals clearly identifiable by assigned color:
Burgundy=Interventional Cardiology
Red=Vascular Surgery
Blue=Anesthesia and Echocardiology
Green=Cardiothoracic Surgery and Perfusion
Black=Radiology
Yellow=Room Coordinator
Just a quick note about the role of our Room Coordinator. The Room Coordinator is an OR circulating nurse that manages the room for the surgical team at the table. Identifiable by the only unique color in the OR, the Room Coordinator is like an assistant head coach directing activities, making sure checklists and callouts are properly accomplished, and serving as the single point of contact in an emergency, just like on an aircraft carrier.
The color-coded surgical caps created an instant, visual identification of team member specialty, even if people didn't know each others name or if team members were substituted. The team quickly became dependent on this new method of recognition, which was also a significant improvement in patient safety.
The TAVR program at St. Vincent's launched on Valentine's Day and we fixed two broken hearts that day. Miracles do happen and our color-coded surgical caps helped make those miracles occur.
