New York City Uses AHRQ's TeamSTEPPS®, Other AHRQ Resources to Advance Patient Safety

New York City Health and Hospitals Corporation (HHC), the nation’s largest municipal health care delivery system, uses several AHRQ resources to improve patient care and safety, including:

• TeamSTEPPS®, an evidence-based patient safety training program developed by AHRQ and the Department of Defense to improve communication and teamwork skills among health care professionals.
• Hospital Survey on Patient Safety Culture, which assesses staff perspectives on patient safety issues, medical errors, and event reporting.
• Emergency Severity Index, a five-level triage tool designed to provide timely emergency care to patients.

These AHRQ resources were adopted by HHC’s network of 11 acute care hospitals, five nursing homes, six diagnostic and treatment centers, and more than 70 community-based primary care sites. HHC was one of the first civilian hospital systems to adopt TeamSTEPPS, incorporating the program into HHC’s clinical practice guidelines as well as its electronic health records system.

"TeamSTEPPS was a major priority in HHC’s goal to promote patient safety," said Mei Kong, R.N., M.S.N., assistant vice president of corporate patient safety.

TeamSTEPPS situation monitoring prompts are incorporated into the hospital’s electronic health records system to remind medical teams to assess urinary catheter use and to remove catheters when they are no longer needed.

"From 2012 to first quarter 2014, TeamSTEPPS strategies helped reduce catheter-related urinary tract infections by 98 percent at Lincoln Medical and Mental Health Center’s step-down telemetry unit and helped us maintain a zero rate for ventilator-associated pneumonia there," Ms. Kong reported.

TeamSTEPPS strategies also helped reduce fights among patients at the Metropolitan Hospital Center’s adolescent psychiatric unit. Physical altercations there went down 90 percent (from six per month to one per month).

Not only was HHC among the first health systems to adopt TeamSTEPPS, it was also among the first to provide TeamSTEPPS Master Training to employees. This enables trained staff to teach the program to others.

"The training just blossomed across our entire health system," Ms. Kong said. As of October 2014, HHC had nearly 1,000 TeamSTEPPS Master Trainers. "Almost 27,000 of our 38,000 employees have received the TeamSTEPPS Fundamentals Training,” she added. “TeamSTEPPS is reinforced at our patient safety forums and other activities throughout the year."

Caroline Jacobs, M.P.H., M.S., senior vice president of safety and human development for HHC, said that a major advantage of TeamSTEPPS “is its focus on open communication and teamwork, such as empowering staff to express concerns about a patient’s care, periodic ‘huddles’ during the day to discuss a patient’s condition, and sharing important information between the shifts.”

Ms. Jacobs said AHRQ’s Hospital Survey on Patient Safety Culture, conducted about every 18 months and completed by about 25,000 employees and volunteers in 2014, showed that TeamSTEPPS has helped raise awareness of patient safety.

“The most recent survey results showed that over 70 percent of all respondents felt that we are doing things to improve patient safety,” noted Ms. Jacobs. Perceptions about patient safety increased faster at smaller facilities, particularly at long-term care facilities. “Perhaps this is because there is more one-on-one interaction with patients, and the safety measures are more transparent to staff,” she said.

HHC augments its patient safety efforts with another AHRQ-funded resource—the Emergency Severity Index (ESI), a triage tool used in emergency care.

“The ESI has provided specific timeframes within which to treat patients based on the severity of their condition,” said Consuelo Dungca, R.N., Ed.D., deputy executive director, quality management and regulatory affairs. “ESI guidelines have helped emergency care teams at all of our hospitals provide more timely treatment of patients.”