Nebraska Critical Access Hospitals Improve Safety With AHRQ TeamSTEPPS®

The University of Nebraska Medical Center (UNMC) customized the coaching strategies used in the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) curriculum for use in critical access hospitals as part of an AHRQ Knowledge Transfer project. The Medical Center also led trainings in 2008 for 94 providers at 24 of the critical access hospitals in the State.

TeamSTEPPS, a program developed by AHRQ in collaboration with the Department of Defense, is an evidence-based system that establishes interdisciplinary team training systems to serve as the foundation for patient safety strategy.

The TeamSTEPPS training offered in Nebraska was tailored to meet the staffing constraints of small critical access hospitals. In order to minimize the time that providers would be away from their hospitals, the trainings were held separately and were followed by a series of ongoing monthly conference calls.

To assess the impact of TeamSTEPPS on the safety culture of the participating hospitals, UNMC compared the hospitals' pre- and post-training scores on AHRQ's Hospital Survey on Patient Safety Culture. The hospitals that implemented TeamSTEPPS reported improvements in most dimensions of the survey.

Among the 23 hospitals that implemented TeamSTEPPS, scores increased by 1 percent to 6 percent in 10 of 12 dimensions of the survey. The largest increases of 5 percent and 6 percent occurred in "manager actions promoting patient safety" and "hospital management support for patient safety," respectively. Within the acute/skilled care departments, there was greater improvement in these two dimensions. Specifically, for the acute/skilled care departments, scores on these dimensions increased by 8 percent and 6 percent, respectively, after the training.

As a result of participating in the TeamSTEPPS trainings, several Nebraska hospitals made changes in practice. For example:

• Chase County Community Hospital implemented debriefs with all providers and staff after every trauma case. The debriefs—to discuss what went well and to identify opportunities for improvement—take place within 48 to 72 hours after an event. Prior to participating in TeamSTEPPS, the hospital only conducted debriefs with physicians on trauma cases on a monthly basis. Lola Jones, RN, Chase County Community Hospital's CEO, reports that as a result of one of the recent debriefs about a pediatric trauma case, staff and providers determined that they needed a customized pediatric crash cart. Jones notes that, "TeamSTEPPS has helped us improve our communication with each other for the benefit of our patients." She also notes that the hospital's commitment to TeamSTEPPS was instrumental in helping the hospital to recruit a new physician.
• Crete Medical Center developed a shift change report tool to improve information flow during handoffs.
• Saunders Medical Center officials reported using SBAR and communication techniques learned during TeamSTEPPS to improve information transfer from the long-term care unit to the emergency department during care transitions.