Traditionally, incident reporting in health care focuses on adverse events. But what if providers could learn as well – or better – from positive incidents?

That’s the question Channon McKibben, who recently graduated from the University of Iowa College of Nursing’s Student Registered Nurse Anesthetist program, sought to answer with his Learning From Excellence project. Launched in 2018 with the help of Kirke Rogers, MD, McKibben’s project encouraged surgical and anesthesia providers to report incidents of exceptional clinical care and to identify behaviors or processes that could be reproduced to raise the bar for patient care and outcomes.

 Channon McKibben, CRNA     Kirke Rogers, MD

Several “excellence incidents” were reported through the system that McKibben arranged to launch on the Department of Anesthesia’s intranet. Here are excerpts from reports that describe how clear and prompt communication among providers can result in better patient outcomes:

• “Earlier this morning, I had to take my patient back to the operating room for control of bleeding after he decompensated in the ICU… I want to commend the OR staff and the anesthesia team for their excellent response and reaction to the situation. Everyone did outstanding work. The patient was in a very critical condition but he was adequately resuscitated with fluid and blood products and all the instruments needed were immediately made available by the scrub nurses, who did a fantastic job. The patient is recovering well in the ICU and this is all because of the excellent teamwork and reaction time.” Staff involved: Kokila Thenuwara, MBBS; (then CA-2) Paige Keasler, DO; Maen Aboul Hosn, MD, vascular surgeon.
• A patient who was scheduled for a surgical procedure had symptoms of an upper respiratory infection, which could have resulted in canceling the patient’s procedure and putting him behind for a second scheduled procedure. “Via communication between clinicians and the Anesthesia Pre-surgery Evaluation Clinic, we were able to adjust the plan and keep him on schedule. The patient has done very well, and the flexibility and communication allowed us to avoid two OR cancellations.” Staff involved: Susan Lary, CRNA; Christine McNair, CRNA; Debra Szeluga, PhD, MD; Yatish Ranganath, MBBS; Brittany Van Sickle, CRNA.
• A patient who was scheduled for a procedure in the Ambulatory Surgery Center required an awake flexible scope intubation. “The communication with the surgical team the day before the procedure was excellent. The need for the awake intubation was identified early and the team had time to gather the equipment and supplies needed and did not feel rushed. Sheila (McKinley) was at the patient’s side the whole time, eager to help when needed. The patient was well-prepared through a calm and thorough discussion of why the awake intubation was necessary. Every step was explained to her, and this continued throughout the procedure.” Staff involved:  Heather Bair, CRNA; Sheila McKinley, RN; Ingrid Lizzaraga, MBBS, breast surgical oncologist; Carol Keith, anesthesia technician.

McKibben, who presented the results of his project at the 2019 Iowa Association of Nurse Anesthetists meeting in May, found that more than half of the clinical providers he surveyed believe the focus on negative outcomes is too high, and more than 60 percent would prefer to learn about high-quality care with positive patient outcomes.