TUESDAY, Oct. 19 (HealthDay News) -- Surgical death rates might
be reduced if operating room staff borrowed team-building
procedures used by the airline industry, a new study suggests.
A program that trained operating room workers to talk about
potential challenges before surgeries, to use checklists and to
review what went right or wrong after surgeries significantly
reduced the surgical death rate at participating hospitals, the
In the study, researchers analyzed data on more than 182,000
patients who had undergone surgery at 108 Veterans Health
Administration hospitals between 2006 and 2008. Of those hospitals,
74 had implemented the
Medical Team Training program, using error-reducing
techniques borrowed from the aviation industry and NASA (National
Aeronautics and Space Administration).
After one year, deaths at facilities that had implemented the
training program fell by 18 percent, compared to 7 percent at
hospitals that had not yet gone through the training.
The decline in the annual surgical mortality rate was almost 50
percent greater at trained hospitals than un-trained hospitals, the
"The ultimate goal is to have good teamwork and communication to reduce adverse events," said senior study author Dr. James Bagian, a former astronaut who is now the chief patient safety and systems innovation officer for the University of Michigan Health System. "This study shows we had some success. The longer the facility did the program, the greater the improvement in mortality."
The study is in the Oct. 20 issue of the
Journal of the American Medical Association.
Surgical errors remain a major concern in American hospitals. In
fact, a study published Monday in the
Archives of Surgery found that egregious and devastating
errors - operating on the wrong patient or the wrong body site -
still occur. Many of the mistakes cited in that report occurred due
to simple errors in judgment or because surgical teams had failed
to perform standard pre-operation checks.
The Michigan study focused on a training program that includes
two months of planning and preparation with each hospital's
surgical staff and a day-long instruction session. At the time of
its implementation, Bagian was chief patient safety officer for the
Veterans Health Administration's National Center for Patient
The training emphasizes the importance of teamwork and effective
communications; encourages surgeons, anesthesiologists, nurses and
technicians to challenge one another if they notice safety lapses;
and encourages the use of checklists to guide discussions that
include preoperative briefings and postoperative debriefings.
Like NASA, operating rooms tend to be hierarchical, with the
surgeon at the top. This structure means other operation room staff
are sometimes hesitant to speak up, Bagian said.
"When you look at problems and adverse events in health care, most of them have as one of their major causative factors a failure of communication," Bagian said. "Based on my background in aviation and NASA, it always was stunning to me that in health care we were very casual and not rigorous in the way we communicated."
According to Bagian, prior research has also shown that
physicians tend to rate themselves as good communicators, even
though the rest of the OR staff doesn't necessarily agree.
Lots of workers can relate, no doubt. "The bosses think
communication is great, people down the line think it's not as
good," Bagian said.
To alleviate that type of disconnect, Bagian recommends
briefings and debriefings, in which operating room staff get
together for a few moments before a surgery to discuss concerns,
anticipate challenges, and make sure they have the right tools and
Post-op debriefings were a learning tool that helped operating
room staff avoid future errors, he said.
The briefings can be done quickly, and the study found
procedures actually took less time after implementation of the
program, Bagian said.
Dr. Peter Pronovost, a professor of anesthesiology and critical
care medicine at Johns Hopkins University School of Medicine who
wrote an accompanying editorial, said the study provides strong
evidence that teaching operating room staff about teamwork and
effective communication can reduce deaths among surgical
"Medicine has for so long emphasized technical work over team work. We focus on putting tubes in the right places, or tying knots so that wounds don't fall apart," Pronovost said.
"We needed to do that but we have relatively under-invested in teamwork skills," he added. "Poor communication leads to a significant amount of preventable harm, and this study provides a practical way to address some of the teamwork challenges."
Agency for Healthcare Research and Quality has more on medical
errors and patient safety.
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