Team training, locally modified checklists and pre- and post-operative briefings can save lives, according to a study in the October 20 issue of JAMA. But what ultimately makes a difference, according to one of the authors, is improved communications among the surgical team.
In 2006, the Veterans Health Administration implemented a nationwide Medical Team Training program. Clinicians at 74 facilities were trained to conduct checklist-guided pre-operative briefings and post-operative debriefings, and to "implement other communication strategies such as recognizing red flags, rules of conduct for communication, stepping back to reassess a situation, and how to conduct effective communication between clinicians during care transitions."
They were trained to work collaboratively and to "challenge each other when they identify safety risks."
The 74 VA hospitals that had operating room personnel participate in a team-training program reported an 18% decrease in observed mortality, versus 7% in the 34 facilities that had not yet provided the training. Investigators reported a nearly 50 percent greater decrease in the annual surgical mortality rate in the trained group than in the nontrained group.
The checklist-driven pre-operative briefing was a key component in reducing mortality because it provided a chance to identify and correct problems before surgery, the authors note. It also set the stage for how the team would communicate during surgery.
The debriefing gave team members a chance to voice what worked well and what needed improvement. Those lessons were then applied to future cases, explains James P. Bagian, MD, former director, VA National Center for Patient Safety and now at the University of Michigan.
The training encouraged team members—the scrub tech, the nurse, the surgeon, the anesthesiologist, etc.—to speak up if they had a safety concern, but simply telling the surgical team they are free to speak up doesn't mean they will, Bagian, one of the study's authors, notes.