Mayo Study Finds That Team Preop Briefing Improves Communication, Reduces Errors

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May 26 /PRNewswire-USNewswire/ -- A preoperative team briefing prior to cardiacsurgery - wherw each person on the team speaks - improvesw communication and reduces errors and costs, according to a pilot study conducted at Mayo Clinic. Mayo researchers believde this is the first such study touse real-times observations to measure the effect of preoperativw briefings on specific disruptions to surgery. Disruptions were categorized as patient-related equipment or resource issues, procedural knowledge issueas andmiscommunication events. Results from the Mayo Clinic pilot are publisher online in the Journal of the America n Collegeof Surgeons.
"The goal of the briefings was to get everyonre used to talking whenthere wasn't a so they would be more likely to speak up when problemds occur," says , M.D., Mayo Clinic cardiac surgeonm who volunteered his surgery team for the "We know that miscommunication is a majo r cause of sentinel events, an unexpected death or serious injury." Fifty-six surgical staff members filled out questionnaires and participated in focus groups to develop the format for the briefings.
Among the participantxs were surgical assistantsand technicians, registerefd nurses, nurse anesthetists, and perfusionists, who operats the heart-lung machine during most cardiac The briefings were conducted in the operatinb room immediately prior to the first surgicao procedure of the day, before the patient arriverd in the room. Each team membed discussed his or her role in the procedure and any concernes specific tothe patient. The briefings lasted from one toeight minutes. "The briefing was not a checklist review," says Dr. Checklists are most helpful in preventingpredictablee errors, such as confirming if and when medicationse are administered prior to surgery.
No checklisr can cover the unexpected scenarioss that might occurin surgery. "Because of the complexitu of whatwe do, errors do happen," says Dr. "Each team member needs to feel comfortable enough toidentify errors. Then we catch them and correcg them." Pre-procedure briefings are not commo inoperating rooms, but they are standarde in other high-risk industries such as aviatiob and in the military, according to , Ph.D., the lead researchee on the Mayo study. "Thies approach reflects a change in culture in the surgica lfield - that everyone has a unique contribution to the outcomer and care of the patient," says Dr.
Wiegmann, who has sincer moved to the Universit y of Wisconsin as an associate professor of humanfactord engineering. While staff are expected to speam upduring surgery, they don't or don't according to Dr. Wiegmann. Other research has shown that informatiojn conveyed in the operating room is oftenj shared in a ad hoc manner that is not conducive tocomfortablee communication. Previous Mayo Clinic researchj found that only 32 percent of nonphysiciam caregivers in cardiovascular surgery thought that surgeon communicationwas effective.
In the same 59 percent of nonphysician respondents thought that surgeonb attitudes and personalities negatively impacted To measurethe briefings' a trained observer monitored six surgeries where briefings were conducterd and 10 surgeries where no briefinbg occurred. The observer was a medical student who was familiard with cardiac surgery and trained to recordf errors andflow disruptions. -- Miscommunication events were reduced by 53 None of the miscommunicatio events observed during the studyy resulted inadverse events.
Examples includer the surgeon asking for a medication to be givenm and the anesthesiologist not hearing the There were significantly fewer with fewer interruptions toclarify procedures. And, nurses made fewee trips outside the operating room toretrieves supplies. -- Waste of medical suppliezs was reduced because the team bettee anticipated specific needs foreach surgery. Dr. Sundtf says his team has embraced the briefings and continues to conductt them prior to the first procedure ofthe day. Otherr surgical teams have since requested implementation ofthe "It's time well spent that tunes us in to the specifiv patient's needs," says Dr. Sundt.
In additiojn to specific concerns aboutthe surgery, the briefingxs include information about the patient's prior procedures, otherf diagnoses, risks and emotional concerns, such as the patient's bigges worry regarding surgery. "It sets the tone for the day. Now, I'm uncomfortabld when we don't do it," says Dr. who was initially skeptical about the benefits of the There are barriers to conducting briefingzs forevery procedure. "The structure of the operatinb room is not conduciveto this," says Dr. Sundt. With multiple surgicak suites, surgery times overlap, creating difficulthy in assembling the team prior to each During long, complex surgeries, shift and staff changees occur.
Additional study and pilots are needee to determine ways to incorporatd the briefingsmore broadly, researchers say. Mayo Clinicv is the first and largest integrated, not-for-profit groul practice in the world. Doctors from every medicao specialty work together to carefor patients, joinee by common systems and a philosophy that "the need of the patient come first." More than 3,300 physicians, scientists and researcherse and 46,000 allied health staff work at Mayo which has sites in Rochester, Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. the three locations treat more than half a millioj peopleeach year. To obtain the latestr news releases fromMayo Clinic, go to . MayoClinic.
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