Improved operating room teamwork via SAFETY prep: a rural community hospital's experience.

BACKGROUND: Effective teamwork contributes to patient safety in the operating room (OR). For the busy rural surgeon, enhancing OR teamwork can be difficult. This manuscript describes results from the initial implementation of a preoperative briefing protocol at a rural community hospital. METHODS: From July 2006 to February 2007, teamwork among OR staff working with a single general surgeon at a rural hospital in Alaska was evaluated before and after introduction of a preoperative briefing protocol. After each case, participants completed a questionnaire applying a 6-point Likert-type scale targeting effectiveness of both the preoperative briefing and OR team interaction. Mean values were calculated from 20 cases before introduction of the preoperative briefing and from another 16 cases after its introduction. Statistical analysis of the difference between pre- and post-protocol team performance was conducted with Student's t test. Mean procedure times were calculated for matched cases pre- and post-intervention and were compared with Wilcoxon's exact test. RESULTS: Ten members of the OR staff, including the general surgeon, completed both pre- and post-protocol questionnaires. Four additional members of the OR staff completed only pre-protocol questionnaires, and three additional members of the OR staff completed only post-protocol questionnaires. After implementation of the preoperative briefing protocol, the mean score of overall preoperative briefing was 1.01 units higher than before (p < 0.0001), and overall OR team interaction was 0.50 units higher (p < 0.0001). The overall mean post-intervention procedure time was shorter than the overall mean pre-intervention procedure time (31 +/- 12 min versus 50 +/- 18 min) for four categories of matched cases. Because of the small sample size, statistical significance was not achieved (p = 0.057). CONCLUSIONS: Implementation of a preoperative briefing protocol improved overall preoperative briefing and OR team interaction in the study setting. These findings are encouraging for enhancing teamwork and patient safety through implementation of a systematic protocol.

Implementation of a preoperative briefing protocol improves accuracy of teamwork assessment in the operating room.

This study examined the effect of implementing a new preoperative briefing protocol on self- and peer-assessments of individual operating room (OR) teamwork behaviors. From July 2006 to February 2007, OR teamwork performance at a rural community hospital was evaluated before and after training and implementation of the protocol. After each case, every member on the team completed a 360-degree type teamwork behavior evaluation containing both self- and peer-assessments using a six-point Likert type scale (1 = definitely no to 6 = definitely yes). Individual behavior change was measured using the mean scale score of pre and postprotocol assessments. Statistical analysis included t test for both pre/post and self/peer differences. Data were available for one general surgeon and nine OR staff (pre = 20 cases, post = 16 cases). The preprotocol self-assessment mean score was significantly higher than peer-assessment (5.63 vs 5.29, P < 0.0267). Pre and postprotocol peer assessment mean scores revealed a statistically significant gain in teamwork behaviors. No difference was observed in postassessment mean scores for self- and peer-assessments. Individuals overestimated their teamwork behaviors before protocol implementation. Using a preoperative protocol seems to improve OR staff teamwork behaviors and self-assessment accuracy. The use of a 360-degree assessment method targeting specific, observable behaviors may be useful in evaluating team-based interventions and enhancing teamwork effectiveness.

From the flight deck to the operating room: an initial pilot study of the feasibility and potential impact of true interdisciplinary team training using high-fidelity simulation.

BACKGROUND: The operating room is a dynamic environment in which proper teamwork is essential. After piloting a simulation-based interdisciplinary operative team training program, we examined the impact of these sessions on the participants. METHODS: Three interdisciplinary operating room teams participated in the training model. Each team of 3 or 4 members completed the training in a virtual minimally invasive operating room using a standardized operative scenario. Upon completion of the training, participants completed a voluntary and anonymous training effectiveness questionnaire. RESULTS: All 10 participants completed the training evaluation questionnaires. Across the 3 teams, all participants felt that the training was worthwhile and would participate again. Eight participants said that the session would change their practices in the operating room. All participants felt that the session was effective in promoting team communication skills and crisis-related teamwork. Nine of the 10 felt that the training model was effective in recognizing operating room errors. CONCLUSIONS: Implementing true interdisciplinary team training with a high-fidelity simulation can be accomplished effectively. Team training has the potential for facilitating positive behavioral changes in operating room personnel that are important for adaptive team function in a crisis situation.