Drop in surgical deaths seen in hospitals with team-trained staff

Hospitals that had their operating room staff participate in a medical team training program showed a significantly lower surgical mortality rate than centers not involved in the program, according to the results of a study appearing in the Journal of the American Medical Association.

For their study, Julia Neily, RN, MS, MPH, of the National Center for Patient Safety, Department of Veterans Affairs, in Hanover, N.H., and colleagues compared the surgical mortality rates of hospitals which had staff who participated in the Veterans Health Administration’s (VHA) medical team training program with those that did not. The surgical care teams of the hospitals that underwent the training received 2 months of preparation and a day-long onsite learning session, according to a Journal of the American Medical Association (JAMA) and Archives Journals press release.

“Using the crew resource management theory from aviation adapted for health care, clinicians were trained to work as a team; challenge each other when they identify safety risks; conduct checklist-guided preoperative briefings and postoperative debriefings; and 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,” the researchers wrote.

Mortality rates

Neily and her colleagues used data from the VHA Surgical Quality Improvement Program and interviews conducted between 2006 and 2009. The researchers analyzed 182,409 procedures performed at 108 VHA hospitals.

The researchers found a baseline risk-adjusted mortality rate of 17 per 1,000 procedures at the trained hospitals vs. 15 per 1,000 procedures at the non-trained centers. Both types of centers showed mortality rates of 14 per 1,000 procedures at the end of the study.

Impact of training

“After controlling for baseline differences, the 74 trained facilities experienced a significant decrease of 18% in observed mortality,” the researchers noted. “Mortality decreased by 7% in the non-trained facilities.”

After adjusting the results for surgical risk and volume, the researchers discovered that the morality rate dropped 0.5 per 1,000 procedure deaths for every quarter of training. In addition, they found that the rate was reduced by .6 per 1,000 procedures for each increase in the degree of debriefings at the centers.

“It is our hypothesis that conducting preoperative briefings is a key component in reducing mortality because it provides a final chance to correct problems before starting the case,” the researchers wrote. “The use of conducting briefings and debriefings requires a more active participation and involvement than sometimes occurs when a checklist is used by itself. During follow-up interviews, facilities provided specific examples of having avoided adverse events because of the briefing.”

Reference:

Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693-1700.

Source: The ORTHOSuperSite, October 25, 2010