Getting teams to talk: development and pilot implementation of a checklist to promote interprofessional communication in the OR
- L Lingard,
- S Espin,
- B Rubin,
- S Whyte,
- M Colmenares,
- G R Baker,
- D Doran,
- E Grober,
- B Orser,
- J Bohnen,
- R Reznick
- Correspondence to: Dr L Lingard Associate Professor, University of Toronto, Educational Scientist, Wilson Centre for Research in Education, Toronto, Ontario, Canada M5G 2C4;
- Accepted 12 June 2005
Background: Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members’ willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions.
Methods: A checklist prototype was developed and OR team members were asked to implement it before 18 surgical procedures. A research assistant was present to prompt the participants, if necessary, to initiate each checklist discussion. Trained observers recorded ethnographic field notes and 11 brief feedback interviews were conducted. Observation and interview data were analyzed for trends.
Results: The checklist was implemented by the OR team in all 18 study cases. The rate of team participation was 100% (33 vascular surgery team members). The checklist discussions lasted 1–6 minutes (mean 3.5) and most commonly took place in the OR before the patient’s arrival. Perceived functions of the checklist discussions included provision of detailed case related information, confirmation of details, articulation of concerns or ambiguities, team building, education, and decision making. Participants consistently valued the checklist discussions. The most significant barrier to undertaking the team checklist was variability in team members’ preoperative workflow patterns, which sometimes presented a challenge to bringing the entire team together.
Conclusions: The preoperative team checklist shows promise as a feasible and efficient tool that promotes information exchange and team cohesion. Further research is needed to determine the sustainability and generalizability of the checklist intervention, to fully integrate the checklist routine into workflow patterns, and to measure its impact on patient safety.
↵* The researchers’ presence in the operating room did serve as a visual prompt for the participants. However, in these 14 cases, the participants clearly expected and prioritized the checklist discussion.
↵† While information exchange is a defining feature of the checklist intervention, observers were not able to gauge independently whether the checklist discussions increased the amount of information available to the team unless this was revealed through an explicit exchange among team members.
This research has been presented as an oral abstract at two meetings: Association for Surgical Education Annual Meeting, Houston, April 2004 and Continuing Medical Education Congress, Toronto, May 2004
This research was funded by the Canadian Institutes of Health Research (CIHR) and the Physicians of Ontario through the PSI Foundation. L Lingard is supported by a CIHR New Investigator Award and as the BMO Financial Group Professor in Health Professions Education Research. B Orser is supported by an Ontario Ministry of Health Career Award.
The authors have no competing interests in the conduct of this study or the publication of this paper.