Evaluation of a preoperative team briefing: a new communication routine results in improved clinical practice
- Lorelei Lingard1,
- Glenn Regehr2,
- Carrie Cartmill3,
- Beverley Orser4,5,
- Sherry Espin6,
- John Bohnen7,8,
- Richard Reznick9,
- Ross Baker10,
- Lorne Rotstein7,11,
- Diane Doran12
- 1Centre for Education Research & Innovation, University of Western Ontario, London, Ontario, Canada
- 2Center for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
- 3The Learning Institute, The Hospital for Sick Children, Canada
- 4Department of Anesthesia and Physiology, University of Toronto
- 5Department of Anesthesia, Sunnybrook Health Sciences Centre
- 6Daphne Cockwell School of Nursing, Ryerson University
- 7Faculty of Medicine, University of Toronto, Toronto, Canada
- 8Department of Surgery, St. Michael's Hospital
- 9Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
- 10Health Policy, Management and Evaluation, University of Toronto
- 11Division of General Surgery, University Health Network
- 12Faculty of Nursing, University of Toronto
- Correspondence to Dr Lorelei Lingard, Centre for Education Research and Innovation, Health Sciences Addition, Room H112, University of Western Ontario, London, Ontario, Canada N6A 5C1.
Contributors Study concept and design: RB, JB, DD, SE, LL, BO, GR, RR, LR. Acquisition of data: CC, SE, LL. Analysis and interpretation of data: RB, JB, CC, DD, SE, LL, BO, GR, RR, LR. Drafting of the manuscript: CC, LL, GR. Critical revision of the manuscript for important intellectual content: RB, JB, DD, SE, LL, BO, GR, RR, LR. Statistical analysis: CC, GR. Obtained funding: LL. Administrative, technical and material support: CC. Study supervision: LL.
- Received 16 January 2009
- Revised 25 September 2009
- Accepted 8 November 2009
- Published Online First 8 February 2011
Background Suboptimal communication within healthcare teams can lead to adverse patient outcomes. Team briefings were previously associated with improved communication patterns, and we assessed the impact of briefings on clinical practice. To quantify the impact of the preoperative team briefing on direct patient care, we studied the timing of preoperative antibiotic administration as compared to accepted treatment guidelines.
Study design A retrospective pre-intervention/post-intervention study design assessed the impact of a checklist-guided preoperative team briefing on prophylactic antibiotic administration timing in surgical cases (N=340 pre-intervention and N=340 post-intervention) across three institutions. χ2 Analyses were performed to determine whether there was a significant difference in timely antibiotic administration between the study phases.
Results The process of collecting and analysing these data proved to be more complicated than expected due to great variability in documentation practices, both between study sites and between individual practitioners. In cases where the timing of antibiotics administration was documented unambiguously in the chart (n=259 pre-intervention and n=283 post-intervention), antibiotic prophylaxis was on time for 77.6% of cases in the pre-intervention phase of the study, and for 87.6% of cases in the post-intervention phase (p<0.01).
Conclusions Use of a preoperative team checklist briefing was associated with improved physician compliance with antibiotic administration guidelines. Based on the results, recommendations to enhance timely antibiotic therapy are provided.
Access to data: LL had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Role of the sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.
Funding This research was funded by the Canadian Institutes of Health 10 Research (CIHR), reference number 57796. LL is supported by the CIHR New Investigator Research Award and as the BMO Financial Group Professor in Health Professions Education Research at the University Health Network. GR is supported as the Richard and Elizabeth Currie Chair in Health Professions Education Research at the University Health Network. BO's research is supported by a Canada Research Chair. Canadian Institutes of Health Research (CIHR), reference number 57796160 Elgin Street, 9th Floor Address Locator 4809A Ottawa, ON, K1A 0W9, Canada.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.