Elsevier

Surgery

Volume 150, Issue 4, October 2011, Pages 771-778
Surgery

Central Surgical Association
Team training can improve operating room performance

This paper is dedicated to Dr. Bob McQuillan, a friend, colleague, and strong advocate for team work and safety in the OR. This paper represents research in which he was the Principal Investigator and was instrumental in bringing to completion.
https://doi.org/10.1016/j.surg.2011.07.076Get rights and content

Background

This study was conducted to determine if team training using a federally sponsored team training program improves operating room (OR) performance and culture.

Methods

The TeamSTEPPS program, a team training program designed and tested for health care applications, was provided to the OR staff. The training occurred over 2 months to all members of the OR team, including scrub technicians, nurses, certified registered nurse anesthetists, anesthesiologists, surgeons, and all anesthesiology and surgical resident staff.

Results

After 9 months, there was a significant improvement in the OR staff team work (score 53.2 to 62.7; P < .05) and OR communications (score 47. 5 to 62.7; P < .05). There was significant improvement in OR first case starts (69% to 81%), Surgical Quality Improvement Program measures (antibiotic administration, 78% to 97% [P < .05]; venous thromboembolism administration, 74% to 91% [P < .05]; and beta blocker administration, 19.7% to 100%; P < .05) and patient satisfaction (willingness to recommend, 77% to 89.3% [P < .05]). NSQIP measured overall surgical morbidity and mortality, which were both significantly improved (mortality, 2.7% to 1% [P < .05]; morbidity, 20.2% to 11.0% [P < .05]), indicating a significant change in the overall OR culture. A year later, the data showed that factors linked to regulatory requirements, such as Surgical Quality Improvement Program measures linked to the time out remained improved while first case on time starts decreased (81% to 69%; P < .05), patient willingness to recommend decreased (89.3% to 80.8%; P < .05), surgical mortality increased (1% to 1.5%; P < .05), and surgical morbidity increased (11% to 13%; P < .05) reflecting a degree of culture deterioration which has persisted.

Conclusion

These data confirm that team training improves OR performance, but continued team training is required to provide sustained improved OR culture.

Section snippets

Methods

The TeamSTEPPS program was used because: (1) the program was founded on evidence-based training techniques and principles; (2) it was designed for the health care professional; (3) it had been field tested; and (4) it was robust enough to provide training at several levels, including the training of mentors and coaches. The initial training involved the leadership team comprised of the Chair of Anesthesiology, Chair of Surgery, Operating Room Director, and Administrative Manager of Operative

Results

The questionnaires given to the participants were completed in the fall of 2006 as the pretesting and at the end of 2007 as the study training end-point. The benchmark AHRQ survey questionnaire assessing knowledge about teamwork and safety was high, at an average of 81% correct answers, and was identical both before and after TeamSTEPPS implementation. This indicates that the participants had a good foundation of knowledge on teamwork and safety. Self-assessment of communication and teamwork

Discussion

This paper presents evidence that team training can improve OR efficiency and outcomes. It joins the growing evidence that teamwork and team training are important in OR safety and efficiency.1, 2, 3, 4 What is unique about our finding is the evidence of improvement in several aspects of OR performance. We found improvement in the OR staff team skills, staff communications, OR efficacy in case starts and room turnover, patient evaluations, surgical outcomes as measured by SQIP parameters, and

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