Teamwork, training decrease surgery mortality rate
While medical teams and hospital staff do their best to prevent death related to surgery, it still occurs. Many institutions have implemented programs to decrease that number, but there is not enough data to fully explain the effectiveness.
VHA program effective
A consortium of researchers from the National Center for Patient Safety, Dartmouth Medical School, The University of Texas Medical Branch Galveston, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston, focused on the Veterans Health Administration Medical Team Training program and found that through implementation, the death rate decreased by 18 percent.
"This is the first study to demonstrate a decline in surgical mortality through the use of this particular training program," said Dr. David H. Berger, professor and vice chair of the department of surgery at BCM and co-author of the retrospective study which appears in the current edition of the Journal of the American Medical Association.
The training program, which was first implemented in the Michael E. DeBakey VA Medical Center, includes two months of preparation and training, a one-day conference and one year of quarterly coaching interviews.
Some of the important aspects of the training program include creating a pre and postoperative checklist which includes formal briefings and debriefings before and after surgeries. Another important factor in training is instruction in teamwork and communication which includes identifying and challenging others when safety risks are known, recognizing "red flags," stepping back to reassess a situation and clinicians effectively during patient care transitions.
This was followed by four quarterly follow up structured interviews for one year to support, coach, and assess the program.
"What is important about this study is that there is a similar group that can be used as a control. We can look not only at the statistics from those hospitals involved in the training program, but we can also compare them to a similar group that has not yet gone through the training," said Berger, who is also chief of the surgical service at the DeBakey VA Medical Center.
Results showed an overall decrease in the mortality rate related to surgery among all facilities. However, those that had undergone the training program decreased the mortality rate by 18 percent, while those that had not, decreased the mortality rate by 7 percent.
"This program includes not just the surgeons but also the OR nurses and even administrative support staff," said Berger. "The care of each patient involves the entire team."
The nationwide program was put into effect in 2006 after three years of pilot programs. Within the VHA, there are 153 hospitals. Surgeries are performed at 130, but only 74 hospitals had implemented the training program when the current study began.
Other contributing researchers include: Julia Neily, Priscilla West, Drs. Peter D. Mills, Yinong Young-Xu, Brian T. Carney, Lisa Mazzia, Douglas E. Paull, and James P. Bagian, all with the National Center for Patient Safety, Department of Veterans Affairs. Drs. Mills and Young-Xu are also with the Department of Psychiatry, Dartmouth Medical School. Dr. Bagian is also with the University of Texas Medical Branch Galveston and the F. Edward Hebert School of Medicine in Bethesda, Md.
Funding for this study came from the Veterans Health Administration National Center for Patient Safety and the Michael E. DeBakey VA Medical Center.