Surgery Complications Down With Better Teamwork

Hospitals that introduced a program to boost communication and teamwork among doctors and nurses saw a decrease in surgery-related complications, according to a new study.

The findings come a year after researchers reported a drop in patient death rates with the same program.

Together, the reports are evidence that better team-focused care can improve patient outcomes, said Dr. Douglas Paull, a surgeon at the Veterans Health Administration's National Center for Patient Safety in Ann Arbor, Michigan who worked on the study.

Under the system, which is designed to catch medical errors before they lead to harm, the surgery team uses a checklist to discuss the patient and the procedure before starting surgery, then debriefs afterward. Patients may be involved in the briefings as well.

"Patients like it, staff like it, it is better for morale," Paull told Reuters Health. Doctors and nurses "work in teams, we care about one and other and we care about the patient, and it shows and outcomes are better."

Paull and his colleagues compared infections, blood clots and other complications in patients being treated at 42 Veterans Health Administration (VHA) facilities that had implemented the so-called Medical Team Training program and another 32 that hadn't.

They used data from almost 120,000 surgeries performed at those hospitals between 2006 and 2008.

In the year before surgical staff were trained in the communication and teamwork program, hospitals in that group had 90 non-fatal complications out of every 1,000 surgeries, on average. That dropped to 75 in the year after the program was established.

In comparison, there was a smaller drop from 81 complications to 76 for every 1,000 surgeries in facilities that hadn't taken up the program. That change could have been due to chance, the researchers reported this week in the Archives of Surgery.

Specifically, facilities implementing Medical Team Training saw a drop in surgery-related blood clots and both skin surface and deep wound infections.

In all, 37 of the 42 facilities with the new system improved their complication rates, versus 22 of the 32 hospitals without the extra focus on teamwork and communication.

"If you look at our training programs, we've so much focused on tying knots and putting tubes in the right place -- individual skills," said Dr. Peter Pronovost, a critical care doctor who has studied surgical complications at the Johns Hopkins University School of Medicine in Baltimore.

"But we've underfocused on teamwork and that systems view, and a lot of patients are suffering needlessly because of it," Pronovost, who was not involved in the new work, told Reuters Health.

Paull said that the VHA is "leading the charge" in promoting communication and teamwork in its doctors and nurses, but that the same philosophy can be applied to other hospitals as well.

"I think you would find that health care organizations around the world now, they get it, they understand the magnitude of teamwork and communication errors," he told Reuters Health.

Lack of communication "drives up costs, it injures patients needlessly, and it's entirely preventable," Paull added.

Pronovost said that patients and their families can be aware of that aspect of their care, and speak out if they feel uncomfortable.

"If your clinician isn't welcoming of your questions, isn't welcoming of you being a partner on your team, that should be a red flag," he said.

"If they're welcoming not only your input but the nurses' input and other members of the care team's input, that's a really positive sign that they're likely to make wise decisions."