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October 19th, 2010
05:45 PM ET

Better teamwork save lives in the O.R.

Teamwork saves lives, concludes a study published Tuesday in the Journal of the American Medical Association.

Veterans Affairs hospitals adopting surgical team training saw mortality rates drop from 17 deaths per 1,000 cases to 14 deaths per 1,000 cases, researchers found.

Dr. James Bagian, a study author and former NASA astronaut, said the VA training took a page from the aviation and the nuclear power industries, which have used checklists and improved communication to reduce risks.

“So the question is how do you do that - communicate? It wouldn’t be enough to tell people to communicate better,” said Bagian, who was the VA’s first director of the National Center for Patient Safety, from 1998 until recently.

Instead, surgical teams at VA hospitals began conducting briefings before and after surgery, guided by checklists, to anticipate problems and learn from mistakes. Surgical teams are composed of surgeons, anesthesiologists, nurse anesthetists, nurses and technicians.

Before an operation, team members might be asked what worries them most about the case, Bagian said. Afterwards, the teams discuss “what did we do well, what didn’t we do well so we can do better next time.”

In the O.R., the training encouraged all members of the team to voice safety concerns. The training mirrored what NASA and airlines do to encourage crew members to question the pilot if they see problems.

Not only did team training reduce the mortality rate, the longer the training was in place, the more the mortality rate dropped, the study found.

The authors reviewed results for 108 hospitals and 182,409 procedures performed from 2006 to 2008.

The study looked at what happened at 74 hospitals as they implemented surgical team training, compared with 34 hospitals that had not yet undergone training. At the hospitals with no training, the mortality rate per 1,000 cases also dropped, from 15 to 14.

But the authors stressed the drop was greater at the hospitals where surgical team training was in place: 18 percent compared with 7 percent.

Since mid 2009, all VA hospitals have adopted surgical team training, said Bagian, who  is now on the faculty at the University of Michigan Medical School and the College of Engineering.

The team training arose from a pilot program in 2003. Previously, team training showed other benefits, including more procedures starting on time, increased job satisfaction and lower nurse turnover rates, according to Bagian.

The study appears in the October 20 edition of JAMA.


soundoff (10 Responses)
  1. Constantine

    Hmm – that really cant be shocking to anyone

    October 19, 2010 at 21:52 | Report abuse | Reply
  2. Micki

    You know what else would probably help? Stiffer penalties for physicians that verbally attack the members of their surgical team so that the nurses and technicians have better recourse. I hate getting screamed at by anesthesia because of something that isn't my fault. I apologize they changed what comes in the kit you use, if you stop yelling, I can make some suggestions.

    October 20, 2010 at 05:06 | Report abuse | Reply
  3. LADoc

    While an interesting study, the results are not compelling. Though I have not read the study, the article does nothing to suggest that the reduction in mortality was due to the program that was implemented. The authors noting a larger percentage is rather irrelevant considering the study hospitals had a slightly greater mortality to begin with. While communication is very appropriate, requiring protocols is not the answer. As for Micki, I sit on numerous hospital oversight committees and at least at the hospials I work at, physicians who repeatedly create hostile work environments are dealt with in a successful escalating system. I would suggest voicing your concerns with your administrators rather than CNN.

    October 24, 2010 at 19:46 | Report abuse | Reply
    • Safety is a science

      To LADoc: You're entitled to your opinion, but as a scientist, you should first read the study before passing judgement. The science of quality improvement has many scientific studys that indicate that protocols are the answer (read Atule Gwande). The great scientist, Richard Fyneman, said that "Science is what we use to keep from fooling ourselves."

      October 26, 2010 at 10:52 | Report abuse |
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.