Effects of structured intraoperative briefings on patient outcomes: multicentre before-and-after study

Abstract

Background Operations require collaboration between surgeons, anaesthetia professionals, and nurses. The aim of this study was to determine whether intraoperative briefings influence patient outcomes. Methods In a before-and-after controlled trial (9 months baseline; 9 months intervention), intraoperative briefings were introduced in four general surgery centres between 2015 and 2018. During the operation, the responsible surgeon (most senior surgeon present) briefed the surgical team using the StOP? protocol about: progress of the operation (Status), next steps (Objectives), possible problems (Problems), and encouraged asking questions (?). Differences between baseline and intervention were analysed regarding surgical-site infections (primary outcome), mortality, unplanned reoperations, and duration of hospital stay (secondary outcomes), using inverse probability of treatment (IPT) weighting based on propensity scores. Results In total, 8256 patients underwent surgery in the study. Endpoint data were available for 7745 patients (93.8 per cent). IPT-weighted and adjusted intention-to-treat analyses showed no differences in surgical-site infections between baseline and intervention (9.8 versus 9.6 per cent respectively; adjusted difference (AD) –0.15 (95 per cent c.i. −1.45 to 1.14) per cent; odds ratio (OR) 0.92, 95 per cent c.i. 0.83 to 1.15; P = 0.797), but there were reductions in mortality (1.6 versus 1.1 per cent; AD –0.54 (−1.04 to −0.03) per cent; OR 0.60, 0.39 to 0.92; P = 0.018), unplanned reoperations (6.4 versus 4.8 per cent; AD –1.66 (−2.69 to −0.62) per cent; OR 0.72, 0.59 to 0.89; P = 0.002), and fewer prolonged hospital stays (21.6 versus 19.8 per cent; AD –1.82 (−3.48 to −0.15) per cent; OR 0.87, 0.77 to 0.98; P = 0.024). Conclusion Short intraoperative briefings improve patient outcomes and should be performed routinely.

Standardizing The Intraoperative Adverse Events Assessment to Create a Positive Culture of Reporting Errors in Surgery and Anesthesiology

“…Tschan et al, found that instituting the intraoperative StOP? (Status, Objectives, potential Problems, and encouraging questions) protocol, aimed at improving intraoperative communication and debriefs, was associated with improved surgical-related mortality, reoperation, and length of stay 5. This raises the question as to the impact that standardized iAEs review can have, if implemented, on a larger scale, such as within the World health Organization’s surgical safety checklist.…”

A quality improvement initiative using peer audit and feedback to improve compliance

“…An observation tool was developed, which included standard items and criteria, but was easily adaptable to local needs and specific SSCs. It was based on existing tools such as the Checklist Usability Tool [ 5 ], the WHOBARS [ 16 ], findings from a national study on structured intraoperative briefings [ 17 ], elements of Closed Loop Communication [ 18 , 19 ] and basics of the anatomy of the SSC [ 20 ]. The observation tool was tested in two hospitals: one person from the programme team and one person from the respective hospital (surgeon, anaesthetist or nurse) simultaneously observed the SSC application.…”

No impact of sex on surgical site infections in abdominal surgery: A multi-center study

“…This database was created in the context of a prospective trial that assessed the effects of structured intraoperative briefings on patient outcomes including SSI. [16] The database includes data from patients undergoing surgery in four Swiss hospitals (2 university hospitals, and two non-university referral centres) between May 2015 and March 2018. The database was initiated after obtaining approval from the respective local ethical committees (leading committee: Kantonale Ethikkommission Bern #161/2014).…”

“…This database was created in the context of a prospective trial that assessed the effects of structured intraoperative briefings on patient outcomes including SSI. [16] The database includes data from patients undergoing surgery in four Swiss hospitals…”

“…This database was created in the context of a prospective trial that assessed the effects of structured intraoperative briefings on patient outcomes including SSI. [16] The database includes data from patients undergoing surgery in four Swiss hospitals procedures and complications as SSI were extracted. For the final analysis 82 patients with death within 30 days after surgery were excluded.…”