Team Training in the Perioperative Arena: A Methodology for Implementation and Auditing Behavior

Abstract

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.

Debriefing in the OR: A Quality Improvement Project

“…Hospital executives, including the vice president of Perioperative Services and the medical director, supported this initiative. Because the presence of leaders has been recognized to be crucially important to the success of new debriefing initiatives, the coaches provided all seven OR nurse managers with additional information about ways to help guide and support staff members through the debriefing process.…”

“…In January 2017, our facility launched our version of the SSC in our ORs along with the TeamSTEPPS structure for communication. TeamSTEPPS is an evidence‐based protocol that provides tools and education to improve teamwork in a hospital setting . The driving factors behind this initiative included a need to improve communication through a structured and standardized format among all surgical team members.…”

“…The coach's availability beyond the duration of the surgical procedure provides an opportunity for staff members to ask questions in a one‐on‐one conversation . It should be noted that use of coaches can influence better results via the Hawthorne effect . Coaches are recognized leaders and can develop a rapport with staff members and physicians .…”

“…After additional analysis of the process, personnel noted that coaching was a viable and sustainable intervention strategy in the setting of a large medical center . In another large teaching center, the TeamSTEPPS training and auditing program was implemented and the improved communication techniques helped reduce unintentionally retained foreign bodies and wrong‐person and wrong‐site procedures by 67% during a two‐year period …”

Communication: an enabling competency

“…Communication training for a whole team, such as Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS), has been shown to be effective. Team STEPPS was created by defence and healthcare quality groups in the USA and utilizes team training concepts around leadership, situational monitoring, mutual support and communication …”