Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture

Sacks, Greg D.; Shannon, Evan Michael; Dawes, Aaron J.; Rollo, Johnathon C.; Nguyen, David K.; Russell, Marcia M.; Ko, Clifford Y.; Maggard-Gibbons, Melinda

doi:10.1136/bmjqs-2014-003764

Cited by 155 publications

(114 citation statements)

References 66 publications

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“…Establishing and sustaining a safety culture is a national public health priority (32). Multi-pronged programs like CUSP that promote executive engagement, multidisciplinary rounds, and use of communication tools, improve staff perceptions of safety and teamwork, along with care processes and outcomes (33–35). The implementation of other bundles, combined with TRiP and CUSP, have resulted in improvement in healthcare-associated infections, including central line-associated bloodstream infections and VAP (16–19).…”

Section: Discussionmentioning

confidence: 99%

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events

Rawat

Yang

Ali

et al. 2017

Critical Care Medicine

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Objective Ventilator-associated events (VAE) are associated with increased mortality, prolonged mechanical ventilation, and longer ICU stay. Given strong national interest in improving ventilated patient care, the NIH and AHRQ funded a two-state collaborative to reduce VAEs. We describe the collaborative’s impact on VAE rates in 56 ICUs. Design Longitudinal quasi-experimental study. Setting 56 intensive care units (ICUs) at 38 hospitals in Maryland and Pennsylvania from October 2012 to March 2015. Interventions We organized a multifaceted intervention to improve adherence with evidence-based practices, unit teamwork and safety culture. Evidence-based interventions promoted by the collaborative included head-of-bed elevation, use of subglottic secretion drainage endotracheal tubes, oral care, chlorhexidine mouth care, and daily spontaneous awakening and breathing trials. Each unit established a multi-disciplinary quality improvement team. We coached teams to establish comprehensive unit-based safety programs through monthly teleconferences. Data were collected on rounds using a common tool and entered into a web-based portal. Measurements and Results ICUs reported 69,417 ventilated patient-days of intervention compliance observations and 1,022 unit-months of VAE data. Compliance with all evidence-based interventions improved over the course of the collaborative. The quarterly mean VAE rate significantly decreased from 7.34 to 4.58 cases per 1,000 ventilator-days after 24 months of implementation (p=0.007). During the same time period, infection-related ventilator-associated complication (IVAC) and possible and probable ventilator-associated pneumonia (PVAP) rates decreased from 3.15 to 1.56 and 1.41 to 0.31 cases per 1,000 ventilator-days (p=0.018, p=0.012), respectively. Conclusions A multifaceted intervention was associated with improved compliance with evidence-based interventions and decreases in VAE, IVAC and PVAP. Our study is the largest to date affirming that best practices can prevent VAEs.

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Section: Discussionmentioning

confidence: 99%

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events

Rawat

Yang

Ali

et al. 2017

Critical Care Medicine

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“…On the other hand, Willis et al 17 used a realist review method to examine relationships between interventions and sustained culture change. Separate review work has yielded results with limited generalisability by focusing on prespecified healthcare environmental variables, such as nursing culture18–20 or surgical procedures 21. Other work by the ‘Deepening our Understanding of Quality improvement in Europe’ (DUQuE) team examined relationships between organisational-level culture and quality management systems 22.…”

Section: Introductionmentioning

confidence: 99%

Association between organisational and workplace cultures, and patient outcomes: systematic review protocol

et al. 2016

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IntroductionDespite widespread interest in the topic, no current synthesis of research is available analysing the linkages between organisational or workplace cultures on the one hand, and patient outcomes on the other. This protocol proposes a systematic review to analyse and synthesise the literature to date on this topic. The resulting review will discuss characteristics of included studies in terms of the type of healthcare settings researched, the measurements of organisational and workplace culture, patient outcomes measured and the influence of these cultures on patient outcomes.Methods and analysisA systematic review will be conducted aiming to examine the associations between organisational and workplace cultures, and patient outcomes, guided by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. An English language search of abstracts will be executed using the following academic databases: CINAHL, EMBASE, Ovid MEDLINE, Web of Science and PsycINFO. The review will include relevant peer-reviewed articles from randomised controlled trials (RCTs), non-RCTs, controlled before and after studies, interrupted time series studies, cross-sectional analyses, qualitative studies and mixed-method studies. Multiple researchers will be involved in assessing the quality of articles for inclusion in the review. This protocol documents a detailed search strategy, including terms and inclusion criteria, which will form the basis of the subsequent systematic review.Ethics and disseminationEthics approval is not required as no primary data will be collected. Results will be disseminated through a peer-reviewed publication and conference presentations.

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“…(17) Our institutional culture during the time of this study was not formally assessed, though likely influenced our results, and thus limits the generalizability of our findings to other institutions. Future studies in this realm should optimally be multi-institutional, and should characterize organizational culture to better explain discordance and determine the particular effect of teamwork training interventions.…”

Section: Discussionmentioning

confidence: 97%

Role confusion and self-assessment in interprofessional trauma teams

Steinemann

Kurosawa

Wei

et al. 2016

The American Journal of Surgery

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Background Trauma care requires coordinating an interprofessional team, with formative feedback on teamwork skills. We hypothesized nurses and surgeons have different perceptions regarding roles during resuscitation; that nurses’ teamwork self-assessment differs from experts’, and that video debriefing might improve accuracy of self-assessment. Methods Trauma nurses and surgeons were surveyed regarding resuscitation responsibilities. Subsequently, nurses joined interprofessional teams in simulated trauma resuscitations. Following each resuscitation, nurses and teamwork experts independently scored teamwork (T-NOTECHS). After video debriefing, nurses repeated T-NOTECHS self-assessment. Results Nurses and surgeons assumed significantly more responsibility by their own profession for 71% of resuscitation tasks. Nurses’ overall T-NOTECHS ratings were slightly higher than experts’. This was evident in all T-NOTECHS subdomains except “leadership,” but despite statistical significance the difference was small and clinically irrelevant. Video debriefing did not improve the accuracy of self-assessment. Conclusions Nurses and physicians demonstrated discordant perceptions of responsibilities. Nurses’ self-assessment of teamwork was statistically, but not clinically significantly, higher than experts’ in all domains except physician leadership.

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Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture

Abstract: CRD42013005987.

Cited by 155 publications

References 66 publications

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events

Two-State Collaborative Study of a Multifaceted Intervention to Decrease Ventilator-Associated Events

Association between organisational and workplace cultures, and patient outcomes: systematic review protocol

Role confusion and self-assessment in interprofessional trauma teams

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