The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon satisfaction in an orthopedic operating room: a prospective study

Abstract

BackgroundThe goal of this project was to implement a daily pre-operative huddle (briefing) for orthopedic cases and evaluate the impact of the daily huddle on surgeons’ perceptions of interruptions and operative delays.MethodsBaseline measurements on interruptions, delays, and questions were obtained. Then the daily pre-operative huddle was introduced. Surgeons completed a surgical outcomes worksheet for each day’s cases. Outcomes evaluated were primarily interruptions and delays starting cases before and following introduction of the huddle.Results19 baseline observations and 19 huddle-implemented observations of surgeon’s days were assessed. Overall, surgeon satisfaction increased and fewer delays occurred after introduction of huddles. Interruptions decreased in all categories including equipment, antibiotics, planned procedure and side. Time required for a huddle was less than one minute per case.ConclusionsIn this pilot study, a daily pre-operative huddle improved the flow of a surgeon’s day and satisfaction and indirectly provided indications of safety benefits by decreasing the number of interruptions and delays. Further studies in other surgical specialties should be conducted due to the promising results. Data was collected from three orthopedic surgeons in this phase; however, as a next step, data should be drawn from the rest of the orthopedic surgical team and other surgical subspecialties as well.

First-Case Operating Room Delays: Patterns Across Urban Hospitals of a Single Health Care System

“…Preoperative briefings, beginning prior to the start of the day, have demonstrated significant value for reducing delays as well as improvements in patient safety. 13,14 Simple education of the surgeon, monitoring of surgeon arrival times and sending out email reminders to arrive 20 minutes prior to case start resulted in dramatic improvement at one institution, where the percentage of on-time starts increased from 24% to 80%. 12 Documentation of reason for physician delay also would be helpful for feedback and process improvement, as would having subcategories of what was not completed by the physician, such as consent, history and physician or late arrival.…”

Fostering a Culture of Safety: The OR Huddle

“…AORN further supported these efforts by offering resources such as AORN's Correct Site Surgery Tool Kit to assist health care professionals in implementing best practices and to promote correct site surgery 3 . Some facilities, however, may need to improve compliance with the use of the surgical checklist or the tool kit and to educate surgical team members as to the benefits of surgical checklists 4 . The use of OR huddles has emerged as an effective form of communication with a proven track record of high reliability in reducing errors 5…”

“…Huddles have also been shown to reduce errors and untoward events 13,14 . Jain et al 4 performed a pilot study in the OR involving the implementation of a daily preoperative huddle for orthopedic procedures. The result was an improvement of the flow of the procedures and surgeons’ experiences and satisfaction.…”

Creating and applying shared mental models in the operating room

“…Communication in the OR can start at the beginning of the day with something as simple as interdisciplinary team members introducing themselves to other team members to create a dialogue 6,15 . When all the interdisciplinary team are present, time can then be allocated to what is sometimes referred to as pre-briefing, for members to discuss their expectations of how the surgical list may unfold 16 . Perioperative nurses are an essential part of generating this discussion as they have been found to favour plans being established and verbalised more than surgeons 11 .…”