The impact of improving teamwork on patient outcomes in surgery: A systematic review

Sun, Rosa; Marshall, Dominic C; Sykes, Mark; Maruthappu, Mahiben; Shalhoub, Joseph

doi:10.1016/j.ijsu.2018.03.044

Cited by 15 publications

(18 citation statements)

References 24 publications

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“…Although not investigated in this study, there is reason to speculate that tensions in the OR can lead to negative patient outcomes and threaten patient safety [7,9,12,26,59], because problems in teamwork have been related to more errors and more complications for surgical teams [60,61].…”

Section: Discussionmentioning

confidence: 99%

“Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

et al. 2019

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BackgroundTense communication and disruptive behaviors during surgery have often been attributed to surgeons’ personality or hierarchies, while situational triggers for tense communication were neglected. Goals of this study were to assess situational triggers of tense communication in the operating room and to assess its impact on collaboration quality within the surgical team.Methods and findingsThe prospective observational study was performed in two university hospitals in Europe. Trained external observers assessed communication in 137 elective abdominal operations led by 30 different main surgeons. Objective observations were related to perceived collaboration quality by all members of the surgical team. A total of 340 tense communication episodes were observed (= 0.57 per hour); mean tensions in surgeries with tensions was 1.21 per hour. Individual surgeons accounted for 24% of the variation in tensions, while situational aspects accounted for 76% of variation. A total of 72% of tensions were triggered by coordination problems; 21.2% by task-related problems and 9.1% by other issues. More tensions were related to lower perceived teamwork quality for all team members except main surgeons. Coordination-triggered tensions significantly lowered teamwork quality for second surgeons, scrub technicians and circulators.ConclusionsAlthough individual surgeons differ in their tense communication, situational aspects during the operation had a much more important influence on the occurrence of tensions, mostly triggered by coordination problems. Because tensions negatively impact team collaboration, surgical teams may profit from improving collaboration, for instance through training, or through reflexivity.

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Section: Discussionmentioning

confidence: 99%

“Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

et al. 2019

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“…Success, i.e., reduction in intraoperative problems, morbidity, and mortality, has been reported both for the introduction of checklists [ 21 ] and for teamwork training [ 26 – 28 ]. However, findings are not unequivocal for both [ 8 , 21 , 28 , 29 ]. Difficulties and obstacles to transferring training to clinical practice are regularly reported in the literature [ 21 , 25 , 30 ].…”

Section: Introductionmentioning

confidence: 97%

“…There is mounting evidence, however, that communication and teamwork within the surgical team are important for patient outcomes, and studies are needed that aim at improving teamwork and assessing clinical patient outcomes [ 8 ]. Research showed problems in about 30% of communication during operations, causing delays, tensions in the team, inefficiencies and procedural errors [ 9 ], undesirable incidents [ 10 ], or flow disruptions, that in turn may lead to procedural errors [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

StOP? II trial: cluster randomized clinical trial to test the implementation of a toolbox for structured communication in the operating room—study protocol

Keller

Tschan

Semmer

et al. 2022

Trials

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Background Surgical care, which is performed by intensely interacting multidisciplinary teams of surgeons, anesthetists, and nurses, remains associated with significant morbidity and mortality. Intraoperative communication has been shown to be associated with surgical outcomes, but tools ensuring efficient intraoperative communication are lacking. In a previous study, we developed the StOP?-protocol that fosters structured intraoperative communication. Before the critical phases of the operation, the responsible surgeon initiates and leads one or several StOP?s. During a StOP?, the surgeon informs about the progress of the operation (status), next steps and proximal goals (objectives), and possible problems (problems) and encourages all team members to voice their observations and ask questions (?). In a before-after study performed mainly in visceral surgery, we found effects of the StOP?-protocol on mortality, length of hospital stay, and reoperation. We intend to assess the impact of the StOP?-protocol in a cluster randomized trial, in a wider variety of surgical specialties (i.e., general, visceral, thoracic, vascular surgery, surgical urology, and gynecology). The primary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces patient mortality within 30 days after the operation. The secondary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces unplanned reoperations, length of hospital stay, and unplanned hospital readmissions. Methods This study is designed as a multicenter, cluster-randomized parallel-group trial. Board-certified surgeons of participating clinical departments will be randomized 1:1 to the StOP? intervention group or to the standard of care (control) group. The intervention group will undergo a training to use the StOP?-protocol and receive regular feedback on their compliance with the protocol. The surgeons in the control group will communicate as usual during their operations. The unit of observation will be operations performed by cluster surgeons. Consecutive patients will be enrolled over 4 months per cluster. A total of 400 surgeons will be recruited, and we expect to collect patient outcome data for 14,000 surgical procedures. Discussion The StOP?-protocol was designed as a tool to structure communication during surgical procedures. Testing its effects on patient outcomes will contribute to implementing evidenced-based interventions to reduce surgical complications. Trial registration ClinicalTrials.gov NCT05356962. Registered on May 2, 2022

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“…All the members of a surgical team, including operating room nurses, nurse anesthesiologists, and doctors, must communicate with each other effectively to provide safe care to patients [ 2 ]. As the operating rooms are very stressful and challenging environments, satisfactory professional communication between nurses and doctors is essential for providing satisfactory care and maintaining patient safety [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Study of the Relationship between Professional Communication and Professional Commitment in Operating Room Nurses

Parnikh

Torabizadeh

Kalyani

et al. 2022

Nursing Research and Practice

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Background. Operating rooms are among the most complex clinical environments in hospitals where teamwork and professional communication play a very important part. Professional commitment is an influential factor in the personnel’s professional communication and can affect the outcomes of healthcare services. Objective. The present study aims to investigate the relationship between professional communication and professional commitment in the operating room nurses in teaching hospitals. Study Design. The present study used a descriptive-correlational design. Participants were selected via census sampling from hospitals in Shiraz over a period of three months. The participants were 350 operating room nurses who met the inclusion criteria. Data were collected using professional communication and a professional commitment questionnaire. The collected data were analyzed using the descriptive and inferential statistics in SPSS v v. 22. Findings. The operating room nurses’ mean scores for professional communication (136.81 ± 13.77) and professional commitment (71.42 ± 11.62) were found to be high. The results of the Pearson correlation coefficient test showed that there was a statistically significant linear relationship between professional communication and professional commitment ( p < 0.001 , r = 0.235). The results also showed that there was a significant relationship between professional commitment on the one hand and gender ( p = 0.042 ), marital status ( p = 0.047 ), and interest in work ( p = 0 / 000 ) on the other hand. There was also a significant relationship between professional communication and interest in work ( p = 0 / 000 ). Conclusion. Given the significance of professional communication and professional commitment in the operating rooms, it is recommended that healthcare administrators and policymakers take steps to improve these areas. It is suggested that measures should be taken to increase the personnel’s awareness of the principles of professional communication and the significance of professional commitment through regular workshops.

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The impact of improving teamwork on patient outcomes in surgery: A systematic review

Cited by 15 publications

References 24 publications

“Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

“Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams

StOP? II trial: cluster randomized clinical trial to test the implementation of a toolbox for structured communication in the operating room—study protocol

A Study of the Relationship between Professional Communication and Professional Commitment in Operating Room Nurses

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