Tscholl DW, Weiss M, Kolbe M, et al. Anesth Analg. 2015;121:948-956.
This pre-post study demonstrated increases in teamwork after introduction of an anesthesia checklist. Although evidence for checklists in real-world settings is mixed, this work demonstrates their efficacy as part of an intervention study, which is consistent with prior work.
Mazzocco K, Petitti DB, Fong KT, et al. Am J Surg. 2009;197:678-85.
Direct observation of teamwork during surgical procedures revealed that poor teamwork was associated with higher rates of postoperative complications and overall mortality, even after adjusting for preoperative risk. Though suboptimal teamwork is a recognized problem in the operating room, this study is one of the first to directly link team behavior to patient outcomes. One method of improving teamwork, crew resource management training, has been extensively evaluated in a variety of clinical settings. A near miss resulting from poor teamwork is illustrated in a recent AHRQ WebM&M commentary.
Prior to surgery, an anesthesiologist and surgical physician assistant noted a patient's allergy to IV contrast dye, but no order was written. During a time out before the procedure, an operative nurse raised concern about the allergy, but the attending anesthesiologist was not present and the resident did not speak up.
Structured communication tools are being used increasingly to prevent critical communication failures. This study evaluated the impact of an interprofessional preoperative checklist briefing and discovered a significant three-fold reduction in communication breakdowns. While past studies have similarly demonstrated benefits from improved communication in the operating room, this is the first to directly observe how briefings affect team communication. An invited critique, led by Drs. Pronovost and Makary, accompanies the study and applauds the authors' efforts to rigorously evaluate a communication tool.
Wiegmann DA, ElBardissi AW, Dearani JA, et al. Surgery. 2007;142:658-65.
Using a trained observer to monitor for errors and flow disruptions in cardiac surgery operations, this study found that teamwork and communication failures were the strongest predictor of adverse outcomes.
A woman with a fractured right foot receives spinal anesthesia and nearly has surgery for trimalleolar fracture and dislocation of the left ankle. Only immediately prior to surgery did the team realize that the x-ray was not hers.
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