The Efficacy of Medical Team Training: Improved Team Performance and Decreased Perioperative Delays. A Detailed Analysis of 3,580 cases
*Francis A. Wolf1, Lawrence W. Way2, *Lygia Stewart1
1UCSF / SF VAMC, San Francisco, CA;2UCSF, San Francisco, CA
OBJECTIVE(S): Medical Team Training(MTT) has been touted as a way to improve teamwork and patient safety in the operating room(OR). This study was designed to determine whether MTT actually has tangible benefits.
METHODS: OR personnel(surgeons, anesthesiologists, nurses) completed a one-day intensive MTT training. A standardized briefing/debriefing/perioperative routine was developed, including documentation of OR miscues, delays, and defined case score(1-5) assigned by the team. A multi-disciplinary committee reviewed and rectified any systems problems identified. Debriefing items were analyzed comparing baseline data with 12 and 20-month follow-up. A safety attitudes questionnaire was administered at baseline and one year.
RESULTS: 3,580 MTT debriefings were analyzed. One year following MTT, case delays decreased(23% to 9%, p=0.001), mean case score increased(4.07 to 4.87, p<0.0005); both changes were sustained at 20 months. One-year and 20-month follow-up data demonstrated decreased frequency of preoperative delays(16% to 8%, p=0.03), hand-off issues(5.4% to 0.3%, p=0.022), equipment issues/delays(24% to 6%, p<0.0005), cases with low(<3) conduct scores(23% to 3%, p<0.0005); and timing of prophylactic antibiotic administration improved(85% to 97%, p<0.0001). Surveys documented perception of improved teamwork and patient safety. A major systems issue regarding perioperative medication orders was identified and corrected.
CONCLUSIONS: MTT produced sustained improvement in OR team function, including decreased delays and improved case scores. When combined with a high-level debriefing/problem-solving process, MTT can be a foundation for improving OR performance. This is the largest case analysis of MTT and one of the few to document an impact of MTT on objective measures of operating room function and patient safety.