As the nation grapples with surging health care costs, researchers at the University of Connecticut Health Center, Farmington, and Saint Francis Hospital and Medical Center, Hartford, have confirmed two simple cost-effective methods to reduce expensive postoperative complications-communications team training and a surgical checklist. Investigators found that when surgical teams completed communications training and a surgical procedure checklist before, during, and after high-risk operations, patients experienced fewer adverse events such as infections and blood clots. The study is published in the December issue of the Journal of the American College of Surgeons.
Surgical teams come together for one common goal-to treat patients using surgical procedures-but occasionally unforeseen circumstances can occur during the process. Sometimes surgical equipment isn't on hand, or the patient requires more blood than expected, which delays the procedure and requires dispensing more anesthesia while a team member hurries to get needed supplies. Also, surgical team members may have inconsistent information about priorities for the procedure, explained Lindsay Bliss, MD, lead study author and general surgery resident at the University of Connecticut. As many as five to 20 clinicians can be involved in a single operation, depending on its length and complexity. In a larger hospital, some team members may meet for the first time during the procedure. "Everyone brings to the team a different aspect of patient care that they think is the most important," Dr. Bliss said. "But the team has to understand all aspects of patient care and agree on what's important."
Although surgical checklists have existed for a while, they are not universally used. For the University of Connecticut study, Dr. Bliss's colleagues compared three groups of surgical procedures to determine whether communications training coupled with a standardized checklist could bring surgical teams into agreement and reduce patients' complications.
The communications training included three sessions on topics such as differences between introverts and extroverts, effective dialogue among all operating room personnel, and how to use a surgical checklist. Dr. Bliss's team used the one-page Association for Perioperative Registered Nurses Comprehensive Surgical Checklist developed in April 2010. It includes protocols mandated by the World Health Organization, The Joint Commission, and the Centers for Medicare and Medicaid Services, and has been endorsed by the American College of Surgeons and other surgical organizations. For one group of procedures, the surgical team selected operations from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP -) database. These operations occurred between January 2007 and June 2010 and served as the baseline group, since these surgical teams neither had gone through the communications training nor had they used a checklist. Dr. Bliss said pulling this information from the ACS NSQIP database allowed the researchers to access standardized clinical and demographic data on the patients, along with information about 30-day surgical outcomes.
These procedures were compared with two other groups of surgical procedures that occurred between December 2010 and March 2011. In one group, 246 procedures involved surgical teams who had undergone communications training, while the other group included 73 procedures involving surgical teams who had not only gone through the same communications training but also used the checklist.