Date of Award

3-25-2008

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

David Silverman

Abstract

Wrong-site surgery can be a catastrophic event for patients, caregivers, and institutions and often results from failures in communication and teamwork. Although breakdowns in communication are known to be the leading root cause of wrong-site surgery, little is known about the efficacy of strategies to decrease the risk of these preventable events. Operative delays are also often the result of failures in communication and teamwork. Much of the attention toward improving operating room efficiency has focused on OR logistics and has not addressed the critical issue of improved teamwork. The specific aim of this study is to evaluate the impact of operating room briefings on frontline caregiver perceptions of unexpected delays, care coordination, and the risk for wrong site surgery. A case-based version of the Safety Attitudes Questionnaire was administered to OR staff at an academic medical center before and after the initiation of an OR briefings program to measure the change in perceptions of unexpected operative delays, care coordination, and risk associated with wrong site surgery. Items question a caregivers perception of coordination, unexpected operative delays, and awareness of the surgical site. Response options ranged from 1 (disagree strongly) to 5 (agree strongly). MANOVA was employed to test for changes in overall caregiver assessments before and after the implementation of briefings and the percentage of OR staff that agree or disagree with each question was reported. The pre-briefing response rate was 85% (306 out of 360 respondents), and the post-briefing response rate was 75% (116 out of 154). Respondents included surgeons (34.9%), anesthesiologists (14.0%), and nurses (44.4%). The use of briefings was associated with frontline caregiver assessments of a reduced risk for wrong site surgery and improved collaboration (F (6, 390) = 10.15, p < .001). OR caregiver assessments of briefing and wrong-site surgery issues improved for 5 out of the 6 items, e.g., Surgery and Anesthesia worked together as a well-coordinated team (67.9% agreed pre, 91.5% agreed post). The only item which did not improve significantly was, A team discussion before a surgical procedure is important for patient safety, for which responses were favorable pre and post intervention (94.0% versus 93.3 %, respectively). The use of briefings was associated with fewer unexpected delays, with 30.9% of OR personnel reporting a delay pre-briefings, and only 23.3% reporting delays post-briefings (F (1, 397) = 7.66, p < 0.001). In the post-briefing group, a linear relationship between elements of ORBAT and the assessments of unexpected delays was found, e.g., A preoperative discussion included planning for potential problems (beta=-0.34, p<0.001). OR Briefings significantly reduce perceptions of risk for wrong site surgery and improve perceptions of collaboration among OR personnel. OR Briefings also have the potential to increase OR efficiency by significantly reducing unexpected delays in the operating room.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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