Identifying methods to improve heart surgery: an operative approach and strategy for implementation on an organizational level

Abstract

Previous research has found teamwork failures to be strongly associated with the occurrence of surgical error. There have been few efforts to prospectively collect data regarding teamwork failures and technical errors in order to create interventions that would maximize teamwork effectiveness thereby minimizing technical error. Thirty-one cardiac surgical cases were prospectively observed by a trained human factors observer. Events were characterized according to human factors theory and included teamwork failures and technical errors. Surgical team structure was also evaluated in an effort to identify if it had an impact on surgical team performance. A strong correlation (r=0.67, p<0.001) was recognized between the occurrence of technical error (n=155) and teamwork failures (n=178). Teamwork failures consisted of surgeon-technical team failures (n=90, 51%), procedural information failures (n=36, 20%), surgeon-anesthesiologist failures (n=27, 15%), surgeon-perfusionist failures (n=18, 10%), and failures due to handoffs (n=7, 4%). Teams made up of members that were familiar with the operating surgeon had significantly fewer total event failures (8.6+/-1.6 vs 22+/-3.1, p<0.0001) and teamwork failures (5.6+/-1.8 vs 15.4+/-1.9, p<0.0001) in comparison to those teams where the majority of members were unfamiliar with the operating surgeon. These results indicate that the process of cardiac surgery would benefit from interventions to improve teamwork and communication. Such interventions could include preoperative briefings, revised approach to structuring of operative teams to favor members that have gained familiarity with the operating surgeon, standardized communication practices, and postoperative debriefings.