Implementation of a team training program in the treatment of breast cancer patients.

Abstract

e16515 Background: Team Training (TT) principles, used in high-risk industries to reduce errors and improve communication and task coordination, have been applied in other areas of medicine, but never in an outpatient subspecialty setting. We piloted a TT program in a large, academic breast cancer program. Methods: Observations, interviews and anonymous adverse event reporting systems were used to identify areas of vulnerability warranting intervention: 1) communication of changes in chemotherapy orders on the day of treatment ("change orders") 2) missing orders on treatment days that patients were not also scheduled to see their physician (“unlinked” visits) 3) follow-up and communication to other team members on important patient issues (e.g. pending test results or changes in patient status) 4) conflict resolution between providers and staff. For each area, agreements about roles, responsibilities and behaviors were made. Using a train-the-trainer model, clinical leaders trained all providers and staff in TT principles, the agreements, and the tools to support them. Results: The program was evaluated six months after implementation. There was insufficient power to detect a significant difference in communication of change orders because of the infrequency of events (< 2% pre and post-training). However, 100% of providers reported it was easier to communicate change orders and 87% of infusion nurses reported a decrease in non-communicated changes. The incidence of missing orders for unlinked visits decreased from 30% to 2%. Press-Ganey patient satisfaction scores suggested improvement in patient perception of care coordination. Providers, infusion nurses and support staff reported strongly positive perceptions of improvement in efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of patient care. Similarly, all groups reported improved relationships and more respectful behavior among team members (91%, 85%, 93%). Conclusions: Team Training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination. Widespread implementation of this strategy is ongoing at our institution.