Improving the multidisciplinary Team Brief; a trainee led quality improvement project.

Abstract

Background: The project was developed following the NatSSIPs2 consultation and recent publication to improve patient safety, team working, and efficiency.1 To meet the Team Brief standards and improve their quality we wanted to introduce a formalised approach at the Royal London Hospital. Methods: Quality improvement (QI) methodology was used to guide the project during the ‘CANDLE’ (Curriculum and Delivery Learning Event) regional QI training. A driver diagram was created and stakeholders analysed. The project began in September 2022 with the aim to implement the Team Brief standard by January 2023. Results: A snapshot audit and staff survey were performed in October 2022. Thirteen Team Briefs from a broad range of specialties were audited, and 27 staff members responded to the survey. The results of this were used to define the issues with team brief and to create a multidisciplinary team brief proforma. This was initially trialled over a 2-week period from 16 to 29 November. After the initial trial, the design was refined based on feedback. Well-being was included with individual and team ‘RAG’ (red, amber, green) ratings and inclusion of ‘Greatix’ QR code to encourage reporting of good feedback. Appropriateness of staffing was also recorded. The use of the new proforma was audited between 26 November 2022 and 20 January 2023. Usage was sporadic, only 38% of lists (183/480), except in the orthopaedic trauma theatres where uptake was much higher. The staff in these theatres were interviewed to ascertain why uptake was so good; it was because of nurse in charge adoption. The project was presented at local audit meetings, and a QI celebration event. This led to buy-in from the senior management team. The proforma was reintroduced in February 2023. The project became self-sustaining with recruitment of other members to the QI team and became imbedded in the local culture. Feedback from the most recent theatre audit meeting was excellent. From 20 February to 10 March 2023 the proforma was used in 79.3% (119/150) of main theatre lists. Conclusion: The multidisciplinary Team Brief project has introduced a proforma which has been adopted consistently in theatres and created a self-sustaining change. The proforma includes structured organisational information to improve patient safety and communication but also focusses on team working, psychological safety, and well-being. The CANDLE course for curriculum and delivery of QI supported trainee leadership, teamwork, and delivery of QI. 1.National Safety Standards for Perioperative Care 2. Centre for Perioperative Care. January 2023. Available from https://cpoc.org.uk/sites/cpoc/files/documents/2022-12/CPOC_NatSSIPs2_Summary_2023.pdf (accessed March 2023)