Preoperative Briefing in the Operating Room: Shared Cognition, Teamwork, and Patient Safety

Abstract

Contemporary preoperative team briefings conducted to improve patient safety focus mainly on supplying identification details regarding the patient and the surgical procedure. Drawing on cognitive theory principles, in this study a briefing protocol was developed that presents a broader perspective model of the patient and the planned procedure. In addition to customary identification details and drug sensitivities, the new briefing also includes review of significant background information, needed equipment, planned surgery stages, and so forth. The briefing content was developed following 130 continuous, nonstructured observations conducted in gynecologic and orthopedic operating rooms. The briefing form was designed as a large poster hung in a visible position on the operating room wall. The poster guides the team members (ie, nurses, surgeons, and anesthesiologists) in their conduct. Briefing is conducted orally, and no written records are required. The number of nonroutine events (ie, situations that, if not corrected, might lead to patient harm) observed in the 130 surgeries conducted without briefing was compared with the number of events in 102 surgeries in which briefing was conducted. There was a 25% reduction in the number of nonroutine events when briefing was conducted and a significant increase in the number of surgeries in which no nonroutine event was observed. Team members evaluated the briefing as most valuable for their own work, the teamwork, and patient safety. Following the study, the new briefing format was accepted and adopted for routine use. Team briefings designed to supply a broader-perspective surgery model may be an easy-to-apply tool to reduce the number of nonroutine events during surgery and increase patient safety. Contemporary preoperative team briefings conducted to improve patient safety focus mainly on supplying identification details regarding the patient and the surgical procedure. Drawing on cognitive theory principles, in this study a briefing protocol was developed that presents a broader perspective model of the patient and the planned procedure. In addition to customary identification details and drug sensitivities, the new briefing also includes review of significant background information, needed equipment, planned surgery stages, and so forth. The briefing content was developed following 130 continuous, nonstructured observations conducted in gynecologic and orthopedic operating rooms. The briefing form was designed as a large poster hung in a visible position on the operating room wall. The poster guides the team members (ie, nurses, surgeons, and anesthesiologists) in their conduct. Briefing is conducted orally, and no written records are required. The number of nonroutine events (ie, situations that, if not corrected, might lead to patient harm) observed in the 130 surgeries conducted without briefing was compared with the number of events in 102 surgeries in which briefing was conducted. There was a 25% reduction in the number of nonroutine events when briefing was conducted and a significant increase in the number of surgeries in which no nonroutine event was observed. Team members evaluated the briefing as most valuable for their own work, the teamwork, and patient safety. Following the study, the new briefing format was accepted and adopted for routine use. Team briefings designed to supply a broader-perspective surgery model may be an easy-to-apply tool to reduce the number of nonroutine events during surgery and increase patient safety. Changing Culture: A New View of Human Error and Patient SafetyCHESTVol. 137Issue 2PreviewIn this issue of CHEST (see page 443 ), Einav and colleagues1 report the results of a study on preoperative briefings and patient care during gynecologic and orthopedic surgery. The findings of this study are important, not only because they indicate that preoperative briefings can reduce nonroutine events during surgery, but because they represent a prevailing shift in how human error and patient safety are viewed within many surgical specialties as well as the health-care community in general. Traditionally, surgical outcomes have been attributed primarily to the technical skills of the individual surgeon. Full-Text PDF