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

^a Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States
^b Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
^c Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States

Received 3 April 2008; received in revised form 1 July 2008; accepted 2 July 2008.

^_* Corresponding author. (Email: aelbardissi{at}partners.org).

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Key Words: Patient safety • Error • Human factors • Teamwork • Communication

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				S. A.M. Nashef Editorial comment: Better the devil you know? Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 1033 - 1033. [Full Text] [PDF]