Cecily O’Connor
RedwoodAge.com

A Mayo Clinic pilot study found that short, preoperative briefings with surgical staff before cardiac surgery helped to reduce cost, errors and miscommunication.

Fifty-six surgical staff members filledout questionnaires and participated in focus groups to develop a briefing format. Surgical assistants and technicians, registered nurses, nurse anesthetists, and perfusionists who operate the heart-lung machine during most cardiac surgeries, were among the participants.

The briefings – which are not yet a routine part of surgery - were conducted in the operating room ahead of the day’s first surgical procedure before the patient arrived in the room. Each team member discussed his or her role in the procedure and any concerns related to the patient. The briefings lasted from one to eight minutes.

Improved communication is critical at a time when the aging boomer generation is expected to put a strain on the healthcare system. Surgeon shortages and rising medical costs are among the key factors that could leave boomers short of care just when they need it the most. So, increased emphasis on the overall quality of care is important to minimize negative health outcomes.

The goal of the briefings was to get everyone used to talking when there wasn't a problem, so they would be more likely to speak up when problems occur," said Dr. Thoralf Sundt, Mayo Clinic cardiac surgeon who volunteered his surgery team for the study. "We know that miscommunication is a major cause of sentinel events, an unexpected death or serious injury.

‘Errors Do Happen’
To measure the effectiveness, researchers compared six surgeries where briefings were conducted and 10 surgeries where no briefing occurred. When the briefings were conducted, miscommunication problems were cut by 53 percent. Medical supply waste also was reduced because the team better anticipated specific needs for each surgery.

Because of the complexity of what we do, errors do happen," Dr. Sundt said. "Each team member needs to feel comfortable enough to identify errors. Then we catch them and correct them.

While pre-procedure briefings are not common in operating rooms, they are standard in other high-risk industries such as aviation and in the military, said Dr. Douglas Wiegmann, lead researcher on the Mayo study. Separate research has shown that information conveyed in the operating room is often shared in a tense, ad hoc manner that is not conducive to comfortable communication.

That’s why additional studies and pilots are needed to determine ways to incorporate the briefings more broadly, researchers said. Dr. Sundt said his team has “embraced” the briefings and continues to conduct them prior to the first procedure of the day.

In addition to specific concerns about the surgery, the briefings include information about the patient's prior procedures, other diagnoses, and risks and emotional concerns, such as the patient's biggest worry regarding surgery.

"It sets the tone for the day,” Dr. Sundt said.

Results from the Mayo Clinic pilot are published online in the Journal of the American College of Surgeons.