News and Headlines
Safety Study =
Shows
Nurses High in Teamwork
With communication breakdowns a leading cause of wrong= -site surgeries, collaboration in the operating room represents a critical factor= in keeping patients safe. However, a recent study found perceptions of teamwork varies dramatically across disciplines.
Operating room staff responding to the Safety Attitudes
Questionnaire (SAQ), developed by Johns Hopkins University, reported surgeo=
ns
exhibit the lowest levels of teamwork (3.68 on a scale of one to five, with
five being very high) and nurses the highest rating (4.2 of five). Results
appeared in the May issues of the Annals of Surgery and the Journal of t=
he
To create the SAQ, the researchers modified surveys us= ed in intensive care units and the aviation industry for use in the operating room setting. The theory behind using such surveys is that improving work-area issues improves safety, according to co-researcher J. Bryan Sexton, Ph.D., = an assistant professor of anesthesia and critical care medicine at Johns Hopki= ns.
“The SAQ provides hospitals with an accurate met= hod for rating safety in the OR because it asks frontline caregivers about the = OR work environment,” said lead researcher Martin A. Makary, M.D., MPH, an assistant professor in the Department of Surgery at The Johns Hopkins University School of Medicine, in a written statement.
Recognizing the importance of teamwork and collaborati= on in improving safety, the Joint Commission on Accreditation of Healthcare Organization will require hospitals to measure culture, starting in 2007. A= bout 700 hospitals are now using the SAQ, and the Johns Hopkins’ team anticipated more will begin administering it.
The researchers administered the questionnaire to all = of the operating room caregivers in a health system with 60 hospitals in 16 states. Surgeons returned 222 surveys, nurses 1,058, surgical technicians 564, anesthesiologists 170 and nurse anesthetists 121.
Eighty-five percent of surgeons rated teamwork among s= urgeons as high or very high and 88 percent rated collaboration and communication h= igh or very high with nurses. But only 48 percent of nurses rated teamwork with surgeons as high or very high.
“Such differences underscore the disconnect in teamwork,” the authors said in the paper. They explained that during discussions with participants during survey feedback sessions, nurses and physicians described teamwork differently. Nurses thou= ght it meant “having their input respected.” Physicians, on the oth= er hand, viewed good collaboration as “having nurses who anticipate their needs and follow instructions.”
“Results, like those telling us that surgeons ra= te poorly in teamwork, help target areas for improved communication and provid= e a benchmark for rating strategies aimed at improving patient safety,” <= span class=3DSpellE>Makary said.
The study authors suggested improving collaboration by conducting operating room briefings, during the time-out to review everyone= on the team’s name and role, the operative plan and potential issues in = the case and debriefings to talk about lessons learned on the case that could a= pply to future surgeries. Johns Hopkins has instituted such briefings and debriefings and found them beneficial in building teamwork.
“The results have already led to improvements in= the OR,” says Makary. “Before every operation, we now require a presurgery checklist similar to what pilots do before take-off. This not only minimizes errors b= ut also improves teamwork.”
AORN, an association of periopera= tive nurses, understands the connection between communication and safety and has launched a pilot project that will implement intense team training at five different types of hospitals across the country.
Leslie Durgin, AORN vice p= resident of external affairs, said that Kaiser Permanente pioneered such briefings, = with good results, but the association wants to see if they will work in other settings.
“Nurse satisfaction w= ent off the charts in terms of improvement,” Durgin said. Participants will learn to address each other by name and acknowledge that they heard each other’s warnings, although they do not need to accept them. Anyone in the operating room can stop the procedure from begin= ning if he or she has a concern.
AORN consultant Human Performance Training Institute w= ill administer questionnaires pre- and post-training and observe and coach caregivers in the operating room. AORN expects to have the results of its s= tudy in June 2007.