The Efficacy of Medical Team Training: Improved Team Performance and Decreased Operating Room Delays A Detailed Analysis of 4863 Cases
Department of Surgery, University of California, San Francisco, CA, USA. Annals of surgery
(Impact Factor: 8.33).
09/2010; 252(3):477-83; discussion 483-5. DOI: 10.1097/SLA.0b013e3181f1c091
Medical team training (MTT) has been touted as a way to improve teamwork and patient safety in the operating room (OR).
OR personal completed a 1-day intensive MTT training. A standardized briefing/debriefing/perioperative routine was developed, including documentation of OR miscues, delays, and a case score (1-5) assigned by the OR team. A multidisciplinary MTT committee reviewed and rectified any systems problems identified. Debriefing items were analyzed comparing baseline data with 12 and 24-month follow-up. A safety attitudes questionnaire was administered at baseline and 1 year.
A total of 4863 MTT debriefings were analyzed. One year following MTT, case delays decreased (23% to 10%, P < 0.0001), mean case score increased (4.07-4.87, P < 0.0005), and both changes were sustained at 24 months. One-year and 24-month follow-up data demonstrated decreased frequency of preoperative delays (16%-7%, P = 0.004), hand-off issues (5.4%-0.3%, P < 0.0001), equipment issues/delays (24%-7%, P < 0.0001), cases with low (<3) case scores (23%-3%, P < 0.0005), and adherence to timing guidelines for prophylactic antibiotic administration improved (85%-97%, P < 0.0001). Surveys documented perception of improved teamwork and patient safety. A major systems issue regarding perioperative medication orders was identified and corrected.
MTT produced sustained improvement in OR team function, including decreased delays and improved case scores. When combined with a high-level debriefing/problem-solving process, MTT can be a foundation for improving OR performance. This is the largest case analysis of MTT and one of the few to document an impact of MTT on objective measures of operating room function and patient safety.
Available from: Susan Nancarrow
- "Apart from work by Weaver et al. , interventions were delivered to ad hoc teams. Outcome measures included attitudes [40-43], team performance [41-43], team function case delays and case scores , and learning behavior . Only Wolf et al.  reported a sustained effect at 24 months. "
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ABSTRACT: Approximately 70 to 80% of healthcare errors are due to poor team communication and understanding. High-risk environments such as the trauma setting (which covers a broad spectrum of departments in acute services) are where the majority of these errors occur. Despite the emphasis on interprofessional collaborative practice and patient safety, interprofessional teamworking in the trauma setting has received little attention. This paper presents the findings of a scoping review designed to identify the extent and nature of this literature in this setting. The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched from January 2000 to April 2013 for results of interprofessional teamworking in the trauma setting. A hand search was conducted by reviewing the reference lists of relevant articles. In total, 24 published articles were identified for inclusion in the review. Studies could be categorized into three main areas, and within each area were a number of themes: 1) descriptions of the organization of trauma teams (themes included interaction between team members, and leadership); 2) descriptions of team composition and structure (themes included maintaining team stability and core team members); and 3) evaluation of team work interventions (themes included activities in practice and activities in the classroom setting).
Descriptive studies highlighted the fluid nature of team processes, the shared mental models, and the need for teamwork and communication. Evaluative studies placed a greater emphasis on specialized roles and individual tasks and activities. This reflects a multiprofessional as opposed to an interprofessional model of teamwork. Some of the characteristics of high-performing interprofessional teams described in this review are also evident in effective teams in the community rehabilitation and intermediate care setting. These characteristics may well be pertinent to other settings, and so provide a useful foundation for future investigations.
Available from: Lisbet Meurling
- "Some results have suggested that such methods are more useful than other types of interventions in hospital settings (Zeltser and Nash, 2010). In addition, a number of studies have demonstrated a positive organisational impact (Grogan et al., 2004; Eppich et al., 2008; Wolf et al., 2010; Neily et al., 2010a Neily et al., , 2010b Weaver et al., 2010), although the evidence supporting that observation is weak, and it is not clear exactly how an organisation is affected (Buljac-Samardzic et al., 2010; Zeltser and Nash, 2010). Salas et al. (2008) have suggested that for such interventions to be successful, they must be undertaken in a psychologically safe environment in which there is no risk of negative consequences (Salas et al., 2008). "
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ABSTRACT: This study aims to describe implementation of simulator-based medical team training and the effect of this programme on inter-professional working in an intensive care unit (ICU).
Over a period of two years, 90 percent (n = 152) of the staff of the general ICU at Karolinska University Hospital, Huddinge, Sweden, received inter-professional team training in a fully equipped patient room in their own workplace. A case study method was used to describe and explain the planning, formation, and results of the training programme.
In interviews, the participants reported that the training had increased their awareness of the importance of effective communication for patient safety. The intervention had even had an indirect impact by creating a need to talk, not only about how to communicate efficaciously, but also concerning difficult care situations in general. This, in turn, had led to regular reflection meetings for nurses held three times a week. Examples of better communication in acute situations were also reported. However, the findings indicate that the observed improvements will not last, unless organisational features such as staffing rotas and scheduling of rounds and meetings can be changed to enable use of the learned behaviours in everyday work. Other threats to sustainability include shortage of staff, overtime for staff, demands for hospital beds, budget cuts, and poor staff communication due to separate meetings for nurses and physicians.
The present results broaden our understanding of how to create and sustain an organizational system that supports medical team training.
Available from: Stanley R. Maloy
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ABSTRACT: One of the greatest advances in molecular genetics has been the application of selectable transposons in molecular biology. After 30 years of use in microbial genetics studies, transposons remain indispensable tools for the generation of null alleles tagged with selectable markers, genetic mapping, manipulation of chromosomes, and generation of various fusion derivatives. The number and uses of transposons as molecular tools continues to expand into new fields such as genome sciences and molecular pathogenesis. This chapter outlines some of the many uses of transposons for molecular genetic analysis and strategies for their use.
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