Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program

doi:10.1016/j.amjsurg.2010.07.011

The American Journal of Surgery

Volume 200, Issue 5, November 2010, Pages 620-623

Presented at the Association of VA Surgeons 34th Annual Meeting, May 9, 2010, Indianapolis, IN.

https://doi.org/10.1016/j.amjsurg.2010.07.011 Get rights and content

Abstract

Background

The purpose of this study was to examine the outcomes of checklist-driven preoperative briefings and postoperative debriefings during the Veterans Health Administration (VHA) medical team training program.

Methods

A briefing score (1, never started; 2, started then discontinued; 3, maintained on original targeted cases; 4, expanded to other services; 5, briefing all cases, all services) was established at 10.1 ± .3 months after introduction of the checklist. Outcomes included antibiotic and deep venous thrombosis prophylaxis compliance rates before and after use of the checklist.

Results

Antibiotic (97.0% ± .1% vs 92.1% ± 1.5%; P = .01) and deep venous thrombosis (95.7% ± .8% vs 85.1% ± 4.6%; P = .05) prophylaxis compliance rates were higher after initiation of a surgical checklist.

Conclusions

Checklist-driven preoperative briefings and postoperative debriefings are associated with improvements in patient safety for surgical patients.

Section snippets

Materials and Methods

The VHA MTT program, as described in detail previously, includes specific training on the use of preoperative briefings and postoperative debriefings, checklists, teamwork, and other CRM techniques.6, 7 More than 12,000 operating room, postanesthesia care unit, and surgical intensive care unit providers underwent training. One hundred thirty facilities conducting surgical services in the VHA were included between March 4, 2005, and June 17, 2009. The Briefing Guide (BiG) study focused on 74

Results

Facility and surgical checklist demographics are shown in Table 1. Surgical checklists were developed by an implementation team at each facility during the course of the MTT program. The most common elements listed among the 74 submitted checklists included were as follows: patient identification (68), procedure (68), equipment (67), position (65), imaging (65), antibiotics (65), blood availability (62), allergy (61), site (61), implants (59), DVT prophylaxis (58), and postoperative disposition

Comments

Teamwork and communication failure are a major cause of medical errors, including those that occur in the operating room.¹⁰ Large organizational databases confirm communication errors as a leading cause of sentinel events, including wrong-site surgeries.¹¹ Aviation-based CRM techniques and tools, adapted for health care, appear to address these communication errors.3, 12 Preoperative briefings guided by a checklist have been associated with improved teamwork and communication.13, 14

The current

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Association of VA SurgeonsBriefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Comments

Surgery

J Am Coll Surg

Am J Surg

Am J Surg

Jt Comm J Qual Patient Saf

Chest

Saf Sci

The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre

Qual Saf Health Care

Association of VA Surgeons
Briefing guide study: preoperative briefing and postoperative debriefing checklists in the Veterans Health Administration medical team training program