Improved teamwork in cardiac operating room is key to improving patient safety

Improving communication and teamwork among members of cardiac surgery teams are among the recommendations included in a new scientific statement on reducing preventable mistakes in the cardiac operating room.

The statement was crafted by a committee made up of members from three American Heart Association councils. Among other recommendations, the statements addresses communication within and between cardiac surgery teams, issues with the physical workspace, and issues with the organizational culture of the cardiac operating room.

Risk for failure in the cardiac surgery setting

“Preventable errors are often not related to the failure of technical skill, training or knowledge, but represent cognitive, system or teamwork failures,” statement co-chair Joyce A. Wahr, MD, FAHA, and colleagues wrote.

According to the study background, communication failure was the leading cause of 65% of sentinel events (unexpected deaths or serious injuries, or the risks thereof) reported by the Joint Commission between 2004 and 2012. Also, previous research showed that communication issues were the primary cause of 89% of teamwork failures in cardiac surgery settings. Another prior study showed that surgical adverse events occurred in 12% of cardiac surgery patients vs. in 3% of other surgical patients, and that 54% of these events were preventable.

Recommendations for the operating room

To improve communication and teamwork issues, the committee strongly recommended that cardiac surgery teams use checklists and/or briefings before each surgery and postoperative debriefings after each surgery. Training for the entire team is also suggested to improve communication, leadership and situational awareness. The committee also encouraged the implementation of formal handoff protocols during the transfer of care of a patient to new medical personnel. It emphasized that the elements of teamwork are summarized by the 6 “C’s”: communication, cooperation, coordination, cognition, conflict resolution and coaching.

Regarding the physical environment, the committee’s suggestions included investigating the optimal design and testing of an operating room’s information systems. This could “reduce alarm-related distractions and improve clinicians’ ability to integrate knowledge from multiple sources,” Wahr and colleagues wrote.

The committee made two strong recommendations on implementing policies regarding professionalism and quality. First, hospitals should immediately implement policies that define disruptive behavior for medical professionals, develop transparent formal procedures for addressing the issue, and develop interventions to eliminate them. Second, each hospital should “commit to a culture of safety by establishing a robust quality assurance and [quality improvement] program.” This program, according to the committee, should identify hazards of all kinds, devote leadership and resources to eliminating those hazards, and “encourage and value the input of all members of the cardiac surgery team in a nonpunitive atmosphere.”

Finally, the committee called for further research to study which human and systems factors tend to lead to the most errors in the cardiac operating room, as well as to assess the efficacy of existing methods to improve safety culture.

For more information:

Wahr JA. Circulation. 2013;doi:10.1161/CIR.0b013e3182a38efa.

Disclosure: See the full study for a list of the committee members’ relevant financial disclosures.