Hospitals Apply Lessons Learned in the Airline Industry to Improve OR Safety

A recent study conducted by Northwestern Memorial Hospital found that integrated team training and pre-operative discussions increase staff communication and teamwork, thus reducing the potential for operating room errors.  The study, published in the February issue of Archives of Surgery, was conducted by implementing a communication model known in the airline industry as Crew Resource Management, which was tailored to the specific needs of a surgical environment.  The model aims to improve communication, develop attitudes conducive to teamwork and minimize the hierarchy by encouraging input from every team member regarding “near miss” or potential adverse events or errors. 

The study goal was to measure how improved staff interaction would impact operating room efficiency, patient safety and staff satisfaction. Northwestern Memorial trained more than 1,100 staff members over a two-week period, including operating room physicians, nurses, technicians and other personnel. Each participated in a four-hour classroom curriculum and intraoperative coaching on team related behaviors, followed by feedback sessions.  The operating room staff was also asked to implement and document several measures of communication including newly established pre-operative discussions, existing checklists, known as “time-outs” and post-operative debriefings.  

After the training was complete, researchers compared pre-training surgical observations and feedback to post-training observations and feedback, in order to determine the effectiveness of the communication model. 

“Communication is the cornerstone to ensuring operating room safety,” said Amy Halverson, MD, surgical oncologist and study author. “Following the training, 75 percent of staff felt the program resulted in better staff communication and an improved sense of teamwork.”

The study also revealed that pre-operative meetings play an important role in avoiding potential mishaps, with more than one-third of employees surveyed stating they felt the meetings helped avoid error. 

“There are several layers to our surgical safety checklist to ensure a safe operating environment,” said Halverson.  “The training helped implement new procedures, while also increasing compliance of existing safety measures such as team ‘time outs,’ which increased from 47 percent compliance prior to training to near 100 percent post training.”

“This study demonstrates a direct correlation between an improved sense of teamwork and a safer, more efficiently run operating room environment, said Karen J. Anderson, RN, MBA, MSN, CNOR, director of surgical services.  It is one of many safety measures we’ve put in place to uphold quality standards.  As we achieve success, we continue to build from what we’ve learned, always looking for additional ways to provide a positive working environment for our staff and enhance patient care.”