Improving communication and strengthening teamwork among cardiac surgery teams are among recommendations for reducing preventable mistakes in the cardiac OR, according to a statement from the American Heart Association.
The statement provides recommendations for improving patient safety after the association reviewed evidence-based research focused on communication within and between teams, the physical workspace and the organizational culture of the cardiac OR.
“In multiple studies, self-assessment of communication and teamwork skills by surgeons and anesthesiologists is disturbingly discordant with the opinions of their associated nursing and perfusion staff,” the statement authors wrote. “Surgeons rated the teamwork of other surgeons as high/very high 85% of the time, but nurses rated their collaboration with surgeons as high/very high only 48% of the time.”
The authors also noted that in the OR, “conflicts are often poorly managed through avoidance, yielding or competition, when collaboration and compromise would yield a better outcome. Collaboration and compromise are particularly difficult when there is status asymmetry, whereby one member has greater power or seniority, such as physicians with nurses or an attending physician with residents.”
Highlights of the statement, published Aug. 5 on the website of the journal Circulation, include:
• Using checklists and/or briefings before every cardiac surgery, followed by postoperative briefings;
• Developing institutional policies to define disruptive behaviors by medical professionals in all hospital settings, with transparent, formal procedures for addressing unacceptable behaviors;
• Establishing an institutional culture of safety by implementing a robust quality improvement system that encourages input from all team members to continuously identify and correct safety hazards.
“From the data available,” the authors wrote, “it appears that teams should be trained as teams, not as individuals; that use of simulated scenarios is effective; that both executive leadership and nurse managers are critical to effective implementation; and that repetition, continued coaching or both are required to strengthen and maintain benefits.”
The authors noted the critical elements of teamwork can be summarized by the Six Cs: communication, cooperation, coordination, cognition, conflict resolution and coaching.
The statement is available as a PDF: http://circ.ahajournals.org/content/early/2013/08/05/CIR.0b013e3182a38efa.full.pdf.