JAMA: Training programs linked to lower surgical mortality

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When operating room personnel participated in a medical team training program, rates of surgical mortality declined, according to a study published in the Oct. 20 edition of the Journal of the American Medical Association.

To bulk up on sparse data evaluating the association between training programs and surgical outcomes, Julia Neily, RN, of the National Center for Patient Safety at the Department of Veterans Affairs, and colleagues used data from the Veterans Health Administration Surgical Quality Improvement Program and conducted interviews between 2006 and 2008 to evaluate 182,409 sample procedures at 108 VA facilities (74 with the training, 34 without).

The medical team training program included two months of preparation and planning. The program utilized checklist-guided preoperative briefings and postoperative debriefings and communication strategies, in addition to a required day-long on-site learning session that incorporated lectures, group interactions and videos.

Neily and colleagues compared VA sites who participated in training programs to those who did not by comparing urban status, complexity, surgical volume, baseline observed and risk-adjusted mortality rate and O to E (observed events to expected events) mortality ratios.

Additionally, interviews were conducted at one, four, eight and 12 months after the learning sessions.

At the beginning of the study, baseline rates of risk-adjusted mortality were 17 per 1,000 procedures per year for facilities implementing the training programs and 15 per 1,000 procedures per year for those with no training programs.

At the study's conclusion, the researchers reported that the rates of risk-adjusted mortality for both groups were equal—14 per 1,000 procedures per year.

After controlling for baseline characteristics, such as surgical volume or urban status, the researchers found that the 74 trained facilities experienced a significant decrease in observed mortality, 18 percent. For facilities without training programs, this rate decreased by 7 percent.

In facilities with a training program, the researchers reported a 50 percent decrease in annual mortality after a propensity-matched mortality assessment was conducted.

The researchers also adjusted for surgical risk and volume and found that during every quarter of training, mortality decreased 0.5 per 1,000 procedures. After an increase in the degree of briefing and debriefings at facilities, Neily et al reported that mortality rates decreased by 0.6 per 1,000 procedures.

Lastly, of the 74 trained facilities, 47.2 percent, 46 percent and 66.2 percent reported that communication among the operating staff, staff awareness and overall efficiency had improved.

The training programs also allowed staff to resolve issues such as fixing breaking equipment or instruments, which could have led to the reduction of intraoperative delays and the prevention of adverse events.

“The use of conducting briefings and debriefings requires a more active participation and involvement than sometimes occurs when a checklist is used by itself. During follow-up interviews, facilities provided specific examples of having avoided adverse events because of the briefing.

“Participation in the Veterans Health Administration Medical Team Training program was associated with lower surgical mortality,” the authors concluded.