Surgical environment
shift to team interaction may be spurred by new policy
By Dale
Bratzler, DO, MPH
Medical director of the Hospital Interventions Quality Improvement
Organizations Support Center and the Hospital Quality of Care
Measures Special Study
Oklahoma Foundations for Medical Quality
The surgical environment is becoming much more team based than it has been in the past due to growing recognition of the important role all perioperative personnel play, whether they care for the patient in the operating suite, preoperative or postoperative care units.
Looking at most of the changes toward team-based care, a good portion rely to a great extent on better implementation of standardized practice, such as the use of a more appropriate checklist or other systems-based interventions used for every case to ensure that care is delivered safely.
The World Health Organization's Safe Surgery Checklist is one example of this systems-based intervention. This checklist takes a page from the aviation industry's model for standardized safety practice and applies it to the operating room suite by requiring input from members of the perioperative team working throughout a patient's continuum of care.
A critical element of a team approach to patient care is markedly improved communication. Also taken largely from the aviation example, the idea is that everybody in the cockpit or the operating room is equally responsible for the safety of the patient. You can't work in an environment with any communication barriers created by hierarchy or fear of retribution. The operating room nurse must be willing to step up and stop the operation--the system--when they see something that is potentially going wrong.
As part of field surveys with the SCIP initiative, we are seeing more of this open communication implemented in perioperative practice. In recent visits to high-performance hospitals, it became very, very clear when we talked to operating room staff that everybody, from the top to the bottom, was willing to stop and speak up if they saw something going wrong that might impact patient safety.
By using more protocols, standardized operating room procedures, checklists and markedly improved communication, perioperative staff are truly working as a team, in contrast to the old model where the surgeon was viewed as the captain of the ship. In this marked hierarchy those at the lower end may not have felt comfortable speaking up and stepping in when they saw something going wrong.
This shift to team-thinking is more important than ever, especially with healthcare shifting toward pay for performance. As the Centers for Medicare & Medicaid Services and other third-party payers enforce no-pay rules for certain hospital-acquired conditions, these rules will force hospitals to look even closer at team-based responsibility for ensuring the right care for the patient.
Think about the ways a team approach may prevent hospital-acquired conditions like mediastinitis after coronary artery bypass graft surgery or the development of pressure ulcers. There are so many steps within the process of caring for a patient that can result in these hospital-acquired conditions. Everyone on the team has to take a role in the responsibility to prevent these complications from occurring.
As I talk to all hospitals about these new payment rules, I highlight the fact that, in reality, the additional reimbursement facilities used to get from Medicare probably didn't cover most of their costs of caring for the complication anyway. In other words, when those complications occurred it was probably a money-losing proposition to the hospital anyway, even though they were getting a little extra money from the Medicare program.
From a business perspective and a patient safety perspective, the best strategy is to prevent hospital-acquired conditions and other complications from occurring in the first place and a team-approach is proving a successful way to address this prevention. Doing so will result in lower costs to the payers and the hospital, and it's clearly the right thing to do for the patient.
Dale Bratzler, DO, MPH, currently serves as the Medical Director of the Hospital Interventions Quality Improvement Organizations Support Center and the Hospital Quality of Care Measures Special Study located at the Oklahoma Foundations for Medical Quality. In these roles, he provides clinical and technical support for local and national hospital quality improvement initiatives including the Medicare national Pneumonia Project and the National Surgical Care Improvement Project. Bratzler has published and presented locally and nationally on many occasions on topics related to healthcare quality, particularly related to improving care for pneumonia, increasing vaccination rates, and reducing surgical complications. In addition to leading national studies that have audited practice patterns related to care pneumonia patients and surgical patients, he has actively participated in the development of national guidelines for surgical antimicrobial prophylaxis.
Read more news from AORN Management Connections.