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The Efficacy of Medical Team Training: Improved Team Performance and Decreased Operating Room Delays: A Detailed Analysis of 4863 Cases

Wolf, Francis A. MD*†; Way, Lawrence W. MD*; Stewart, Lygia MD*†

doi: 10.1097/SLA.0b013e3181f1c091
Original Articles

Objectives: Medical team training (MTT) has been touted as a way to improve teamwork and patient safety in the operating room (OR).

Methods: OR personal completed a 1-day intensive MTT training. A standardized briefing/debriefing/perioperative routine was developed, including documentation of OR miscues, delays, and a case score (1–5) assigned by the OR team. A multidisciplinary MTT committee reviewed and rectified any systems problems identified. Debriefing items were analyzed comparing baseline data with 12 and 24-month follow-up. A safety attitudes questionnaire was administered at baseline and 1 year.

Results: A total of 4863 MTT debriefings were analyzed. One year following MTT, case delays decreased (23% to 10%, P < 0.0001), mean case score increased (4.07–4.87, P < 0.0005), and both changes were sustained at 24 months. One-year and 24-month follow-up data demonstrated decreased frequency of preoperative delays (16%–7%, P = 0.004), hand-off issues (5.4%–0.3%, P < 0.0001), equipment issues/delays (24%–7%, P < 0.0001), cases with low (<3) case scores (23%–3%, P < 0.0005), and adherence to timing guidelines for prophylactic antibiotic administration improved (85%–97%, P < 0.0001). Surveys documented perception of improved teamwork and patient safety. A major systems issue regarding perioperative medication orders was identified and corrected.

Conclusions: MTT produced sustained improvement in OR team function, including decreased delays and improved case scores. When combined with a high-level debriefing/problem-solving process, MTT can be a foundation for improving OR performance. This is the largest case analysis of MTT and one of the few to document an impact of MTT on objective measures of operating room function and patient safety.

Medical team training produced sustained improvement in operating room team function, including decreased delays and improved case scores, when combined with a high-level debriefing/problem-solving process.

From the *Department of Surgery, University of California, San Francisco, CA; and †Department of Surgery, VA Medical Center, San Francisco, CA.

Presented at the annual meeting of the American Surgical Association, April 2010.

The authors have no commercial sponsorships.

The authors have no financial disclosures relevant to this study.

Reprints: Lygia Stewart, MD, Surgical Service (112), 4150 Clement Street, San Francisco, CA 94121. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.