Authors: Roee Ber, MD; Dennis London, MD; Samya Senan; Yasmin Youssefi; David Harter, MD; John Golfinos, MD; Donato Pacione, MD (New York, NY)
Miscommunication and discoordination among surgical teams is a known cause of preventable medical harms and operating room inefficiencies and inhibits surgical training. Technology may help overcome these challenges.
We used one of the authors’ personal experience as a former air-force F-15 pilot to design a combat aviation pre- and post- operative communication workflow in the neurosurgery department and tested its effect on safety and efficiency. We hypothesized that the adoption of this workflow through a tailored technological platform will increase compliance and improve chances of sustainability.
Data was collected prospectively from neurosurgical cases at NYU Langone Medical Center before (January-May, 2020) and after (June-October, 2020) implementation of this workflow.
Primary outcomes were morbidity and mortality per the department’s criteria, and intraoperative last-minute requests as reported by operating room staff blinded to the intervention (and the surgical team blinded to the presence of a report). Secondary outcomes were subjective teamwork assessments from team questionnaires.
Briefs and debriefs were executed using a custom mobile application and were defined as non-mandatory for residents and attendings.
Data was collected from 637 and 893 cases during the pre- and post-intervention periods respectively.
There was no significant difference in the preoperative ASA score of the pre- and post-intervention patient populations (P=0.24). The rate of intraoperative last-minute requests significantly decreased from 16.6% to 10.5% (P=0.048). There was no significant change in morbidity and mortality between periods.
In subjective questionnaires, there was a statistically significant increase in preoperative communication (P=0.006), resident familiarity with the case (P=0.004), resident preparedness for the case as assessed by attendings (P=0.02), and resident’s comfort in raising safety concerns (P=0.03).
Implementation of structured team communication practices in the neurosurgery department through a technological platform improved education and communication between surgical teams and led to a reduction in last-minute surgical requests that could impact on cost.