Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety.
Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A trouble-free operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.
The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds LS13EX, UK.
Sotiris C
SC
Papaspyros
Kalyana C
KC
Javangula
Rajeshwara Krishna Prasad
RK
Adluri
David J
DJ
O'Regan
D000368:Aged; D001291:Attitude of Health Personnel; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D057189:Checklist; D002983:Clinical Competence; D003299:Cooperative Behavior; D030141:Feedback, Psychological; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D009873:Operating Rooms; D010348:Patient Care Team / Q000458:organization & administration*; D036301:Qualitative Research; D011787:Quality of Health Care; D000078329:Workforce