Association between implementation of a medical team training program and surgical mortality.
BACKGROUND
There is insufficient information about the effectiveness of medical team training on surgical outcomes. The Veterans Health Administration (VHA) implemented a formalized medical team training program for operating room personnel on a national level.


OBJECTIVE
To determine whether an association existed between the VHA Medical Team Training program and surgical outcomes.


METHODS
A retrospective health services study with a contemporaneous control group was conducted. Outcome data were obtained from the VHA Surgical Quality Improvement Program (VASQIP) and from structured interviews in fiscal years 2006 to 2008. The analysis included 182,409 sampled procedures from 108 VHA facilities that provided care to veterans. The VHA's nationwide training program required briefings and debriefings in the operating room and included checklists as an integral part of this process. The training included 2 months of preparation, a 1-day conference, and 1 year of quarterly coaching interviews


METHODS
The rate of change in the mortality rate 1 year after facilities enrolled in the training program compared with the year before and with nontraining sites.


RESULTS
The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.76-0.91; P = .01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR, 0.93; 95% CI, 0.80-1.06; P = .59). The risk-adjusted mortality rates at baseline were 17 per 1000 procedures per year for the trained facilities and 15 per 1000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1000 procedures per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in the risk-adjusted surgical mortality rate was about 50% greater in the training group (RR,1.49; 95% CI, 1.10-2.07; P = .01) than in the nontraining group. A dose-response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2-1.0; P = .001).


CONCLUSIONS
Participation in the VHA Medical Team Training program was associated with lower surgical mortality.
Neily
Julia
J
National Center for Patient Safety, Department of Veterans Affairs, Hanover, New Hampshire, USA. Julia.Neily@va.gov
Mills
Peter D
PD
Young-Xu
Yinong
Y
Carney
Brian T
BT
West
Priscilla
P
Berger
David H
DH
Mazzia
Lisa M
LM
Paull
Douglas E
DE
Bagian
James P
JP
D016022:Case-Control Studies; D002983:Clinical Competence; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009872:Operating Room Technicians / Q000193:education; D009873:Operating Rooms; D010348:Patient Care Team / Q000592:standards*; D057216:Propensity Score; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000592:standards; D014481:United States; D000078329:Workforce