title: Surfacing safety hazards using standardized operating room briefings and debriefings at a large regional medical center.
abstract: BACKGROUND
  Briefings and debriefings, previously shown to be a practical and feasible strategy to improve interdisciplinary communication and teamwork in the operating room (OR), was then assessed as a strategy to prospectively surface clinical and operational defects in surgical care--and thereby prevent patient harm.
  
  
  METHODS
  A one-page, double-sided briefing and debriefing tool was used by surgical teams during cases at the William Beaumont Hospital Royal Oak (Royal Oak, Michigan) campus to surface clinical and operational defects during the study period (October 2006-May 2010). Defects were coded into six categories (with each category stratified by briefing or debriefing period) during the first six months, and refinement of coding resulted in expansion to 16 defect categories and no further stratification. A provider survey was used in January 2008 to interview a sample of 40 caregivers regarding the perceived effectiveness of the tool in surfacing defects.
  
  
  RESULTS
  The teams identified a total of 6,202 defects--an average of 141 defects per month--during the entire study period. Of 2,760 defects identified during the six-defect coding period, 1,265 (46%) surfaced during briefings, and the remaining 1,495 (54%) during debriefings. Equipment (48%) and communication (31%) issues were most prominent. Of 3,442 defects identified during the 16-defect coding period, the most common were Central Processing Department (CPD) instrumentation (22%) and Communication/Safety (15%). Overall, 70 (87%) of the 80 responses were in agreement that briefings were effective for surfacing defects, as were 59 (76%) of the 78 responses for debriefings.
  
  
  CONCLUSIONS
  Briefings and debriefings were a practical and effective strategy to surface potential surgical defects in the operating rooms of a large medical center.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, USA.
authors.forename: Jathin
authors.initials: J
authors.lastname: Bandari
authors.forename: Kathy
authors.initials: K
authors.lastname: Schumacher
authors.forename: Michelle
authors.initials: M
authors.lastname: Simon
authors.forename: Danielle
authors.initials: D
authors.lastname: Cameron
authors.forename: Christine A
authors.initials: CA
authors.lastname: Goeschel
authors.forename: Christine G
authors.initials: CG
authors.lastname: Holzmueller
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Welsh
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D003142:Communication; D017144:Focus Groups; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008824:Michigan; D009873:Operating Rooms / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*; D017751:Safety Management / Q000458:organization & administration; D013523:Surgical Equipment