title: Bariatric surgery with operating room teams that stayed fixed during the day: a multicenter study analyzing the effects on patient outcomes, teamwork and safety climate, and procedure duration.
abstract: BACKGROUND
  Bariatric surgery durations vary considerably because of differences in surgical procedures and patient factors. We studied the effects on patient outcomes, teamwork and safety climate, and procedure durations resulting from working with operating room (OR) teams that remain fixed for the day instead of OR teams that vary during the day.
  
  
  METHODS
  Data were collected in 2 general teaching hospitals, consisting of patientrelated demographic and intraoperative data and of staffrelated survey data on team work and safety climate. The procedure durations of fixed and conventional OR teams were analyzed by comparison of means tests and by regression methods to control for the effects of surgeon, surgical experience, and procedure type.
  
  
  RESULTS
  For both hospitals, we obtained the following 4 results for working on bariatric procedures with OR teams that remained fixed for the day. First, patient outcomes did not worsen. Second, teamwork and safety climate (both measured on a 5-point scale) improved significantly, for teamwork + 0.86 (95% confidence interval [CI], 0.54 to 1.18) and for safety climate + 0.75 (95% CI, 0.40 to 1.11). Third, the procedures were performed significantly faster, as both the mean and the SD of procedure durations decreased. After correcting for learning effects, the average reduction of durations was 10.8% (99% CI, 5.0% to 15.3%, or 4 to 13 minutes). This gain was mainly realized for surgical time (12%; 99% CI, 5% to 18%, or 3 to 11 minutes). The effect on peripheral time, defined as procedure time minus surgical time, is not significant (3%; 99% CI, -6% to 12%, or -1 to 3 minutes). Fourth, additional gains were obtained by performing the same type of procedure multiple times within the same day (5% per every next procedure of the same type; 99% CI, 3% to 7%, or 3 to 6 minutes).
  
  
  CONCLUSIONS
  Working with fixed teams in bariatric surgery reduced procedure durations and improved teamwork and safety climate, without adverse effects on patient outcomes.
authors.affiliation: Econometric Institute, Erasmus School of Economics, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. stepaniak@casema.nl
authors.forename: Pieter S
authors.initials: PS
authors.lastname: Stepaniak
authors.forename: Christiaan
authors.initials: C
authors.lastname: Heij
authors.forename: Marc P
authors.initials: MP
authors.lastname: Buise
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.forename: J Frans
authors.initials: JF
authors.lastname: Smulders
authors.forename: Simon W
authors.initials: SW
authors.lastname: Nienhuijs
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D050110:Bariatric Surgery / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D018401:Sample Size; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult