title: Team consistency and occurrences of prolonged operative time, prolonged hospital stay, and hospital readmission: a retrospective analysis.
abstract: BACKGROUND
  Human factors research has suggested benefits of consistent teams yet no surgical team consistency measures have been established for teamwork improvement initiatives.
  
  
  METHODS
  Retrospective analysis was conducted of teams performing consecutive elective procedures of unilateral primary total knee and hip replacement between June 2008 and May 2010 at a large tertiary medical center. Surgeons who performed fewer than 50 cases of the procedures during the study period were excluded. A team was defined as consistent when its nurse and surgical technologist members were both among the three most frequent working with the surgeon during the study period. Odds ratios for prolonged operative time (in the longest quartile), prolonged hospital stay (longer than median), and 30-day all-cause readmissions were adjusted for patient characteristics (sex, age, comorbidity, American Society of Anesthesiology status), surgery characteristics (procedures, time of day), and surgeons.
  
  
  RESULTS
  Inconsistent teams performed 61% of the 1,923 cases with eight surgeons, each of which worked with a median of 43.5 (range, 28-58) nurses and 29 (range, 13-47) technologists. Inconsistent teams were associated with higher likelihood of prolonged operative time [odds ratio 1.52, 95% confidence interval (CI) 1.20-1.91], higher likelihood of prolonged hospital stay (odds ratio 1.51, 95% CI 1.23-1.86), and more readmissions (adjusted odds ratio 1.42, 95% CI 1.07-1.89).
  
  
  CONCLUSIONS
  Team consistency was an independent predictor of prolonged operative time, prolonged hospital stay, and 30-day hospital readmission in elective, primary, unilateral total knee, and hip replacement procedures, after adjusting for patient and surgery characteristics and surgeons.
authors.affiliation: Baylor Scott & White Health, 8080 N. Central Expressway, Suite 500, Dallas, TX, 75206, USA, Yan.Xiao@BaylorHealth.edu.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xiao
authors.forename: Alan
authors.initials: A
authors.lastname: Jones
authors.forename: Beilei Belinda
authors.initials: BB
authors.lastname: Zhang
authors.forename: Monica
authors.initials: M
authors.lastname: Bennett
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mears
authors.forename: Jay D
authors.initials: JD
authors.lastname: Mabrey
authors.forename: Donald
authors.initials: D
authors.lastname: Kennerly
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D010348:Patient Care Team / Q000458:organization & administration*; D010359:Patient Readmission; D012189:Retrospective Studies; D013997:Time Factors