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Simple methods reduce postoperative complications


Communications team training and a surgical checklist are cost-effective methods that can reduce expensive postoperative complications, according to researchers.

Investigators found that when surgical teams completed communications training and used a surgical procedure checklist before, during and after high-risk operations, patients experienced fewer adverse events.

Researchers with the University of Connecticut Health Center, Farmington and Saint Francis Hospital and Medical Center in Hartford compared three groups of surgical procedures to determine whether communications training coupled with a standardized checklist could bring surgical teams into agreement and reduce patients’ complications.

Data from the American College of Surgeons National Surgical Quality Improvement Program were compared for 2,079 historical control cases, 246 cases with team training and 73 cases with both team training and a surgical checklist.

The communications training included three sessions on topics such as differences between introverts and extroverts, effective dialogue among all OR personnel and how to use a surgical checklist. The checklist was the one-page Association for periOperative Registered Nurses Comprehensive Surgical Checklist, developed in April 2010 with protocols mandated by the World Health Organization, The Joint Commission and the Centers for Medicare & Medicaid Services.

When surgical teams had no communications training and did not use checklist, more than 23% of the procedures resulted in complications (surgical site infections, deep vein thrombosis, pulmonary embolisms and urinary tract infections) within 30 days. About 16% of procedures by surgical teams who participated only in communications training led to complications within 30 days, and only 8.2% of the procedures had a 30-day complication when the surgical teams used both the communications training and the checklist.

Even small steps such as making sure everyone on the team introduced themselves before the procedure helped reduce complications. “The theory is that this brings a sense of accountability and makes sure that everyone’s voice can be heard,” Lindsay Bliss, MD, the study’s lead author and a general surgery resident at the University of Connecticut, said in a news release. “No one on the surgical team is a nameless, faceless body. The checklist makes sure everyone is advocating for the patient.”

Bliss said while the study builds on previous research about the benefits of using checklists, it is the first to look at how communications training can help surgical teams have productive conversations around patient care while using the checklist.

The drop in postoperative complications also has implications for national healthcare spending because Medicare and other health insurance providers are starting to decline reimbursement for complications that result from clinician errors, especially within a month of the patient’s procedure, the researchers noted. Postoperative infections are among the most expensive medical errors, costing $14,500 per case on average, according to a 2010 report by the Society of Actuaries and Milliman, Inc.

“I don’t think anyone goes into this profession expecting to hurt the patient, but it happens more than any of us would like,” Bliss said. “Every adverse outcome results in more expense. It means a longer stay in the hospital and more treatment. Communicating and using a checklist do not just add extra minutes on to the procedure. There is an ethical and financial obligation tied to both tools.

“The checklist is publicly available online []. The cost of a photo copy in exchange for reducing patient morbidity is a fabulous return on investment.”

The study appears in the December issue of the Journal of the American College of Surgeons. The study abstract is available at


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