Preoperative Safety Briefing Project

Abstract

Context: Increased media attention on surgical procedures that were performed on the wrong anatomic site or wrong patient has prompted the health care industry to identify and address human factors that lead to medical errors.

Objective: To increase patient safety in the perioperative setting, our objective was to create a climate of improved communication, collaboration, team-work, and situational awareness while the surgical team reviewed pertinent information about the patient and the pending procedure.

Methods: A team of doctors, nurses, and technicians used human factors principles to develop the Preoperative Safety Briefing for use by surgical teams, a briefing similar to the preflight checklist used by the airline industry. A six-month pilot of the briefing began in the Kaiser Permanente (KP) Anaheim Medical Center in February 2002. Four indicators of safety culture were used to measure success of the pilot: occurrence of wrong-site/wrong procedures, attitudinal survey data, near-miss reports, and nursing personnel turnover data.

Results: Wrong-site surgeries decreased from 3 to 0 (300%) per year; employee satisfaction increased 19%; nursing personnel turnover decreased 16%; and perception of the safety climate in the operating room improved from "good" to "outstanding." Operating suite personnel perception of teamwork quality improved substantially. Operating suite personnel perception of patient safety as a priority, of personnel communication, of their taking responsibility for patient safety, of nurse input being well received, of overall morale, and of medical errors being handled appropriately also improved substantially.

Conclusions: Team members who work together and communicate well can quickly detect and more easily avoid errors. The Preoperative Safety Briefing is now standard in many operating suites in the KP Orange County Service Area. The concepts and design of this project are transferable, and similar projects are underway in the Departments of Radiology and of Labor and Delivery at KP Anaheim Medical Center.

Figure 1.

Preoperative Safety Briefing document used by surgical teams in the KP Orange County Service Area. (Logo of the University of Texas Center of Excellence for Patient Safety Research and Practice reproduced by permission of the Center.)

Figure 2.

Change in the perception of teamwork climate among operating suite personnel after implementation of Preoperative Safety Briefing. Anesthesia personnel included physicians and certified registered nurse assistants. Surgery personnel included surgeons and operating suite team members.

Figure 3.

Comparison of perceived quality of teamwork between disciplines and personnel throughout the pilot study. Quality of Teamwork rated on a scale from 1 (“very low”) to 5 (“very high”).

Figure 4.

Turnover of registered nurses in KP OCSA decreased as use of the Preoperative Safety Briefing became more common among operating suites.