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Association Between Implementation of a Medical Team Training Program and Surgical Mortality

Neily J, et al, JAMA 2010;304:1693-1700

VA Study: 3 yrs, 100 facilities, >100,000 proc

Focus on CRM with training similar to previous study

VASQIP (formerly Nat’l Surg Qual Impr Prgm) Data were main outcome measures. Also captured briefing/de-briefing

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Improvements Reported by Medical Team Training Facilities From Structured Interviews

Communication among OR staff 35%

Staff awareness 34%

Overall efficiency 49%

Equipment use during surgery 44%

Reduced length of procedures 15%

Improved first-case start times 30%

No. of Facilities

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Results

At trained facilities: 18% decrease in mortality (P=.01) vs 7% in non-trained facilities (P=.59)

Dose-response relationship for increased training quarters

For every increase in briefing/debriefing, mortality was reduced by 0.6/1000 procedures