Development and Pilot Evaluation of a Preoperative Briefing Protocol for Cardiovascular Surgery

Received 29 October 2008; accepted 15 January 2009. published online 17 April 2009.

Background

Preprocedural briefings have been adopted in many high consequence environments, but have not been widely accepted in medicine. We sought to develop, implement, and evaluate a preoperative briefing for cardiovascular surgery.

Study Design

The briefing was developed by using a combined questionnaire and semistructured focus group approach involving five subspecialties of surgical staff (n=55). The results were used to design and implement a preoperative briefing protocol. The briefing was evaluated by monitoring surgical flow disruptions, circulating nurse trips to the core, time spent in the core, and cost-waste reports before and after implementation of the briefing across 16 cardiac surgery cases.

Results

Focus group data indicated consensus among surgical staff concerning briefing benefits, duration, location, content, and potential barriers. Disagreement arose concerning timing of the brief and the roles of key participants. After implementation of the briefing, there was a reduction in total surgical flow disruptions per case (5.4 preimplementation versus 2.8 postimplementation, p=0.004) and reductions in per case average of procedural knowledge disruptions (4.1 versus 2.17, p=0.004) and miscommunication events (2.5 versus 1.17, p=0.03). There was no significant reduction in disruptions because of equipment preparation or disruptions from patient-related issues. On average, briefed teams experienced fewer trips to the core (10 versus 4.7, p=0.004) and spent less time in the core (397.4 seconds versus 172.3 seconds, p=0.006), and there was a trend toward decreased waste (30% versus 17%, p=0.15).

Conclusions

These findings demonstrate the feasibility of creating a specialty-specific preoperative briefing to decrease surgical flow disruptions and improve patient safety in the operating room.

a Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN

b College of Medicine, Mayo Clinic, Rochester, MN

c Institute of Public Health, University of Cambridge, Cambridge, England

d Department of Surgery, Brigham and Women's Hospital, Boston, MA

e Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI

Correspondence address: Sarah E Henrickson, MA, Mayo Clinic, 200 First St SW, Rochester, MN 55005

Disclosure Information: Nothing to disclose.

PII: S1072-7515(09)00131-8

doi:10.1016/j.jamcollsurg.2009.01.037

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