Operating Room Briefings and Wrong-Site Surgery

Makary, Martin A.; Mukherjee, Arnab; Sexton, J. Bryan; Syin, Dora; Goodrich, Emmanuelle; Hartmann, Emily; Rowen, Lisa; Behrens, Drew C.; Marohn, Michael; Pronovost, Peter J.

doi:10.1016/j.jamcollsurg.2006.10.018

« Previous Next »Journal of the American College of Surgeons
Volume 204, Issue 2 , Pages 236-243, February 2007

Operating Room Briefings and Wrong-Site Surgery

Martin A. Makary, MD, MPH
- Department of Surgery, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Center for Surgical Outcomes Research, Johns Hopkins Medical Institutions, Baltimore, MD
- Correspondence address: Martin A Makary, MD, MPH, Johns Hopkins University School of Medicine, Johns Hopkins Medical Institutions, 600 N Wolfe St, Carnegie 683, Baltimore, MD 21224.
Arnab Mukherjee, BA
- Center for Surgical Outcomes Research, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
- Yale University School of Medicine, Yale University School of Management, New Haven, CT
J. Bryan Sexton, PhD
- Department of Anesthesiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Center for Surgical Outcomes Research, Johns Hopkins Medical Institutions, Baltimore, MD
Dora Syin, BS
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
Emmanuelle Goodrich, MPH
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
Emily Hartmann, MSS
- Georgetown University School of Medicine, Washington, DC.
Lisa Rowen, RN, DScN
- Department of Nursing, Johns Hopkins University School of Nursing, Johns Hopkins Medical Institutions, Baltimore, MD
Drew C. Behrens
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD
- Columbia University, New York, NY
Michael Marohn, DO, FACS
- Department of Surgery, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
Peter J. Pronovost, MD, PhD
- Department of Surgery, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Department of Anesthesiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD
- Department of Nursing, Johns Hopkins University School of Nursing, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Quality and Safety Research Group, Johns Hopkins Medical Institutions, Baltimore, MD

Received 8 August 2006; received in revised form 4 October 2006; accepted 18 October 2006. published online 08 December 2006.

Background

Wrong-site surgery can be a catastrophic event for a patient, caregiver, and institution. Although communication breakdowns have been identified as the leading cause of wrong-site surgery, the efficacy of preventive strategies remains unknown. This study evaluated the impact of operating room briefings on coordination of care and risk for wrong-site surgery.

Study Design

We administered a case-based version of the Safety Attitudes Questionnaire (SAQ) to operating room (OR) staff at an academic medical center, before and after initiation of an OR briefing program. Items questioned overall coordination and awareness of the surgical site. Response options ranged from 1 (disagree strongly) to 5 (agree strongly). MANOVA was used to compare caregiver assessments before and after the implementation of briefings, and the percentage of OR staff agreeing or disagreeing with each question was reported.

Results

The prebriefing response rate was 85% (306 of 360 respondents), and the postbriefing response rate was 75% (116 of 154). Respondents included surgeons (34.9%), anesthesiologists (14.0%), and nurses (44.4%). Briefings were associated with caregiver perceptions of reduced risk for wrong-site surgery and improved collaboration [F (6,390)=10.15, p < 0.001]. Operating room caregiver assessments of briefing and wrong-site surgery issues improved for 5 of 6 items, eg, “Surgery and anesthesia worked together as a well-coordinated team” (67.9% agreed prebriefing, 91.5% agreed postbriefing, p < 0.0001), and “A preoperative discussion increased my awareness of the surgical site and side being operated on” (52.4% agreed prebriefing, 64.4% agreed postbriefing, p < 0.001).