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Hospitals try to improve patient safety in the OR

A new quality-improvement project encourages better communication among surgical team members.

By Kevin B. O'Reilly, amednews staff. May 8, 2006.

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Surgeons traditionally have ruled the roost in operating rooms, with the belief being that the best way to reduce errors and get superior results is to give surgeons what they want and stay out of their way.

But a group of at least two dozen hospitals met in April to explore a more collaborative approach to improving surgical care that still leaves the surgeon in charge, but creates an atmosphere where others are freer to speak up and more likely to have what they say heard.

The hospitals met in Chicago as part of Transformation of the OR, or TOR, a multiyear collaborative quality improvement project developed by VHA, an Irving, Texas-based alliance of more than 2,400 nonprofit health care organizations. A VHA survey of TOR participants found that as many as 60% of nonsurgical OR staff agreed with this statement: "In the ORs here, it is difficult to speak up if I perceive a problem with patient care."

That lack of communication can lead to adverse outcomes for patients, said Jeff Dunn, MD, senior medical director of the TOR project.

"What the surgeon usually sees as good communication is that his instructions are listened to by others," Dr. Dunn said. That approach is no longer good enough in an era when complicated laparoscopic, robotic and endovascular surgeries are becoming increasingly common, he said.

Miscommunication among colleagues is partially responsible for 44% of medical errors, according to a 2004 study in the Annals of American Family Medicine.