2017 HSC Section 2 - Practice Management

Otolaryngology–Head and Neck Surgery 154(2)

Weaknesses of this study include its retrospective nature and the fluidity of a large surgical department. The ENT service performed 287 more cases with 125 more turnovers in the year following the implementation of TS than it did the year prior. These differences may have served as con- founding variables if there had been a significant change in OR efficiency in either direction. However, since efficiency was essentially the same, it is reasonable to assume that the departmental changes were not masking TS effects. Additionally, we began evaluating TS immediately after its implementation and did not allow for a ‘‘washout’’ interval while the health care team adjusted to the program. We chose to start measuring efficiency changes immediately after implementation because the providers had completed extensive training before the program began, which should have minimized the adjustment period. Nevertheless, there may have been some initial decrease in efficiency due to the process change in the OR. We did examine the effi- ciency data for the first 6 months after TS implementation ( Table 2 ), and the intervals were very similar to those mea- sured at 12 months, which supports the idea that there was minimal washout effect. Conclusion TS did not lead to significant changes in efficiency within the otolaryngology surgical service in the year after its implementation. In fact, the ENT service at a major teach- ing hospital was able to maintain its OR efficiency despite adopting the rigorous TS patient safety initiative. Although TS is a highly acclaimed evidence-based method improving patient safety and teamwork, more study is needed to deter- mine if it can decrease sentinel events and other preventable medical errors. Acknowledgments We sincerely thank Ms Elizabeth Gessner for assistance with data- base review.

Ahmed , data collection and statistical analysis, prepare and edit manuscript, final approval, accountable for accuracy; Nicholas J. Scalzitti , interpretation and analysis of data, preparation and edit- ing manuscript, final approval, accountable for accuracy; Matthew Stringer , data collection, data analysis, review and editing manu- script, final approval, accountable for accuracy; N. Scott Howard , data analysis and interpretation, review and editing manuscript, final approval, accountable for accuracy; Stephen Maturo , study design, data analysis, review and editing manuscript, final approval, accountable for accuracy.

Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

References

1. Kesselheim AS, Ferris TG, Studdert DM. WIll physician-level measures of clinical performance be used in medical malprac- tice litigation? JAMA . 2006;295:1831-1834. 2. Bacchetta MD, Girardi LN, Southard EJ, et al. Comparison of open versus bedside percutaneous dilatational tracheostomy in the cardiothoracic surgical patient: outcomes and financial anal- ysis. Ann Thorac Surgery . 2005;79:1879-1885. 3. Clancy CM. TeamSTEPPS: optimizing teamwork in the perio- perative setting. AORN J . 2007;86:18-22. 4. Gawande AA, Thomas EJ, Zinner MJ, Brennan TA. The inci- dence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery . 1999;126:66-75. 5. Steelman VM. Excellence in perioperative management: estab- lishing a culture of safety. AORN J . 2014;100:1-3. 6. Forse RA, Bramble JD, McQuillan R. Team training can improve operating room performance. Surgery . 2011;150:771-778. 7. Clapper TC, Ng GM. Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing . 2013;9:e287-e292. 8. Weld LR, Stringer MT, Ebertowski JS, et al. TeamSTEPPS improves operating room efficiency and patient safety [pub- lished online April 17, 2015]. Am J Med Qual . 9. Nundy S, Mukherjee A, Sexton JB, et al. Impact of preoperative briefings on operating room delays: a preliminary report. Arch Surg . 2008;143:1068-1072.

Author Contributions Alexandra Shams , data collection and interpretation, drafted manuscript, final approval, accountable for accuracy; Mostafa

181