MORSim Publications

Can team training make surgery safer? Lessons for national implementation of a simulation-based programme

Jennifer Weller, Ian Civil, Jane Torrie, David Cumin, Alexander Garden, Arden Corter, Alan Merry. Can team training make surgery safer? Lessons for national implementation of a simulation-based programme. New Zealand Medical Journal. 2016; 129(1443): 9-17.

Aim: Unintended patient harm is a major contributor to poor outcomes for surgical patients and oftenreflects failures in teamwork. To address this we developed a Multidisciplinary Operating Room Simulation(MORSim) intervention to improve teamwork in the operating room (OR) and piloted it with 20 OR teamsin two of the 20 District Health Boards in New Zealand prior to national implementation. In this study, we
describe the experience of those exposed to the intervention, challenges to implementing changes in clinical
practice and suggestions for successful implementation of the programme at a regional or national level.

Methods: We undertook semi-structured interviews of a stratified random sample of MORSim
participants 3–6 months after they attended the course. We explored their experiences of changes in
clinical practice following MORSim. Interviews were recorded, transcribed and analysed using a general
inductive approach to develop themes into which interview data were coded. Interviews continued to the
point of thematic saturation.

Results: Interviewees described adopting into practice many of the elements of the MORSim intervention
and reported positive experiences of change in communication, culture and collaboration. They described
sharing MORSim concepts with colleagues and using them in teaching and orientation of new staff. Reported
barriers to uptake included uninterested colleagues, limited team orientation, communication hierarchies,
insufficient numbers of staff exposed to MORSim and failure to prioritise time for team information sharing
such as pre-case briefings.

Conclusion: MORSim appears to have had lasting effects on reported attitudes and behaviours in clinical
practice consistent with more effective teamwork and communication. This study adds to the accumulating
body of evidence on the value of simulation-based team training and offers suggestions for implementing
widespread, regular team training for OR teams.


Can team training make surgery safer   [open in new window|view inline]


Bissett (2016) editorial   [open in new window|view inline]

Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention

Weller J, Cumin D, Civil I, Torrie J, Garden A., et al. Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention. New Zealand Medical Journal. 2015; 129(1439): 60-67.

ABSTRACT

Aims: We ran a Multidisciplinary Operating Room Simulation (MORSim) course for 20 complete
general surgical teams from two large metropolitan hospitals. Our goal was to improve teamwork and
communication in the operating room (OR). We hypothesised that scores for teamwork and communication
in the OR would improve back in the workplace following MORSim. We used an extended Behavioural
Marker Risk Index (BMRI) to measure teamwork and communication, because a relationship has previously
been documented between BMRI scores and surgical patient outcomes.

Methods: Trained observers scored general surgical teams in the OR at the two study hospitals before and
after MORSim, using the BMRI.

Results: Analysis of BMRI scores for the 224 general surgical cases before and 213 cases after MORSim
showed BMRI scores improved by more than 20% (0.41 v 0.32, p<0.001). Previous research suggests that
this improved teamwork score would translate into a clinically important reduction in complications and
mortality in surgical patients.

Conclusions: We demonstrated an improvement in scores for teamwork and communication in general
surgical ORs following our intervention. These results support the use of simulation-based multidisciplinary
team training for OR staff to promote better teamwork and communication, and potentially improve
outcomes for general surgical patients.


Improved scores for observed teamwork   [open in new window|view inline]

Multidisciplinary operating room simulation-based team training to reduce treatment errors: a feasibility study in New Zealand hospitals

Weller J, Cumin D, Torrie J, Boyd M, Civil I., et al. Multidisciplinary operating room simulation-based team training to reduce treatment errors: a feasibility study in New Zealand hospitals. New Zealand Medical Journal. 2015; 128(1418): 40-51.

ABSTRACT

Aims: Communication failures in healthcare are frequent and linked to adverse events and treatment errors. Simulation-based team training has been proposed to address this. We aimed to explore the feasibility of a simulation-based course for all members of the operating room (OR) team, and to evaluate its effectiveness.

Methods: Members of experienced OR teams were invited to participate in three simulated clinical events using an integrated surgical and anesthesia model. We collected information on costs, Behavioural Marker of Risk Index (BMRI) (a measure of team information sharing) and participants’ educational gains.

Results: We successfully recruited 20 full OR teams. Set up costs were NZ$50,000. Running costs per course were NZ$4,000, excluding staff. Most participants rated the course highly. BMRI improved significantly (P = 0.04) and thematic analysis identified educational gains for participants.

Conclusion: We demonstrated feasibility of multidisciplinary simulation-based training for surgeons, anesthetists, nurses and anaesthetic technicians. The course showed evidence of participant learning and we obtained useful information on cost. There is considerable potential to extend this type of team-based simulation to improve the performance of OR teams and increase safety for surgical patients.


MORSim a feasibility Study   [open in new window|view inline]

Information transfer in multidisciplinary operating room teams: a simulation-based observational study

Cumin, D, Skilton C, & Weller J. Information transfer in multidisciplinary operating room teams: a simulation-based observational study. BMJ Quality & Safety. 2016; 0: 1-8. doi:10.1136/bmjqs-2015-005130

ABSTRACT

Background: Communication of clinically relevant information between members of the operating room (OR) team is critical for safe patient care. Formal communication processes, such as briefing, sign in and time out, are designed to promote this.

Aims: We investigated patterns of communication of clinically relevant information between OR staff in simulated surgical scenarios, to identify factors associated with effective information sharing. We focused on the influence of precase briefing, sign in and time out, which we defined as formal team communications.

Method: Twenty teams of six participated in two scenarios during a day-long course. Participants each received unique, clinically relevant items of information (information probes) prior to simulations and were tested post scenario on recall of the information in the probe. Using videos of the simulations, we coded each time an information probe was mentioned against a structured framework.

Results: Of the 145 instances where a probe was mentioned at least once, 75 (51.7%) were mentioned during a formal team communication. However, there were 89 instances of a possible 234 (38%) where a probe was never mentioned. Some team members were more likely to mention the information than others. When probes were mentioned during formal team communications, significantly more team members were attentive (1.4 vs 2.3; p<0.001), the information was significantly more likely to be recalled and the team was five times more likely (p=0.01) to recall the information than if the information was only mentioned outside of a formal communication.

Conclusion: While our study supports the value of formal team communications during precase briefing, sign in and time out in the Surgical Safety Checklist, our findings suggest suboptimal transmission of information between team members and unequal contributions of information by different professional groups.


Information transfer MORSim   [open in new window|view inline]

A Systematic Review of Simulation for Multidisciplinary Team Training in Operating Rooms

Cumin D, Boyd M, Webster C, & Weller J. A Systematic Review of Simulation for Multidisciplinary Team Training in Operating Rooms. Society for Simulation in Healthcare. 2013; 8(3): 171-9.

Summary Statement: Current simulation training initiatives predominantly occur in uniprofessional silos and do little to integrate different disciplines working in the operating room (OR). The objective of this review was to determine the current status of work describing simulation for full OR multidisciplinary teams including barriers to conducting OR multidisciplinary team training and factors contributing to successful courses. We found a total of 18 articles from 10 research groups. Various scenarios and simulators were used, and training sessions were generally perceived as realistic and beneficial by participants despite rudimentary integration of surgical and anesthetic models. Measures of performance involved a variety of both technical and nontechnical ratings of the simulations. Challenges to conducting the simulations included recruitment, model realism, and financial costs. Future work should focus on how best to overcome the barriers to implementation of team training interventions for full OR teams, particularly on how to engage senior staff to aid recruitment.


Systematic review   [open in new window|view inline]

Edit page