TeamSTEPPS hits the ORs at UNC Medical Center

This fiscal year, TeamSTEPPS training of health-care professionals involved in patient care is an organizational goal across UNC Medical Center. On Wednesday morning, Jan. 25, more than 600 physicians and staff who work in operating rooms at UNC Hospitals, Ambulatory Surgical Center, and Hillsborough Hospital received the training. Kicking off the training was UNC athletic director Bubba Cunningham; closing the meeting was a new TeamSTEPPS-enhanced surgical safety checklist that is now live.

TeamSTEPPS hits the ORs at UNC Medical Center click to enlarge Bubba Cunningham addresses physicians and staff in Old Clinic Auditorium at the start of the TeamSTEPPS training.
TeamSTEPPS hits the ORs at UNC Medical Center click to enlarge Attendees are shown a Time Out led by Dr. Anthony Charles. TeamSTEPPS training co-leaders Janet Chadwick and Peggy McNaull are on the stage.

Bubba Cunningham opened last week’s TeamSTEPPS training by identifying several key points of emphasis that make Carolina coaches and their programs successful: preparation, real-time adjustments during competition, and post-performance evaluation.

For his coaches, exceling in these three facets requires excellent communication and teamwork. Look, for example, at Jenny Levy, UNC’s women's lacrosse coach for the past 22 years.

“She attributes so much of her program's success to communication,” Cunningham told the attendees in Old Clinic Auditorium at UNC Hospitals, one of three on-campus locations where training took place.

Women’s soccer coach Anson Dorrance and men’s basketball coach Roy Williams both talk about how much they listen to their assistant coaches.

“Roy says, 'Watch me in the huddle -- I ask for input from my assistants,’” Cunningham noted.

The behind-the-scenes work that goes into producing winning outcomes on the court or the field closely mirrors approaches found in TeamSTEPPS, a teamwork- and communication-enhancing program that has proven effective in producing safer – and better – patient outcomes in health-care settings.

After Cunningham’s words, training for more than 600 operating-room professionals from UNC Hospitals, the Ambulatory Surgery Center, Hillsborough Hospital, and Kittner Eye Center was underway.

“It was a milestone,” said training co-leader Peggy McNaull, MD, Associate Professor of Anesthesiology and Pediatrics and Vice Chair for Patient Safety & Quality Improvement. “This is the first time in my 13 years here that I can remember gathering all OR personnel for one specific mission: to produce better patient outcomes by improving communication and teamwork.”

This mission – with TeamSTEPPS as the vehicle – is an organizational goal at UNC Medical Center this fiscal year. 

“All the leading organizations promoting quality and safe patient care recommend teamwork training as a component of a robust patient safety program,” said Erin Eckert, TeamSTEPPS Coordinator with the UNC Institute for Healthcare Quality Improvement (IHQI) and project manager for the training. “TeamSTEPPS has become the standard for healthcare organizations seeking to improve teamwork and patient safety across a wide variety of clinical settings.”

Key team events in TeamSTEPPS include the “Brief,” the “Huddle,” and the “Debrief.” Leaders use briefing to get the team organized and communicating, a huddle to discuss adjustments to the plan, and a debrief to review the team's performance after the event.

In OR settings at UNC Medical Center, these team events occur during “Sign In,” “Time Out,” and “Sign Out.” Team members involved in these events include circulating nurses, scrub techs, surgical attendings and residents, anesthesia providers, perfusionists, and other personnel supporting the case.

During the training, OR personnel were shown videos of successful Sign Ins, Time Outs, and Sign Outs held by teams in ORs at UNC Hospitals. While formal leaders may organize and lead these discussions, they are designed to ensure that all members of the OR team can share information, ask questions, and address any patient safety concerns.

“This openness of communication empowers everyone in the operating room,” said Janet Chadwick, BSN, MBA, CNOR, Manager of Perioperative Education and one of the co-leaders of the training. “Advocating for the patient and asserting your viewpoint are both important for patient safety. While this may lead to conflicting points of view, disagreements handled appropriately can sometimes lead to better outcomes.”

Several years ago, the World Health Organization published a study in the New England Journal of Medicine on the implementation of surgical safety checklists in reducing deaths and major complications from surgery. Data from 4,000 operations at eight hospitals, in eight cities, were compiled. Findings led to the incorporation of surgical checklists in hospitals across the United States, including UNC Hospitals.

As part of the training, OR personnel at UNC Medical Center learned of a new surgical safety checklist which incorporates TeamSTEPPS-based enhancements to the Sign In, Time Out, and Sign Out. The checklist went live immediately after the training on Wednesday, January 25.

“In health care, the stakes are high and the conditions are inherently hazardous,” said training co-leader William Adamson, MD, Division Chief of Pediatric Surgery. “It is critical to improve team performance and reduce opportunities for error.

Hillsborough Hospital and Kittner Eye Center participated in the training via web broadcast. In 2015, before the Hillsborough Hospital opened, all health-care professionals involved in patient care were required to receive TeamSTEPPS training. Last week’s event served as a retraining for many Hillsborough OR personnel.

“TeamSTEPPS was a great way to promote communication and teamwork among the interprofessional team and a phenomenal way to introduce our ‘High Touch – High TEQ’ focus,” said Jeff Strickler, Associate Vice President of Hillsborough Hospital. “Since our opening, our success in optimizing patient outcomes in the realms of teamwork, efficiency, and patient satisfaction can be partly attributed to this early embrace of the TeamSTEPPS tools and behaviors.”

Over the next several months, TeamSTEPPS training will reach into other areas of UNC Medical Center.

“By the end of this year, with this training in the OR and across the hospitals, we believe we will have made significant strides in producing better outcomes for our patients,” said Laura Brown, Director of Operations, IHQI. “And that’s the ultimate goal and why we’re all in health care, no matter what role we play.”

by Zach Read - zachary.read@unchealth.unc.edu

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