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Original Contribution
October 20, 2010

Association Between Implementation of a Medical Team Training Program and Surgical Mortality

Author Affiliations

Author Affiliations: National Center for Patient Safety, Department of Veterans Affairs (Mss Neily and West and Drs Mills, Young-Xu, Carney, Mazzia, Paull, and Bagian) and Department of Psychiatry, Dartmouth Medical School (Drs Mills and Young-Xu), Hanover, New Hampshire; Department of Surgery, Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (Dr Berger); Preventive Medicine and Community Health at the University of Texas Medical Branch, Galveston, and Military and Emergency Medicine—Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland (Dr Bagian).

JAMA. 2010;304(15):1693-1700. doi:10.1001/jama.2010.1506

Context There is insufficient information about the effectiveness of medical team training on surgical outcomes. The Veterans Health Administration (VHA) implemented a formalized medical team training program for operating room personnel on a national level.

Objective To determine whether an association existed between the VHA Medical Team Training program and surgical outcomes.

Design, Setting, and Participants A retrospective health services study with a contemporaneous control group was conducted. Outcome data were obtained from the VHA Surgical Quality Improvement Program (VASQIP) and from structured interviews in fiscal years 2006 to 2008. The analysis included 182 409 sampled procedures from 108 VHA facilities that provided care to veterans. The VHA's nationwide training program required briefings and debriefings in the operating room and included checklists as an integral part of this process. The training included 2 months of preparation, a 1-day conference, and 1 year of quarterly coaching interviews

Main Outcome Measure The rate of change in the mortality rate 1 year after facilities enrolled in the training program compared with the year before and with nontraining sites.

Results The 74 facilities in the training program experienced an 18% reduction in annual mortality (rate ratio [RR], 0.82; 95% confidence interval [CI], 0.76-0.91; P = .01) compared with a 7% decrease among the 34 facilities that had not yet undergone training (RR, 0.93; 95% CI, 0.80-1.06; P = .59). The risk-adjusted mortality rates at baseline were 17 per 1000 procedures per year for the trained facilities and 15 per 1000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1000 procedures per year for both groups. Propensity matching of the trained and nontrained groups demonstrated that the decline in the risk-adjusted surgical mortality rate was about 50% greater in the training group (RR,1.49; 95% CI, 1.10-2.07; P = .01) than in the nontraining group. A dose-response relationship for additional quarters of the training program was also demonstrated: for every quarter of the training program, a reduction of 0.5 deaths per 1000 procedures occurred (95% CI, 0.2-1.0; P = .001).

Conclusion Participation in the VHA Medical Team Training program was associated with lower surgical mortality.