Reuniones Preoperatorias

Operating Room Briefings and Wrong-Site Surgery
Journal of the American College of Surgeons Feb 2007

Martin A. Makary MD, MPH, ‡, §, , , Arnab Mukherjee BA, #, , J. Bryan Sexton PhD†, , Dora Syin BS‡, #, Emmanuelle Goodrich MPH‡, Emily Hartmann MSS‡‡, Lisa Rowen RN, DScN¶, Drew C. Behrens#, ††, Michael Marohn DO, FACS, ‡ and Peter J. Pronovost MD, PhD,

Background
Wrong-site surgery can be a catastrophic event for a patient, caregiver, and institution. Although communication breakdowns have been identified as the leading cause of wrong-site surgery, the efficacy of preventive strategies remains unknown. This study evaluated the impact of operating room briefings on coordination of care and risk for wrong-site surgery.

Study Design
We administered a case-based version of the Safety Attitudes Questionnaire (SAQ) to operating room (OR) staff at an academic medical center, before and after initiation of an OR briefing program. Items questioned overall coordination and awareness of the surgical site. Response options ranged from 1 (disagree strongly) to 5 (agree strongly). MANOVA was used to compare caregiver assessments before and after the implementation of briefings, and the percentage of OR staff agreeing or disagreeing with each question was reported.

Results
The prebriefing response rate was 85% (306 of 360 respondents), and the postbriefing response rate was 75% (116 of 154). Respondents included surgeons (34.9%), anesthesiologists (14.0%), and nurses (44.4%). Briefings were associated with caregiver perceptions of reduced risk for wrong-site surgery and improved collaboration [F (6,390) = 10.15, p < 0.001]. Operating room caregiver assessments of briefing and wrong-site surgery issues improved for 5 of 6 items, eg, “Surgery and anesthesia worked together as a well-coordinated team” (67.9% agreed prebriefing, 91.5% agreed postbriefing, p < 0.0001), and “A preoperative discussion increased my awareness of the surgical site and side being operated on” (52.4% agreed prebriefing, 64.4% agreed postbriefing, p < 0.001).

Conclusions
OR briefings significantly reduce perceived risk for wrong-site surgery and improve perceived collaboration among OR personnel.