Medical Team Training and Surgical Morbidity

Reducing risks associated with surgical procedures has become increasingly important over the past 10 years. In a previous study, researchers analyzed the effect that medical team training (MTT) had on rates of surgical mortality. In a more recent study, the same researchers conducted a retrospective health services study designed to determine whether there is an association between MTT and surgical morbidity. Utilizing data from the Veterans Health Administration (VHA) Surgical Quality Improvement Program (VASQIP) for the years 2006, 2007, and 2008, the analysis included aggregated measures representing 119,383 sampled procedures from 74 VHA facilities that provided care to veterans. Results of the analysis were reported in Archives of Surgery [2011;146(12):1368-1373]. The VHA MTT program was implemented in 2006 to facilitate structured interactive communications in surgical care, with an eye toward improving surgical outcomes. The program requires preoperative briefings and postoperative debriefings outlined by a checklist and cognitive aids. This study compared the annual surgical morbidity rates for facilities using the VHA MTT program with those that did not. The primary outcome measure was the rate of change in annual surgical morbidity rate 1 year following enrollment in the MTT program compared with 1 year prior to enrollment and compared with non-MTT program sites. Annual surgical morbidity rate was defined as the number of VASQIP surgical morbidities divided by the number of procedures during the fiscal year. Of the 74 facilities included in the analysis, 57% (n=42) had implemented the MTT program. The 43% (n=32) facilities not-yet trained served as the contemporaneous control group. The MTT program was implemented in the 42 facilities in 2007; 2006 was used as the baseline year for both groups, and 2008 was chosen by the researchers as the follow-up measure. There were no significant differences between the 2 groups in morbidity or mortality rates, surgical volume, surgical complexity, or urbanicity. Facilities in the MTT program group had a 17% reduction in observed morbidity rate (rate ratio [RR], 0.83; 95% confidence interval [CI], 0.79-0.88; P=.01). There was a nonsignificant reduction of 6% in observed morbidity in facilities not in the program (RR, 0.94; 95% CI, 0.86-1.05; P=.11). Following risk adjustment, both groups showed statistically significant improvement: a decrease of 15% for the MTT program group and a decrease of 10% for the control group. After further adjustment for morbidity and mortality rates, procedure volumes, and propensity scores, the decline in morbidity rates was 20% steeper in the MTT group (RR, 1.20; 95% CI, 1.19-1.22; P=.001). The steeper decline in annual surgical morbidity rates was also observed in specific morbidity outcomes, including surgical infection. In conclusion, the researchers stated: “The Veterans Health Administration MTT program is associated with decreased surgical morbidity.”