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A Preliminary Report

Shantanu Nundy, MD; Arnab Mukherjee, MD; J. Bryan Sexton, PhD; Peter J. Pronovost, MD, PhD; Andrew Knight, MBA; Lisa C. Rowen, RN, DNSc; Mark Duncan, MD; Dora Syin, MD; Martin A. Makary, MD, MPH

Arch Surg. 2008;143(11):1068-1072.

Hypothesis  Preoperative briefings have the potential to reduce operating room (OR) delays through improved teamwork and communication.

Design  Pre-post study.

Setting  Tertiary academic center.

Participants  Surgeons, anesthesiologists, nurses, and other OR personnel.

Intervention  An OR briefings program was implemented after training all OR staff in how to conduct preoperative briefings through in-service training sessions. During the preoperative briefings, the attending surgeon led OR personnel in a 2-minute discussion using a standardized format designed to familiarize caregivers with each other and the operative plan before each surgical procedure.

Main Outcome Measures  The OR Briefings Assessment Tool was distributed to OR personnel at the end of each operation. Survey items questioned OR personnel about unexpected delays during each procedure and the relationship between communication breakdowns and delays. Responses were compared before and after the initiation of the preoperative briefings program.

Results  The use of preoperative briefings was associated with a 31% reduction in unexpected delays; 36% of OR personnel reported delays in the preintervention period, and 25% reported delays in the postintervention period (P<.04). Among surgeons alone, an 82% reduction in unexpected delays was observed (P<.001). A 19% reduction in communication breakdowns leading to delays was also associated with the use of briefings (P<.006).

Conclusions  Preoperative briefings reduced unexpected delays in the OR by 31% and decreased the frequency of communication breakdowns that lead to delays. Preoperative briefings have the potential to increase OR efficiency and thereby improve quality of care and reduce cost.

Author Affiliations: Quality and Safety Research Group, Department of Anesthesiology (Drs Nundy, Mukherjee, Sexton, Pronovost, Syin, and Makary); The Johns Hopkins University School of Medicine (Mr Knight); Department of Surgery, Johns Hopkins Bayview Medical Center (Dr Duncan); Center for Surgical Outcomes Research, Department of Surgery (Drs Pronovost, Syin, and Makary); Department of Health Policy and Management, School of Medicine (Drs Pronovost and Makary); Bloomberg School of Public Health, School of Nursing (Drs Pronovost and Rowen), The Johns Hopkins University, Baltimore, Maryland; and School of Medicine and School of Management, Yale University, New Haven, Connecticut (Dr Mukherjee). Dr Nundy is now with the Department of Internal Medicine, The University of Chicago Medical Center, Chicago, Illinois. Dr Mukherjee is now with the Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University.

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