Surgical Teamwork Essential, Underappreciated

Laird Harrison

May 20, 2019

SAN DIEGO — "Surgery is like a dance," Lygia Stewart, MD, from the University of California, San Francisco (UCSF), told Medscape Medical News. "Expertise matters because it's a team effort."

How well surgical teams work together and whether they are able to stick it out as a group was the topic of a lively discussion here at Digestive Disease Week 2019.

Standards for most surgical specialties require specialized operating-room teams. But increasingly complex general surgery cases have not received similar support, and research has shown this can harm communication and team performance and affect safety and error rates.

"What I think is not generally understood now is how complex general surgery is," Stewart said. The word "general" prompts many to erroneously assume these procedures don't require special expertise, she explained.

Stewart and her colleagues from UCSF and the San Francisco Veterans Affairs Medical Center reviewed 1900 general surgeries and 655 cardiothoracic operations. They used cardiothoracic surgery as the comparison group for their study because this specialty typically relies on stable teams of experienced nurses and technicians.

The researchers read debrief materials that surgical teams filled out for each operation. The forms included scores rating patient hand-offs, equipment quality, and other aspects of group work that affect care.

The degree of expertise was significantly lower in the general surgery teams than in the cardiothoracic teams.

Whereas a specialized nurse was part of the team in about half of general surgeries, such a nurse was involved in nearly 80% of cardiothoracic procedures (< .0001). And expert scrubs were involved in just 33% of general surgeries but 91% of cardiothoracic cases (< .0001).

Less Expertise

This disparity had a negative affect on team performance, coauthor Whitney Goering, MD, also from UCSF, said during her presentation at the meeting. In complex surgical cases, less team expertise was significantly correlated with lower case scores.

Goering also pointed out that not having experienced nurses and scrubs working together can result in delays and wasted equipment.

Scott Jones, MD, from the University of Virginia in Charlottesville, said that his own research corroborates these findings.

Medicare data show that physician-owned medical centers perform high on a scale that combines cost, outcomes, and patient satisfaction, he told Medscape Medical News, and a key factor in their success is having stable surgical teams. "Their outcomes are superior to all hospitals," he reported.

"I'm frequently told that it's too costly to create a special team for general surgery," said Fabrizio Michelassi, MD, from Weill Cornell Medicine in New York City, which makes it difficult to maintain stable teams.

It is unclear why these teams have trouble staying together. "We need to keep bringing this to the boards of hospitals and say it's important for us to train our nurses to become proficient in one area," Goering said.

This study did not evaluate costs, and follow-up research will concentrate on patient outcomes, Stewart added.

Steward, Goering, and Jones have disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2019: Abstract 232. Presented May 19, 2019.

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