Teaming Up for Safety
BIDMC’s labor and delivery team received a plaque from the U.S. Department of Defense for their participation in a national labor and delivery team training study.

While operating rooms and airplane cockpits do not seem to have much in common, care providers at BIDMC are using passenger safety techniques to benefit patients.

Crew Resource Management, a safety training initiative, was introduced by the U.S. Department of Defense and commercial airlines in the 1980s and 1990s after a series of accidents resulting from poor teamwork. This approach is the centerpiece of patient safety efforts adopted by BIDMC’s department of obstetrics and gynecology in 2002, and by the department of surgery last May.

“Caregivers are human beings, each with the potential to make mistakes. We need to establish systems to prevent mistakes from reaching patients,” says Benjamin Sachs, M.D., BIDMC’s chief of obstetrics and gynecology and a leader in a national study tracking the impact of team training in reducing errors. “Teamwork – whether in the cockpit or in the delivery room – can go a long way to catch mistakes before they lead to negative consequences.”

“Team training” is designed to ensure effective communication among physicians, nurses and other personnel. It builds upon the Institute of Medicine’s (IOM) 2000 report, To Err is Human: Building a Safer Health System.

To maintain a high level of safety at BIDMC, interdisciplinary labor and delivery teams meet throughout shifts to discuss each patient’s care, staff workloads and resources. Team members remain aware of activity on the unit and monitor other team members’ actions to share workload.

All team members undergo a four-hour training covering team structure and leadership, communications techniques, planning and problem solving skills, and workload management.

The result has been a culture change in labor and delivery. Attending physicians are now aware of all patients on the unit, not just their own. When a provider calls out from the room for supplies, personnel or assistance, the information is repeated to the requestor for accuracy. The implementation of the contingency team – an ad hoc group of physicians, nurses and technicians who come together for an emergency – has improved emergency response. Team meetings serve as a forum for mentoring of new staff and open discussion of questions and concerns.

Sachs is the principal investigator of a study analyzing more than 47,000 deliveries in 15 civilian and military hospitals nationwide to evaluate the impact of this team approach. Using a weighted index of adverse outcomes that measures complications ranging from maternal death to a perineal tear, the study establishes benchmarks that show the effectiveness of teamwork in reducing errors. Full results will be submitted for publication in September, but at BIDMC, team training has resulted in a 53 percent reduction in potential adverse outcomes in high-risk patients over the past three years.

Building on that success, team training was recently launched in BIDMC’s operating rooms. Led by Donald W. Moorman, M.D., the department of surgery’s vice chair of quality and education, the goal is to provide team training to all surgery team members — including nurses, anesthesiologists, scrub techs and orderlies — to create a “culture of safety.”

“In the old model, surgeons were not allowed to fail, and errors were seen as punishable offenses,” Moorman explains. “The new model still requires a leader, but it also demands respect for the role and function of each member of the team.”

- Jerry Berger