Surgical Team Interventions

By August 17, 2018 No Comments

Anesthesia professionals such as anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) are crucial for successful surgical procedures in the operating room (OR). Yet, innovative changes in healthcare delivery in the United States are evolving the methods by which anesthesia professionals can contribute to the surgical team. Facing mounting pressures to emphasize patient satisfaction alongside efficacy and quality measures, medical management experts such as anesthesia management companies are considering team training intervention programs. In recent literature, team training interventions are implemented in the OR in multiple arenas. Two of note are interventions in the practices of information technology systems and non-technical skills acquisition. Anesthesia professionals are key to each of these arenas, as the following article will discuss at length.

Anesthesia Information Management Systems (AIMS) are specialized technology platforms that provide the capacity for anesthesiologists and CRNAs to track, monitor, and gauge anesthesia throughout the perioperative cycle. The most universal form of AIMS is a software or hardware add-on to the common electronic medical records (EMR) system utilized in healthcare centers. AIMS integrates data from multiple streams, guided by the anesthesiologist, at several time points throughout the perioperative journey. Furthermore, throughout the surgery, AIMS will adapt to change in real-time. This provides a two-fold benefit in that it encourages the anesthesia practitioners and surgeons to focus less on monitoring patient vital signs and more on the strategic course of the surgery. Moreover, the use of AIMS also ensures accurate records of administered medications throughout the surgery, which is essential for administrative functions such as postoperative billing, inventory, and reimbursement. In such a way, AIMS increases the availability of historical records for surgeries, therefore meeting insurance reimbursement requirements and improving postoperative recovery for the patient. AIMS developments have sought to integrate the technology into OR team training interventions. A recent study examined the impact of connecting AIMS to a hospital’s operating room data management system. The researchers discovered that opening access to AIMS data increased the utilization and accuracy of anesthesia data. Even more, the intersection of AIMS and operating room data management systems allowed practitioners to refer back to accurate data, supporting retrospective and clinical research initiatives within the institution.




Team training interventions are also in implementation through the delivery of non-technical skills acquisition to key surgical staff, including anesthesia professionals. In 2017, the Journal of Patient Safety published a paper that underlined the effects of a short team training intervention on the surgical teams’ observed NOTSS score, or nontechnical skills in surgery score. The authors aimed to address the statistic that nearly 60% of adverse events that occur during surgery are the result of subpar teamwork and communication. So, the researchers came up with an intervention to address non-technical skills. The intervention was designed as a pre-test, post-test interrupted time series design that included repeated measures analysis to evaluate the strength and changes in surgical team members’ NOTSS scores over time. In addition, the intervention was implemented in a large tertiary hospital with over twenty operating rooms to attain a high sample n number. The team training program involved a simulations DVD with live follow-up. At the study’s conclusion, the researchers detected a strong post-test rise in NOTSS score among intervention recipients, thereby strengthening their confidence in the team training intervention program. Further studies will validate the use of this specific form of team training, taking into account the context of institution-specific anesthesia and surgical practitioners.

Anesthesiologists and CRNAs have a crucial role to play in the evolution of surgical team management in the OR. As cornerstones of the surgical experience, anesthesia practitioners are optimal to serve in leadership roles with regards to patient advocacy and intra-practitioner communication. As research into operational excellence in the OR continues to develop, anesthesia management companies, anesthesiologists, and CRNAs will emerge as leaders in the journey for excellent patient care both in and out of the OR.