Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Cardiac surgery is a team sport

Norman Silverman, MD
Physician
October 16, 2011
Share
Tweet
Share

It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical education of surgical staff, advances in technology and classic peer review of adverse outcomes have impacted death and complication rates. However, preventing avoidable harm is still a significant challenge despite innumerable checklists, preoperative briefings, postoperative debriefings and team training programs.

That is why a recent report published in the Journal of the American Medical Association from the Veterans Health System is so remarkable. Seventy-four facilities underwent a team-training program comprised of 2 months of instruction, a 1 day conference and 1 year of quarterly coaching interviews and audits. The program was aimed at forming a cohesive approach towards improving patient safety by surgeons, anesthesiologists, nurses and associated operating room heathcare staff. Over a two year period, the 30 day mortality rate for major surgical procedures at participating hospitals was reduced 18% which absolute rate was only 1/2 the concurrent mortality at hospitals that has not undergone the training. Supporting the value of institutional commitment to this approach was the “dose-response” relationship between successive calendar quarterly training and mortality rate. The death rate progressively decreased with each sequential 3 month period of participation. The 182,409 procedures were not cardiac, but the principles certainly apply to open-heart surgery. The efficacy of this new approach is more impressive given the fact that the hospitals not yet enlisted had in place what were felt to be effective, up-to-date quality programs.

The secrets to success were frequent and open communication, a decision-making structure that welcomes imput collegially regardless of rank, a just culture towards reporting adverse events and constant training of all team members that was not limited to new hires.What most distinguished the training protocols was mandatory participation by all team members, i.e. no one was too senior to participate, and training sessions were embedded in the workload, not sporadic or after hours.

The lay public may read this information and wonder what the big “breakthrough” is. Do not surgical team already “work together”? Do you have to teach medical staff how to talk to each other? The truth is that all the well-meaning medical personnel involved in an open-heart operation come from different types of training programs, report to separate administrative departments, are rewarded and disciplined by different criteria and have varying personal and professional goals. Cohesion does not come naturally. But obviously, when the leadership of surgical centers are committed to getting all the team players continuously focused on systematic safety procedures and open communication not only can work place morale be enhanced, but patients’ lives can be saved.

Norman Silverman is a cardiothoracic surgeon and founder of Heart Surgery Guide.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension

October 16, 2011 Kevin 0
…
Next

The rewards of medicine can be overwhelming

October 16, 2011 Kevin 3
…

Tagged as: Specialist, Surgery

Post navigation

< Previous Post
MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension
Next Post >
The rewards of medicine can be overwhelming

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Norman Silverman, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Impersonal care from the new generation of physicians

    Norman Silverman, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Considering cancer and heart disease in opposing ways

    Norman Silverman, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The ability to quantify empathy

    Norman Silverman, MD

More in Physician

  • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

    Anonymous
  • The man in seat 11A survived, but why don’t our patients?

    Dr. Vivek Podder
  • When did we start treating our lives like trauma?

    Maureen Gibbons, MD
  • Medicalizing burnout misses the real problem

    Jessie Mahoney, MD
  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Cardiac surgery is a team sport
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...