Using TeamSTEPPS to improve interdisciplinary collaboration during high-risk procedures at a community hospital

Purpose:
The purpose of a community hospital work environment initiative was to improve practice through multidisciplinary, interdepartmental communication and patient safety using TeamSTEPPS tools during a new high risk patient procedure: the thoracoabdominal aortic aneurysm (TAAA).

Relevance/Significance:
Surgical treatment of TAAA is crucial to prevent rupture but is associated with high postoperative mortality. A new hospital surgeon has a high volume of TAAA patients. Nursing recognized ineffective communication is among the top 3 root causes of sentinel events reported to the Joint Commission. Nursing led the implementation of TAAA surgery using TeamSTEPPS, an evidence-based teamwork system to improve communication, teamwork skills, and patient safety to improve the practice environment.

Strategy and Implementation:
OR and ICU Nurses led the implementation by collaborating with the surgeon, anesthesia, surgical assistants, and pharmacy. They used TeamSTEPPS tools to simulate the operation and post-surgical care prior to caring for a TAAA patient. The goals of the simulations were to practice effective multidisciplinary communication skills and identify safety concerns. The TeamSTEPPS tools of Brief, Simulate, and Debrief were used. During the Brief the surgeon communicated with team expected complications and management of the simulated case. Simulation occurred with all disciplines involved in caring for the patient from the OR to the ICU. Debrief, led by nursing, occurred after every simulation to identify areas of opportunity related to patient safety, teamwork, and communication. The TeamSTEPPS tools were repeated until the entire team was confident to care for a TAAA patient. Successfully the team cared for TAAA patients and continues to use the tools of Brief and Debrief with every patient.

Evaluation:
The team has successfully cared for TAAA patients with zero mortality. Using the TeamSTEPPS tools the team identified 8 safety concerns that immediately changed their work environment such as a ICU nurse in the OR to transport the patient to ICU. Due to effective communication and skilled care the hospital's average length of stay (ALOS) is 8 days compared to literature report of ALOS 9.8 days.

Implications for Practice:
Nursing leadership successfully led multidisciplinary work environment practice changes for communication and patient safety of TAAA patients. Implications for nursing practice include replicating the multidisciplinary use of TeamSTEPPS tools for all high mortality patient care.