A program enforced by the Veterans Health Administration (VHA) to enhance surgical outcomes and help structured interactive communication in surgical care results in fewer surgical complications, according to an article published in the December issue of the Archives of Surgery, one of the JAMA/Archives .

Over the last 10 years, significant efforts to lower risk linked to surgery have been instigated. Even though headlines are dominated by surgical mortality, it is the more prevalent non-fatal surgical complications that could present the initial signs of failures in the medical system. The VHA initiated a nationwide Medical Team Training (MTT) program in 2006 that requires pre- and postoperative briefings and debriefings instructed by a checklist and using cognitive aids.

In order to find out if there is a connection between surgical morbidity and the VHA Medical Team Training program, Yinong Young-Xu, Sc.D., M.A., M.S., of the National Center for Patient Safety, Department of Veterans Affairs, White River Junction, Vt., and colleagues carried out a retrospective health services investigation. The team examined 119,383 procedures at 74 VHA facilitates that provide care to veterans. At 42 facilities (57%) the MTT program was enforced, while 43% (32 facilities) without training served as a control group.

The investigators said:

“Facilities in the MTT program (n=42) had a significant decrease of 17 percent in observed annual surgical morbidity rate. Facilities not trained (n=32) had an insignificant decreased of 6 percent in observed morbidity.

After adjusting for surgical risk, we found a decrease of 15 percent in morbidity rate for facilities in the MTT program and a decrease of 10 percent for those not yet in the program.”

Although in both groups the risk of surgical complications decreased, the decline was 20% higher in the MTT group.

They conclude:

“In conclusion, participation in the VHA MTT program, which emphasizes communication and teamwork during an operation through checklist-driven briefings and debriefings, is associated with lower surgical morbidity.”

In an invited comment, Gerald M. Fried, M.D., of McGill University, Montreal, Quebec, Canada, goes over several programs designed to improve surgical quality.

As well as the VHA Medical Team Training program investigated by Young-Xu and colleagues, Dr. Fried highlights the method known as “fast track surgery” – in which surgeons work together with nurses, anesthesiologists, physical therapists, and nutritionists in order to create and control the perioperative care. In addition, Fried points to the Enhanced Recovery After Surgery (ERAS) collaboration, which has verified enhancement in recovery, morbidity, and postoperative symptoms in large prospective trials involving colorectal surgery.

Dr. Fried concludes:

“A combination of general measures, such as MTT, and procedure-specific evidence-based initiatives are likely to work synergistically to help us realize our goal of quality improvement after surgery.”

Written by Grace Rattue