Team consistency and occurrences of prolonged operative time, prolonged hospital stay, and hospital readmission: a retrospective analysis.

BACKGROUND: Human factors research has suggested benefits of consistent teams yet no surgical team consistency measures have been established for teamwork improvement initiatives. METHODS: Retrospective analysis was conducted of teams performing consecutive elective procedures of unilateral primary total knee and hip replacement between June 2008 and May 2010 at a large tertiary medical center. Surgeons who performed fewer than 50 cases of the procedures during the study period were excluded. A team was defined as consistent when its nurse and surgical technologist members were both among the three most frequent working with the surgeon during the study period. Odds ratios for prolonged operative time (in the longest quartile), prolonged hospital stay (longer than median), and 30-day all-cause readmissions were adjusted for patient characteristics (sex, age, comorbidity, American Society of Anesthesiology status), surgery characteristics (procedures, time of day), and surgeons. RESULTS: Inconsistent teams performed 61% of the 1,923 cases with eight surgeons, each of which worked with a median of 43.5 (range, 28-58) nurses and 29 (range, 13-47) technologists. Inconsistent teams were associated with higher likelihood of prolonged operative time [odds ratio 1.52, 95% confidence interval (CI) 1.20-1.91], higher likelihood of prolonged hospital stay (odds ratio 1.51, 95% CI 1.23-1.86), and more readmissions (adjusted odds ratio 1.42, 95% CI 1.07-1.89). CONCLUSIONS: Team consistency was an independent predictor of prolonged operative time, prolonged hospital stay, and 30-day hospital readmission in elective, primary, unilateral total knee, and hip replacement procedures, after adjusting for patient and surgery characteristics and surgeons.

Use of healthcare failure mode and effect analysis (HFMEA) to quantify risks of the human milk feeding process.

The complexity of the expressed breast milk feeding process in the neonatal intensive care unit was not fully appreciated until we used a healthcare failure mode and effect analysis. This approach identified latent risks and provided semiquantitative estimates of the effectiveness of recommendations. Findings demonstrated nursing interruptions and multitasking requirements contributed to risk, emphasizing the need for focused and isolated expressed breast milk handling to improve patient safety and outcomes.