In 2008, Duke Medicine's early adoption of system-wide teamwork strategies caught the attention of the Agency for Healthcare Research Quality, a branch of the US Department of Health & Human Services.

At their invitation, Duke became one of five medical centers nationwide to become a training center for TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety).

Improving Communication

As the program's name suggests, TeamSTEPPS includes methodologies to bolster teamwork among health care providers at all levels. For Duke's Cardiothoracic OR (CT OR) team, that has meant placing improved communication as priority number one.

"Given the acuity of the patients we see, communication is clearly a component of good care," says Joseph Mathew, MD, chief of the Duke Division of Cardiac Anesthesiology and a member of the CT OR committee for TeamSTEPPS. "In any relationship, if you don't communicate, you don't go anywhere."

To that end, the CT OR team has utilized the briefing and debriefing component of TeamSTEPPS to clear potential blocks in communication and avoid future misunderstandings.

It's a simple concept: before and after a surgical procedure, the team sets aside time to talk face to face. Topics of discussion may include expectations for complications, preferred surgical instruments and equipment, or general feedback -- all within a team culture that encourages engagement of every member.

In the case of the equipment list, "even though the needed instruments are posted on the schedule, the process of vocalizing and reviewing the needs in person has gone a long way," says R. Duane Davis, MD, director of Duke Transplant Services.

This scheduled step also builds in a buffer where decisions are planned and prepared for in advance. "You can avoid surprises if you have a plan A and a plan B, and sometimes a plan C," says Greg Smigla, a clinical cardiac perfusionist.

As TeamSTEPPS begins implementation in other Duke departments and divisions, CT OR is turning its attention to maintaining the standards and changes that have resulted from the program. "Communication is the priority, but trying to improve the process of how we deliver care, from timing issues to how things are standardized to a certain degree, that's where we can really make a difference in patient safety," says Davis.

Implementing TeamSTEPPS in Obstetrics and Radiology

In addition to the Cardiothoracic OR, Duke's Obstetrics and Radiology departments are also taking advantage of the TeamSTEPPS processes to improve patient care quality and safety.

Obstetrics

A multidisciplinary team comprising obstetricians, anesthesiologists, nurses, certified nurse midwives, and support staff attended a two-day TeamSTEPPS training course to form the group of core trainers.

They in turn served as teachers for the department-wide mandatory classes. Classes focused on the elements of effective team communication, with a total of 125 staff members from the Duke Birthing Center participating.

Radiology (Interventional Ultrasound)

Joining an interdisciplinary team of sonographers, radiologists, and technician aides, a set group of radiology nursing staff was identified as ultrasound interventional specialists, which helped to create consistency with communication between physicians and nurses in regards to patient care and flow.

Clear role delineation has helped the entire team coordinate better care. The team has implemented briefing and debriefing processes; every day begins with a meeting of the whole team to discuss the day's cases and any potential concerns.