Incision – What Can We Learn From Familiar Surgical Teams?

Introduction

Definition of a Familiar Team

Surgical care consists of numerous interprofessional interactions, across several key multidisciplinary teams, typically made up of surgeons, nurses, anaesthesiologists, and technicians. Working in the OR requires highly adaptive and task-focused collaboration among team members, often involving safety-critical protocols and sophisticated equipment. Naturally, a history of working together would be desirable.

In a team, members having prior experience working together are referred to as its “familiarity”. Team members who worked extensively for several months or even years establish a high level of familiarity. Research from diverse fields such as police training, suggest that higher team familiarity leads to improved results.

“A growing body of research has identified team familiarity as a consistent driver of improved performance and better outcomes in the OR.”

1. Faster and More Efficient

In 2022, a systematic review published in the Annals of Surgery investigated the impact of team familiarity on OR efficiency. Researchers from the University of Chicago discovered that more familiar teams greatly shorten operative times, with reported reductions between 8% and 16%. This depended on various factors, including surgical complexity and specific measures of familiarity used. For example, more familiar gynaecology teams saved approximately 25 minutes per robotic-assisted sacrocolpopexy compared to less familiar teams. Spinal fusion treatments have been reported to save up to 91 minutes of time.

“Increased familiarity is associated with better team performance, particularly in reducing operative time.”

Beyond operative times, familiar teams can enhance OR preparation and case turnovers. In general surgery, familiar teams cut turnover time by 18% for inguinal hernia repairs and 16% for laparoscopic cholecystectomies. The presence of a dedicated laparoscopic team (vs. a non-dedicated team) also shortens total anaesthesia time by 30 minutes, with fewer delays in equipment setup. Similarly, cardiac surgery and neurosurgical teams that operated together regularly saw fewer disruptions, errors and teamwork failures.

2. Better Clinical Outcomes?

Improving OR team familiarity substantially improves operative efficiency. Nonetheless, the relationship between familiar teams and direct clinical outcomes remains complex. Less familiar teams have been linked to longer postoperative hospitalisation in both cardiac and orthopaedic surgery. For instance, primary hip and knee replacement done by inconsistent surgeon-nurse teams show higher readmission rates (13.2% vs 10.0%), lengthier operative times, and longer hospital stays.

In breast reconstruction, one study found an increased risk for reoperation due to greater rates of surgical site infections in less familiar teams. Surgeons with less than 150 prior case collaborations had significantly higher reoperation rates than surgeons with more than 300. However, other studies have not identified a significant correlation between familiar teams and reduced complications.

3. Complex Logistical Challenges

The advantages of familiar teams in surgery are now well established, prompting the question: how can we leverage these benefits to improve our own care provision?  In practice, logistical challenges pose the greatest obstacles.

Establishing consistent and familiar operative teams can be difficult due to shift patterns, which frequently bring together unfamiliar professionals to cover schedules and maintain services. Additionally, rotational training programs result in regular influx and outflux of surgical residents and trainee nurses. Understaffing and emergency coverage often pushes staff to work outside their familiar teams.

For instance, OR nurses are often assigned to work outside of their specialty areas while on call or filling in for staff absences. Surgical managers also commonly form ad hoc teams with members who do not generally work together.

“There are significant logistical challenges to forming consistent and familiar teams.”

Nonetheless, these challenges also create opportunities for innovation.