JAMA Study Finds TeamSTEPPS® Associated With Reduction in Medical Errors

Implementation of AHRQ’s TeamSTEPPS® team training program, along with other interventions, led to a significant reduction in medical errors and preventable adverse events among hospitalized children, according to an article published December 4 in The Journal of the American Medical Association (JAMA). The study, which examined an intervention involving 84 resident physicians and 1,255 patient admissions in 2009 and 2010 on two inpatient units at Boston Children’s Hospital, found that errors decreased from 33.8 to 18.3 per 100 admissions. The abstract and article, titled “Rates of Medical Errors and Preventable Adverse Events Among Hospitalized Children Following Implementation of a Resident Handoff Bundle,” credited a “handoff bundle” with improvements in verbal and written handoff processes that helped to prevent errors. TeamSTEPPS, developed jointly by AHRQ and the Department of Defense, was one of the programs used to create the Boston Children’s handoff bundle.

2013 Dec 4;310(21):2262-70. doi: 10.1001/jama.2013.281961.

Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.

Starmer AJ, Sectish TC, Simon DW, Keohane C, McSweeney ME, Chung EY, Yoon CS, Lipsitz SR, Wassner AJ, Harper MB, Landrigan CP.

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Abstract

IMPORTANCE:

Handoff miscommunications are a leading cause of medical errors. Studies comprehensively assessing handoff improvement programs are lacking.

OBJECTIVE:

To determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow.

DESIGN, SETTING, AND PARTICIPANTS:

Prospective intervention study of 1255 patient admissions (642 before and 613 after the intervention) involving 84 resident physicians (42 before and 42 after the intervention) from July-September 2009 and November 2009-January 2010 on 2 inpatient units at Boston Children's Hospital.

INTERVENTIONS:

Resident handoff bundle, consisting of standardized communication and handoff training, a verbal mnemonic, and a new team handoff structure. On one unit, a computerized handoff tool linked to the electronic medical record was introduced.

MAIN OUTCOMES AND MEASURES:

The primary outcomes were the rates of medical errors and preventable adverse events measured by daily systematic surveillance. The secondary outcomes were omissions in the printed handoff document and resident time-motion activity.

RESULTS:

Medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3-40.3) to 18.3 per 100 admissions (95% CI, 14.7-21.9; P < .001), and preventable adverse events decreased from 3.3 per 100 admissions (95% CI, 1.7-4.8) to 1.5 (95% CI, 0.51-2.4) per 100 admissions (P = .04) following the intervention. There were fewer omissions of key handoff elements on printed handoff documents, especially on the unit that received the computerized handoff tool (significant reductions of omissions in 11 of 14 categories with computerized tool; significant reductions in 2 of 14 categories without computerized tool). Physicians spent a greater percentage of time in a 24-hour period at the patient bedside after the intervention(8.3%; 95% CI 7.1%-9.8%) vs 10.6% (95% CI, 9.2%-12.2%; P = .03). The average duration of verbal handoffs per patient did not change. Verbal handoffs were more likely to occur in a quiet location (33.3%; 95% CI, 14.5%-52.2% vs 67.9%; 95% CI, 50.6%-85.2%; P = .03) and private location (50.0%; 95% CI, 30%-70% vs 85.7%; 95% CI, 72.8%-98.7%; P = .007) after the intervention.

CONCLUSIONS AND RELEVANCE:

Implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children. Improvements in verbal and written handoff processes occurred, and resident workflow did not change adversely.