Department of Neurosurgery NYU Langone Health New York City, New York, United States
Disclosure(s):
David B. Kurland, MD, PhD: No financial relationships to disclose
Introduction: Numerous studies have shown that improved team communication practices can increase efficiency and reduce complications. We evaluated the effect of an app-based digital preoperative huddle on numerous measures of quality, efficiency and team collaboration.
Methods: We implemented a workflow which included an app-based digital huddle among the surgeons, anesthesiologists, nurses and operating room staff, visible ~18hrs prior to case start time. We used surgical cases from non-participating surgeons as controls and compared outcomes to a pre-intervention period for each group. Quality outcomes included morbidity and mortality, length of stay (LOS) and readmissions rate. Efficiency outcomes included the time to incision and rate of accurate case time prediction within 15% and 30 minutes. Surveys were also collected from participating staff.
Results: Participating surgeons performed 1554 and 689 cases in the pre- and post-intervention periods, respectively, versus 985 and 409 cases among non-participating surgeons. For participating surgeons, there was a decrease in readmissions rate (8.16% to 5.48%, p=0.028) and LOS (4.4 to 3.8 days, p=0.019) following implementation of the digital huddle. Aggregate incidence of morbidity and mortality trended lower for participating surgeons. There was a small, but statistically significant decrease in time to incision (66 mins to 63 mins, p=0.02) in cases performed by participating surgeons. We also observed a significant increase in accurate case time predictions (34.6% to 43.1%, p=0.0005) for participating surgeons. None of these outcomes changed among cases performed by non-participating surgeons. Nursing and anesthesia staff subjectively reported improvement across numerous domains of quality and efficiency, and rated their experience favorably. The average rating for ease of use of the app-based digital huddle was 4.3/5.
Conclusion : Implementation of an app-based digital huddle resulted in decrease in readmission rates, LOS and improved efficiency outcomes. Technology is key for a scalable and sustainable adoption of these practices.
