MedicalResearch.com Interview with:
William Cooper, M.D., M.P.H.
Cornelius Vanderbilt Professor
Pediatrics and Health Policy
Associate Dean for Faculty Affairs
Director, Center for Patient and Professional Advocacy
Vanderbilt University Medical Center
MedicalResearch.com: What is the background for this study?
Response: For surgical teams, high reliability and optimal performance are dependent on effective communication, mutual respect, and continuous situational awareness. Surgeons who model unprofessional behaviors may contribute to undermining a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications.
MedicalResearch.com: What are the main findings?
Response: Among 13,563 patients in a retrospective cohort drawn from two academic medical centers’ National Surgical Quality Improvement Program database, patients whose surgeons had a higher number of coworker reports about unprofessional behavior had a significantly increased risk of surgical and medical complications.
Compared with patients whose surgeons had no reports, those whose surgeons were reported for unprofessional behavior in the 36 months before their operations were more likely to have wound infections and other complications including pneumonia, blood clots, renal failure, stroke and heart attack. Patients whose surgeons had one to three reports of unprofessional behavior were at 18% higher estimated risk of experiencing complications, and those whose surgeons had four or more reports were at nearly 32% higher estimated risk compared to patients whose surgeons had no reports.
There was no difference, however, between study groups in the percentage of patients who died, required a second operation or who were readmitted to the hospital within 30 days of their first operation.
MedicalResearch.com: What should readers take away from your report?
Response: Surgeons who model unprofessional behaviors may contribute to undermining a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We know that ~80% of physicians who receive feedback about their unprofessional behave will improve. Follow-up studies should assess whether reductions in unprofessional behaviors are associated with reduced risk of adverse outcomes of care.
Any disclosures? The authors reported no disclosures. The study was funded by the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center.
Cooper WO, Spain DA, Guillamondegui O, et al. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg. Published online June 19, 2019. doi:10.1001/jamasurg.2019.1738
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