Surgeons have a better perception of teamwork in the OR than nurses do, according to a study conducted by the U.S. Department of Veterans Affairs' National Center for Patient Safety.

Brian Carney, MD, and his team of researchers used questionnaires to gauge communication and collaboration levels among 378 surgical nurses and 312 surgeons at 34 hospitals. The questionnaires revealed that nurses believed they worked best with other nurses, while surgeons rated teamwork high among themselves and with nurses, the researchers report.

To improve teamwork in the OR and institute successful patient safety programs, they recommend that surgical administrators acknowledge as fact the idea that surgeons and nurses may view teamwork differently while working to bridge that perception gap.

Mary Wilson, BSN, RN, CNOR, clinical preceptor for the Ruby Day Surgery Center at West Virginia University Hospitals in Morgantown, W.Va., says she's not surprised at this apparent divide. The issue is ingrained in surgical culture, she says.

"To be fair, surgeons aren't trained to be part of a team, while the importance of teamwork is a critical aspect of a nurse's training," says Ms. Wilson. "To fix the problem, we may have to start there."

In the short term, she suggests administrators develop consistent surgical teams and pair them with the same surgeons as often as possible. Ideally, any misperceptions between the 2 groups about communication and teamwork will dissipate as they work together more regularly.

"It works both ways," she explains. "Nurses will know how particular surgeons work and how to best communicate with them, and surgeons will develop a rapport with the familiar faces and start to see how the team process works."

Daniel Cook

Patients who undergo surgery to repair torn anterior cruciate ligaments or injured meniscal cartilages are no less likely to suffer knee osteoarthritis later in life than those who don't have surgery, according to a Dutch study.

For a study published online and in the August issue of the journal Radiology, researchers from Leiden University Medical Center in the Netherlands examined the cases of 326 patients who'd been treated for knee injuries at 3 Dutch hospitals in 1996 and 1997 and revisited an average of 10 years later.

While the patients benefited from the surgery in the short term, researchers say, the follow-up didn't distinguish much difference in the incidence of arthritis between patients who had and hadn't sought surgical treatment, and even suggested that surgical patients may have been at greater risk of its symptoms.

Given the relatively small patient population examined, the study's authors recommend further research into the immediate and long-range outcomes of arthroscopic knee surgeries.

David Bernard

An investigation into a California hospital's third wrong-site surgery in 4 years cited a surgeon and staff for failing to follow proper verification protocols, leading them to operate on the wrong part of a child's mouth, according to the state Department of Public Health.

The patient had been scheduled for surgery at the Children's Hospital of Orange County in January to loosen a fold of skin between the upper lip and the gum. As a result of a discrepancy in the patient's medical records, however, the surgeon cut the fold of skin beneath the tongue. The patient later had the correct surgery and recovered without complications, says a published report.

The health department also cited the hospital for mistakenly faxing patient records to an auto repair business rather than a physician's office on 6 occasions.

In response to the wrong-site surgery, the hospital required its staff to undergo additional training and revised its policy on and process for verifying patient information. Since 2006, a hospital surgeon has operated on the wrong side of a child's head and another inserted a tube into the wrong ear.

The hospital issued a statement that said in part: "We take patient care and privacy very seriously and have implemented a number of process and policy improvements. CHOC deeply regrets these incidents, and remains committed to the highest standards of care and safety for all patients we are privileged to serve."

Kent Steinriede

In light of the propofol shortage, which alternative agents are you using at your facility for conscious sedation? Etomidate (Amidate), methohexital (Brevital), fospropofol disodium (Lusedra), propofol 1% (Propoven) or thiopental sodium (Pentothal)? Tell us in this week's online poll, and check back next week for the results.

Last week's InstaPoll asked for your take on 3-D imaging technology in the OR. The results, based on 24 responses: