Several years ago, our data revealed that surgery-related claims were the second most common category of cases asserted against CRICO-insured institutions. Further analysis showed that the two main problem areas were intra-operative technical errors, and communication breakdowns.
To address these risks, CRICO convened the CRICO/Harvard Surgical Chiefs’ Safety Collaborative. Comprising Surgical Chiefs from CRICO-insured institutions and guided by facilitator, Atul Gawande, MD, Brigham and Women's Hospital, the Chiefs set out to examine the data and determine the underlying issues. Upon investigation, they discovered that primarily, attendings were not always aware of changes in the status of their patients. Residents delayed or decided not to call the attending.
The convening Chiefs developed guidelines that would “trigger” residents to call the attending. These guidelines should not be construed as a standard of care, but were developed into a “trigger card” that serves as a tool for communication between residents and attendings. Michael Zinner, MD, Chairman, Surgery, Brigham and Women's Hospital, an original member of collaborative said,
“ The trigger card codifies to both attendings and residents that one, communication is welcome; and two, communication is expected. ”
We salute the Chiefs of Surgery who convened and developed the guidelines that are still used today to inform resident-attending communication.