Association between implementation of a medical team training program and surgical morbidity

Arch Surg. 2011 Dec;146(12):1368-73. doi: 10.1001/archsurg.2011.762.


Objective: To determine whether there is an association between the Veterans Health Administration Medical Team Training (MTT) program and surgical morbidity.

Design, setting, and participants: A retrospective health services study was conducted with a contemporaneous control group. Outcome data were obtained from the Veterans Health Administration Surgical Quality Improvement Program. The analysis included aggregated measures representing 119,383 sampled procedures from 74 Veterans Health Administration facilities that provide care to veterans.

Main outcome measures: The primary outcome measure was the rate of change in annual surgical morbidity rate 1 year after facilities enrolled in the MTT program as compared with 1 year before and compared with the non-MTT program sites.

Results: Facilities in the MTT program (n = 42) had a significant decrease of 17% in observed annual surgical morbidity rate (rate ratio, 0.83; 95% CI, 0.79-0.88; P = .01). Facilities not trained (n = 32) had an insignificant decrease of 6% in observed morbidity (rate ratio, 0.94; 95% CI, 0.86-1.05; P = .11). After adjusting for surgical risk, we found a decrease of 15% in morbidity rate for facilities in the MTT program and a decrease of 10% for those not yet in the program. The risk-adjusted annual surgical morbidity rate declined in both groups, and the decline was 20% steeper in the MTT program group (P = .001) after propensity-score matching. The steeper decline in annual surgical morbidity rates was also observed in specific morbidity outcomes, such as surgical infection.

Conclusion: The Veterans Health Administration MTT program is associated with decreased surgical morbidity.

MeSH terms

  • Cause of Death
  • Checklist*
  • Cohort Studies
  • Cooperative Behavior*
  • Cross-Sectional Studies
  • Health Plan Implementation / organization & administration*
  • Hospital Mortality
  • Hospitals, Veterans*
  • Humans
  • Inservice Training / organization & administration*
  • Interdisciplinary Communication*
  • Models, Statistical
  • Patient Safety
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control*
  • Propensity Score
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / mortality
  • Pulmonary Embolism / prevention & control
  • Quality Improvement / organization & administration*
  • Retrospective Studies
  • Surgical Procedures, Operative / standards*
  • United States
  • Venous Thrombosis / epidemiology
  • Venous Thrombosis / mortality
  • Venous Thrombosis / prevention & control