A Simple Solution for a Complex Problem: The "Sterile Cockpit" to Improve Ward Rounds.

Abstract

Background: Ward-round quality impacts patient outcomes, and poor conduct results in increased rates of preventable adverse events. Despite being a core component of patient outcomes, there is minimal literature informing best practice. The aviation industry has mitigated human error using a "Sterile Cockpit" to reduce interruptions and non-essential activities. This study investigated the impact of a "Sterile Cockpit" intervention on surgical ward rounds.

Methods: This prospective experimental study involved audio-visually recording ward rounds. The intervention was a novel "Sterile Cockpit" zone involving the allocation of roles, no interruptions, one speaker at a time, invitation for nursing/allied health contribution, and "checkback" of the plan. The control group was a normal ward round. The primary outcomes were accuracy of documentation and patient satisfaction. Other outcomes included the number of parallel conversations, interruptions, and time at the bedside.

Results: 71 control and 70 "Sterile Cockpit" ward rounds were audio-visually recorded. The "Sterile Cockpit" group had significantly more accurate documentation of case notes (63.6%, SD = 3.45% vs. 77.9%, SD = 3.4, mean difference 14.2, 95% CI: 4.75, 23.7, p = 0.003), increased nurse presence (45% vs. 68%, mean difference 0.38, 95% CI: 0.19, 0.75, p = 0.005), higher patient satisfaction (p = 0.011), reduced interruptions (mean) (0.4, SD = 0.9, vs. 0.2, SD = 0.4, IRR = 0.39, 95% CI: 0.16, 0.96 p = 0.039), and reduced parallel conversations (1.5 vs. 0.4, p < 0.001). Patient notes were completed more contemporaneously, with no additional time taken.

Conclusions: The "Sterile Cockpit" is a no-cost intervention that demonstrates improved patient and process-based outcomes. This design is readily adaptable across specialties with the capacity to improve healthcare quality.