The value of teamwork before, during and after CABG procedures

Patients undergoing CABG visit with multiple physicians before, during and after their surgery. The doctors must collaborate and communicate to ensure everything goes as planned. Teamwork, in this environment, is necessary and important.

A recent study shows that these interactions among healthcare professionals may even help determine patients’ short-term outcomes.

After controlling for several variables, the researchers found that health systems with high levels of teamwork had significantly lower 60-day rates of emergency department visits, readmissions and mortality among Medicare beneficiaries following the index hospitalization. The results were published in Circulation: Cardiovascular Quality and Outcomes on Nov. 8.

“The benefits of planned delivery system reforms focused on team building are likely to extend to surgical care,” the researchers wrote.

The researchers evaluated 251,630 Medicare beneficiaries who were at least 66 years old and underwent CABG between 2008 and 2011. They measured teamwork using the bipartite clustering coefficient.

They mentioned that teamwork for CABG varied significantly among the 1,186 health systems. In fact, the bipartite clustering coefficient ranged from a score of 0 (no physicians sharing multiple patients) to 0.71 (many physicians share multiple patients).

The level of teamwork varies even in the same geographic region. For instance, the researchers cited Fort Worth and Waco, Texas, which are 90 miles apart. They found that the Fort Worth health system had a relatively low level of teamwork and a decentralized structure, while the Waco health system had a high level of teamwork and an effective referral system.

They also discovered a few trends, including that health systems with low levels of teamwork often served a higher proportion of black and Hispanic residents and typically had more primary care physicians and medical specialists but fewer acute care beds and surgeons per capita.

The benefits to teamwork during CABG episodes were striking. Health systems with physicians that worked together frequently had 24.6 percent fewer emergency department visits, 24.4 percent lower readmission rates and 28.4 percent lower mortality rates compared with health systems with low teamwork levels.

“Put differently, initiatives seeking to foster physician teamwork in health systems with low to moderate levels at baseline have the potential to reduce the number of [emergency department] visits, readmissions and deaths after CABG by 71.4, 53.7 and 16.8 per 1000 discharges each year, respectively,” the researchers wrote. “These findings were robust across sensitivity analyses.”

The study had a few potential flaws, according to the researchers. For instance, they used medical claims to infer how well physicians worked together and did not observe them. They also mentioned residual confounders could have effected the results.

Still, they noted that this trial could be helpful in understanding the importance of teamwork and adding to the existing research on care coordination. The government has already launched initiatives such as patient-centered medicals homes, bundled payments and accountable care organizations that encourage physicians to work together.

“Further research is needed synthesizing both quantitative analyses (such as our own) of referral patterns and qualitative analyses of physician information sharing to better understand the contexts that shape physician teams,” they wrote.