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

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.

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.

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.

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.