351 June 2006 Volume 32 Number 6 C ommunication among team members is critical in medicine, particularly in the operating room (OR). Surgical teams are composed of care- givers who, in some cases, may know little about one another or lack a common understanding of a particular patient’s or procedure’s unique needs. Because of such issues and the importance of teamwork during an opera- tion, it is important for OR teams to take the time before a procedure to discuss the operative plan, patient risks, potential hazards, safety concerns, and operating knowl- edge of required equipment. 1,2 OR teams deal with the potential uncertainty inherent with surgery, sophisticated instruments, rapid transfer of critical information to team members, team coordina- tion, and the patient’s condition. 3 Thus, effective team- work is important in the OR, and its absence can lead to poor transfer of critical information, impaired decision making, and, ultimately, increased risk of patient harm. 4,5 Several studies have found communication failures as the root cause in 80% of OR sentinel events, 77% of wrong-site surgery, and other medical errors in the OR. 6–8 To reverse this trend, the Joint Commission on Accreditation of Healthcare Organizations has called for “effective communication” among surgical team members and it mandated the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery™ (Universal Protocol) for surgical procedures in July 2004. 9,10 A team of quality and safety researchers at The Johns Hopkins Medical Institutions responded to this call by creating the OR Briefing tool. This tool provides a struc- tured approach to promote effective interdisciplinary communication and teamwork in the OR. Tool Description The OR Briefing is a preoperative team discussion that takes one to two minutes and is done in the same man- ner as a time-out (often called an “expanded time-out”). Its purpose is to check critical information and promote and support open communication during the operation. The OR Briefing tool includes instructions (Table 1, page 352) and a checklist divided into three sections (Table 2, page 353). The surgeon leads the introduction (Section I), during which names and roles of team mem- bers are written on a whiteboard, and Section II reviews critical information (that is, confirming the correct operation, patient, surgical site, and administration of antibiotics). 9 Section III prompts each caregiver type (surgeon, anesthesiologist, and nurse) for pertinent information related to his or her responsibilities for the Operating Room Briefings: Working on the Same Page Tool Tutorial Martin A. Makary, M.D., M.P.H. Christine G. Holzmueller David Thompson, D.N.Sc., M.S. Lisa Rowen, D.N.Sc., R.N. Eugenie S. Heitmiller, M.D. Warren R. Maley, M.D. James H. Black, M.D. Katherine Stegner, R.N. Julie A. Freischlag, M.D. John A. Ulatowski, M.D., Ph.D. Peter J. Pronovost, M.D., Ph.D. Readers may submit Tool Tutorial inquiries and submissions to Steven Berman at sberman@jcaho.org. Tina Maund, R.N., M.S., serves as Tool Tutorial editor. Copyright 2006 Joint Commission on Accreditation of Healthcare Organizations