Medical errors in the perioperative setting more often result from miscommunication among providers than from lack of medical knowledge or technology failures. Four studies serve to highlight the importance of implementing measures to improve team communication in the OR.
National sample of nurse anesthetists:
(Published in the AANA Journal, Feb. 2018, Vol 86, No 1)
Surveys administered to 3,000 nurse anesthetists to measure variables associated with communication attitudes and behaviors yielded the following findings:
- Nurse anesthetists prefer autonomy and are more comfortable with self-determined decision making as opposed to small group conferral.
- Hierarchy is an ingrained component of medical culture. Hence, once it becomes evident that negotiations have not resulted in resolution, often nurses choose to avoid the conflict and minimize further escalation.
- Individuals who use assertive conflict management enhanced role clarity in the workplace and tended to enjoy greater job satisfaction.
Systematic review of studies of interventions to improve teamwork:
1,242 articles were identified, with all but 287 excluded. Studies of interventions to improve teamwork included briefing protocols, checklists, inter-professional team training, and organizational change. Findings were that simulation-based studies are especially effective, adding observational evidence on communication failures and can provide a powerful trigger to challenge assumptions and change attitudes.
Observations of 128 hours of OR interactions during 35 procedures:
Paired researchers observed interactions at a teaching hospital, with brief interviews conducted following each observation. Findings:
- Patterns of communication were complex, with dominant themes time, safety, sterility, resources, and roles.
- Higher-tension events had a ripple effect.
- Novices responded with behaviors that intensified, rather than resolving, inter-professional conflict.
- Numerous errors related, not to technical competences, but to the interpersonal aspects of the ORs’ functioning.
Qualitative study done at the University of Wisconsin-Madison:
Focus group sessions were held with OR clinicians from three disciplines: anesthesiology, nursing, and surgery, with a total of 23 participants, to explore topics of team identity. Sessions were audio-recorded and transcribed. Insights gained include:
- Intra-operative hand-offs represented a potential source of tension, information loss, and impaired safety.
- Events in the preoperative phase of the case set the tone of the room for the rest of the case.
- Differences in verbal communications between familiar and unfamiliar team members need further exploration.
A peer-reviewed study by the British Medical Journal found that lack of communication was the primary factor contributing to complications from surgery. Good communications in the operating room can be achieved with both improved technology and the implementation of best practices, ADORA author Kristjan Kosic concludes.
