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Clear communication in operating rooms leads to increased patient safety

Clear communication is crucial for coordination in an operating room and for preventing errors during an ongoing operation. Research from the University of Gothenburg that has examined the teamwork in Swedish operating rooms shows that more social aspects in communication can promote patient safety.

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jonas ivarsson
Professor Jonas Ivarsson

In a study of communication within an operation team during work, social mechanisms have been investigated and especially how they are used to manage ambiguities.

Uncertainty and ambiguity can cause problems in all organizations' communication if no correction is possible, but it is especially important in high-risk environments such as operating rooms where communicative errors must quickly be adjusted so that patient safety is not jeopardized.

 

Staff compensating for communication errors

In the study, the researchers analyzed 58 hours of video material during EVAR, so called endovascular aortic repair. They looked at how communicative misunderstandings arose and were handled during an ongoing dialogue between anesthesia nurses and surgeons.

– Since there are several people involved in an operation with different tasks and foci, communication problems sometimes arise. A typical problem may be that a request to perform a particular act is perceived as ambiguous as to when it is expected to be performed – immediately or soon, says Professor Jonas Ivarsson, the study's first author.

In the video recordings, the researchers saw how the operating staff compensated for any communication errors that could arise by using different kinds of requests followed by corresponding confirmations, sometimes in conjunction with eye contact or body language as support.

– We could see that there are social mechanisms at play here which can be used to relieve problems of communication. Some of these mechanisms are not made explicit however and by making them known and used among the staff there is a potential to further strengthen teamwork communication, he says.

Increasing patient safety

In safety critical settings, like surgeries, operating staff really want to keep misunderstandings to a minimum because they prolong operation time and increase interprofessional tensions due to frustration over ineffective communication.

– Our results show that it is possible to design the communication to minimise problems which will in turn increase patient safety, says Jonas Ivarsson.

 

Document

Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating room (PDF)
This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes.Non-participant video-based observations.Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR.The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis.The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations.The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.