Communication failures in the operating room: an observational classification of recurrent types and effects

Abstract

Background: Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in the operating room (OR) and to classify their effects. This study was part of a larger project to develop a team checklist to improve communication in the OR. Methods: Trained observers recorded 90 hours of observation during 48 surgical procedures. Ninety four team members participated from anesthesia (16 staff, 6 fellows, 3 residents), surgery (14 staff, 8 fellows, 13 residents, 3 clerks), and nursing (31 staff). Field notes recording procedurally relevant communication events were analysed using a framework which considered the content, audience, purpose, and occasion of a communication exchange. A communication failure was defined as an event that was flawed in one or more of these dimensions. Results: 421 communication events were noted, of which 129 were categorized as communication failures. Failure types included ''occasion'' (45.7% of instances) where timing was poor; ''content'' (35.7%) where information was missing or inaccurate, ''purpose'' (24.0%) where issues were not resolved, and ''audience'' (20.9%) where key individuals were excluded. 36.4% of failures resulted in visible effects on system processes including inefficiency, team tension, resource waste, workaround, delay, patient inconvenience and procedural error. Conclusion: Communication failures in the OR exhibited a common set of problems. They occurred in approximately 30% of team exchanges and a third of these resulted in effects which jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR.R ecent evidence suggests that adverse events resulting from error happen at unacceptably high rates in the inpatient setting 1 and that ineffective or insufficient communication among team members is often a contributing factor. 2 3 In fact, communication failures have been uncovered at the root of over 60% of sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations. 4 Coroner reports also expose the role of communication in error: a recent inquest report cited ''communications difficulties at all levels of the hospital, including doctors to doctors, doctors to nurses, nurses to nurses and nurses to doctors'' as the primary cause of errors leading to the death of a paediatric patient. 5 There is a growing literature on the critical relationship between teamwork and safety in health care. 6 7 The trend in this literature is towards studying teamwork as a cluster of behaviours-for example, leadership, technical skills, coordination, situational awareness, communication-and producing multidimensional schemes to capture the quality of teamwork. [8][9][10] While these models have reinforced the importance of communication in effective team function, their multidimensionality precludes in depth attention to the individual variable of communication. Theory based attention to communication i...

Using a Boundary Object Framework to Analyze Interorganizational Collaboration

“…Similarly, a communication event has been defined as a verbal or non-verbal exchange between two or more people (Lingard et al 2004). In the context of SoS, an organization communication interface exists when two or more communities of practices transmit and receive information correctly.…”

“…The location and timing factors of communication refer to the physical and temporal situation of the interface (Lingard et al 2004). Lastly, content refers to the representation of information in the object used during the exchange and is divided technical and understanding concerns.…”

The lost sponge: patient safety in the operating room

“…6 Lingard and colleagues found that communication failures were associated with factors such as delayed communication, incomplete and inaccurate content, exclusion of key individuals and issues left unresolved until the point of urgency. 6 One-third of the communication failures resulted in immediate effects, including inefficiency, team tension and procedural error.…”

Camera based face tracking for enhancing surgical teamwork training with non-verbal communication

“…They do not take into account the fact that surgery and other 978-1-4244-2582-2/08/$25.00 c 2008 IEEE medical procedures are always performed as a team and thus, among the technical skills, require non-technical skills like communication, teamwork, leadership, and decision making [4]. Research indicates that failure in communication occurs in 30% of team exchanges and that one third of these failures results in situations putting the patient's life at risk [5]. To increase patient safety, training and improvement of communication among team members has to be an important aspect of clinical simulation.…”