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

March 11, 2004 by Lingard et al. SUMMARY Communication difficulties in all levels of the hospital, including doctors to doctors, doctors to nurses, nurses to nurses and nurses to doctors is the primary cause of errors that may even lead to death in patients. Studies have been conducted and found out that in leadership, technical skills, coordination, attention to communication is necessary to sharpen current insights regarding its critical role in teamwork and safety. For instance, operating room teams have been the focus of much recent research found out that critical information was often transferred in an ad hoc reactive manner and tension eves were frequently high. Interviewed team members varied in their perceptions of team roles and motivations underlying communication events, while they agreed that communicative tension negatively affects administrative, educational, and clinical outcomes. These findings suggest that the current weakness in communication in the OR may derive from a lack of standardization and team integration. Team members do not commonly convene to discuss key issues before a case, decisions are often made without all relevant team members present, and much communication is consequently reactive and tension provoking. Research done by the Controlled Risk Insurance Company (CRICO) in 1991 to 2000, identified inadequate information sharing among team members as a primary trigger for claims and reported that 15% of caim cases included a communication breakdown. One potential solution to the described weakness in OR team communication is to adapt the checklist system. It is anticipated that a carefully adapted checklist system could promote safer, more effective communications in the OR. Effective adaptation of the checklist system for the OR environment requires in depth understanding of the critically relevant information that would optimally be communicated to the team before a surgical procedure. There are four rhetorical factors that provide an effective framework for detecting and categorizing communication failures. Occasion failures is defined as problems in the situation or context of the communication event; content failures is when there is insufficiency or inaccuracy apparent in the information being transferred; audience failures is described as the gaps in the composition of the group engaged in the communication; and lastly, purpose failure happens when the communication events in which purpose is unclear, not achieved, or inappropriate. There are also types of effects resulting from these communication failures: insufficiency; tension, an emotional response to a communication failure; delay in surgical procedure; workaround occurs when there is a violation of an institutional regulation in order to maintain efficient workflow; resource waste, this happens when the use of equipment or personnel that is not required; patient inconvenience, where communication failure creates

undue strain or imposition on patient; and procedural error, communication failure that contributes to mistakes in decision making or failures of technique. REACTION This is a good journal that has given me more knowledge on OR issues. I have observed for myself some occasions of communication failures in the theatre. In my recent duty, there was an episode of misunderstanding of words, the doctor asked for something and a different instrument was brought. Eventually the problem was rectified, no tension or any bad result occurred. But I agree that many errors not only in the OR but in other areas too are results of communication failures.

College of Nursing, Level III Adventist University of the Philippines I am sincerely sorry for being a part of dishonest action. I am ashamed of it and wont repeat the same mistake again. Please, I hope you may find it in your heart to forgive me.

Thank you for accepting my apology.

Godlives M. Umuhoza