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Quantitative analysis of intraoperative communication in open and laparoscopic surgery

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Abstract

Background

Communication is important for patient safety in the operating room (OR). Several studies have assessed OR communications qualitatively or have focused on communication in crisis situations. This study used prospective, quantitative observation based on well-established communication theory to assess similarities and differences in communication patterns between open and laparoscopic surgery.

Methods

Based on communication theory, a standardized proforma was developed for assessment in the OR via real-time observation of communication types, their purpose, their content, and their initiators/recipients. Data were collected prospectively in real time in the OR for 20 open and 20 laparoscopic inguinal hernia repairs. Assessors were trained and calibrated, and their reliability was established statistically.

Results

During 1,884 min of operative time, 4,227 communications were observed and analyzed (2,043 laparoscopic vs 2,184 open communications). The mean operative duration (laparoscopic, 48 min vs open, 47 min), mean communication frequency (laparoscopic, 102 communications/procedure vs open, 109 communications/procedure), and mean communication rate (laparoscopic, 2.13 communications/min vs open, 2.23 communications/min) did not differ significantly across laparoscopic and open procedures. Communications were most likely to be initiated by surgeons (80–81 %), to be received by either other surgeons (46–50 %) or OR nurses (38–40 %), to be associated with equipment/procedural issues (39–47 %), and to provide direction for the OR team (38–46 %) in open and laparoscopic cases. Moreover, communications in laparoscopic cases were significantly more equipment related (laparoscopic, 47 % vs open, 39 %) and aimed significantly more at providing direction (laparoscopic, 46 % vs open, 38 %) and at consulting (laparoscopic, 17 % vs open, 12 %) than at sharing information (laparoscopic, 17 % vs open, 31 %) (P < 0.001 for all).

Conclusions

Numerous intraoperative communications were found in both laparoscopic and open cases during a relatively low-risk procedure (average, 2 communications/min). In the observed cases, surgeons actively directed and led OR teams in the intraoperative phase. The lack of communication between surgeons and anesthesiologists ought to be evaluated further. Simple, inexpensive interventions shown to streamline intraoperative communication and teamworking (preoperative briefing, surgeons’ mental practice) should be considered further.

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References

  1. Vincent C, Moorthy K, Sarker SK, Chang A, Darzi A (2004) Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 239:475–482

    Article  PubMed  Google Scholar 

  2. Yule S, Flin R, Paterson-Brown S, Maran N (2006) Nontechnical skills for surgeons: a review of the literature. Surgery 139:140–149

    Article  PubMed  CAS  Google Scholar 

  3. Mills P, Neily J, Dunn E (2008) Teamwork and communication in surgical teams: implications for patient safety. J Am Coll Surg 206:107–112

    Article  PubMed  Google Scholar 

  4. Reader TW, Flin R, Mearns K, Cuthbertson BH (2009) Developing a team performance framework for the intensive care unit. Crit Care Med 37:1787–1793

    Article  PubMed  Google Scholar 

  5. Manser T (2009) Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 53:143–151

    Article  PubMed  CAS  Google Scholar 

  6. Nagpal K, Vats A, Ahmed K, Smith AB, Sevdalis N, Johansson H, Vincent C, Moorthy K (2010) A systematic quantitative assessment of risks associated with poor communication in surgical care. Arch Surg 145:582–588

    Article  PubMed  Google Scholar 

  7. Sevdalis N, Healey AN, Vincent CA (2007) Distracting communications in the operating theatre. J Eval Clin Pract 13:390–394

    Article  PubMed  Google Scholar 

  8. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohneen J, Orser B, Doran D, Grober E (2004) Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Safety Health Care 13:330–334

    Article  CAS  Google Scholar 

  9. Lingard L, Reznick R, Espin S, Regehr G, DeVito I (2002) Team communications in the operating room: talk patterns, sites of tension, and implications for novices. Acad Med 77:232–237

    Article  PubMed  Google Scholar 

  10. Greenberg CC, Regenbogen SE, Studdert DM, Lipsitz SR, Rogers SO, Zinner MJ, Gawande AA (2007) Patterns of communication breakdowns resulting to injury to surgical patients. J Am Coll Surg 204:533–540

    Article  PubMed  Google Scholar 

  11. Wong HWL, Forrest D, Healey A, Shirafkan H, Hanna GB, Vincent CA, Sevdalis N (2011) Information needs in operating room teams: what is right, what is wrong, and what is needed? Surg Endosc 25:1913–1920

    Article  PubMed  Google Scholar 

  12. Nagpal K, Vats A, Lamb B, Ashrafian H, Sevdalis N, Vincent C, Moorthy K (2010) Information transfer and communication in surgery: a systematic review. Ann Surg 252:225–239

    Article  PubMed  Google Scholar 

  13. Sevdalis N, Lyons M, Healey AN, Undre S, Darzi A, Vincent CA (2009) Observational Teamwork Assessment for Surgery: construct validation with expert vs novice raters. Ann Surg 249:1047–1051

    Article  PubMed  Google Scholar 

  14. Hull L, Arora S, Kassab E, Kneebone RL, Sevdalis N (2011) Observational teamwork assessment for surgery (OTAS): content validation and tool refinement. J Am Coll Surg 212:234–243

    Article  PubMed  Google Scholar 

  15. Hanna GB, Cresswell AB, Cuschieri A (2002) Shadow depth cues and endoscopic task performance. Arch Surg 137:1166–1169

    Article  PubMed  Google Scholar 

  16. Soot SJ, Eshraghi N, Farahmand M, Sheppard BC, Deveney CW (1999) Transition from open to laparoscopic fundoplication: the learning curve. Arch Surg 134:278–281

    Article  PubMed  CAS  Google Scholar 

  17. Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R (2010) Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc 24:2588–2593

    Article  PubMed  Google Scholar 

  18. Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone RL (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318–330

    Article  PubMed  Google Scholar 

  19. Healey AN, Sevdalis N, Vincent CA (2006) Measuring intraoperative interference from distraction and interruption observed in the operating theatre. Ergonomics 49:589–604

    Article  PubMed  CAS  Google Scholar 

  20. Mishra A, Catchpole K, Dale T, McCulloch P (2008) The influence of nontechnical performance on technical outcome in laparoscopic cholecystectomy. Surg Endosc 22:68–73

    Article  PubMed  CAS  Google Scholar 

  21. Shannon CE (1948) A mathematical theory of communication. Bell System Tech J 27(379–423):623–656

    Google Scholar 

  22. Abell N, Springer DW, Kamata A (2009) Developing and validating rapid assessment instruments. Oxford University Press, New York

    Book  Google Scholar 

  23. Yakoub D, Athanasiou T, Tekkis P, Hanna GB (2008) Laparoscopic-assisted distal gastrectomy for early gastric cancer: is it an alternative to the open approach. Arch Surg 18:322–333

    Google Scholar 

  24. Murray A, Lourenco T, de Verteuil R, Hernandez R, Fraser C, McKinley A, Krukowski Z, Vale L, Grant A (2006) Clinical effectiveness and cost effectiveness of laparoscopic surgery for colorectal cancer: systematic review and economic evaluation. Health Tech Assess 10:1–141

    CAS  Google Scholar 

  25. McCormak K, Wake B, Perez C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Tech Assess 9:1–203

    Google Scholar 

  26. Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA (2006) Teamwork in the operating theatre: cohesion or confusion? J Eval Clin Pract 12:182–189

    Article  PubMed  Google Scholar 

  27. Scott T, Mannion R, Marshall M, Davies H (2003) Does organisational culture influence health care performance? A review of the evidence. J Health Serv Res Policy 8:105–117

    Article  PubMed  Google Scholar 

  28. Westli HK, Johnesen BH, Eid J, Rasted I, Brattebø G (2010) Teamwork skills, shared mental models, and performance in simulated trauma teams: an independent group design. Scand J Trauma Resusc Emerg Med 18:47

    Article  PubMed  Google Scholar 

  29. Blom EM, Verdaasdonk EGG, Stassen LPS, Stassen HG, Wieringa PA, Dankelman J (2007) Analysis of verbal communication during teaching in the operating room and potentials for surgical training. Surg Endosc 21:1560–1566

    Article  PubMed  CAS  Google Scholar 

  30. Arora S, Hull L, Sevdalis N, Tierney T, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) Factors compromising safety in surgery: stressful events in the operating room. Am J Surg 199:60–65

    Article  PubMed  Google Scholar 

  31. Prabhu A, Smith W, Yurko Y, Acker C, Stefanidis D (2010) Increased stress levels may explain the incomplete transfer of simulator-acquired skill to the operating room. Surgery 147:640–645

    Article  PubMed  Google Scholar 

  32. Lingard LL, Regehr G, Cartmill C, Orser B, Espin S, Bohnen J, Reznick R, Baker R, Rotstein L, Doran D (2011) Evaluation of preoperative team briefing: a new communication routine results in improved clinical practice. BMJ Qual Saf 20:475–482

    Article  PubMed  Google Scholar 

  33. Arora S, Aggarwal R, Moran A, Sirimanna P, Crochet P, Darzi A, Kneebone R, Sevdalis N (2011) Mental practice: effective stress management training for novice surgeons. J Am Coll Surg 212:225–233

    Article  PubMed  Google Scholar 

  34. Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A (2011) Mental practice enhances surgical technical skills: a randomised controlled study. Ann Surg 253:265–270

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Engineering and Physical Sciences Research Council, UK. The Imperial Centre for Patient Safety and Service Quality is funded by the National Institute of Health Research.

Disclosures

Nick Sevdalis, Helen W. L. Wong, Sonal Arora, Kamal Nagpal, Andrew Healey, George B. Hanna, and Charles A. Vincent have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery and Cancer, Imperial College London and Imperial Centre for Patient Safety and Service Quality, Wright Fleming Building (507), Norfolk Place, London, W2 1PG, UK

    Nick Sevdalis, Helen W. L. Wong, Sonal Arora, Kamal Nagpal, Andrew Healey & Charles A. Vincent

  2. Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK

    George B. Hanna

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  1. Nick Sevdalis
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  2. Helen W. L. Wong
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  3. Sonal Arora
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  4. Kamal Nagpal
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Correspondence to Nick Sevdalis.

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Sevdalis, N., Wong, H.W.L., Arora, S. et al. Quantitative analysis of intraoperative communication in open and laparoscopic surgery. Surg Endosc 26, 2931–2938 (2012). https://doi.org/10.1007/s00464-012-2287-3

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  • DOI: https://doi.org/10.1007/s00464-012-2287-3

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