Operating room (OR) communication ensures that patients receive high quality care in a timely manner. However, when OR communication breaks down, so does the quality of care. OR communication failure takes many forms: an issue might go unresolved, or key information might not be shared with the necessary providers [1]. Not all OR communication failures lead to direct harm, but one study found that roughly 36% of such failures caused inefficiency [1]. Another study determined that flawed systems or practices among providers, as opposed to individual errors or external factors, were responsible for 26% of communication failures [2]. By examining these systems, surgical facilities can improve OR communication to the benefit of both patients and providers.

One proposal for improving OR communication involves providers’ ability to recall the names and ranks of their colleagues. A survey of providers suggests that higher-ranking providers tend to misidentify or forget the names and ranks of lower-ranking providers [3]. Furthermore, most respondents to that survey believed that improving recall of names and ranks would facilitate communication, thereby increasing safety and efficiency. One suggestion for improving name/rank recall was to give providers sterile tags indicating name and rank. A separate study implemented a variation of the name tag system: labeled surgical caps, indicating a team member’s name and rank [4]. The use of labeled surgical caps led to correct recall in 78% of cases, as opposed to just 55% when providers used unlabeled caps. This simple practice requires no additional training for providers and minimal expense for hospitals. Nevertheless, labeling surgical caps does appear to improve name/rank recall and alleviate potentially damaging communication failures.

Other OR communication practices entail shaping a communicative workplace culture. An analysis of community emergency rooms identified two provider practices that contribute to high efficiency: using a colleague’s name and conversing with colleagues about work-related topics [5]. The latter practice is one element of an open workplace culture, requiring top-down support from management. Another long-term practice is to train attending surgeons to be especially communicative, even more so than providers in other roles. Based on a study of communication practices across provider roles, the mood and behavior of the attending surgeon greatly influences the willingness of lower-ranking providers to communicate [6]. However, the same study reveals that attending surgeons are generally unaware about this phenomenon. Although the targeted nature of this proposal should make its implementation easier, time is especially valuable for surgeons and other high-ranking providers, and support from management is necessary to ensure an effective implementation.

In summary, the core of operating room communication involves interpersonal relationships. Academic research has yielded many proposals to improve and expand those relationships, whether encouraging name recall, facilitating work-related conversations, or improving supervisor attitudes toward supervisees. These approaches vary in terms of time and engagement requirements, but none of them require significant monetary expense or the adoption of novel technologies. In fact, novel technologies have been shown to interfere with OR communication, presenting new challenges that surgical facilities should address [7]. As operating room technology evolves, interpersonal relationships between providers become increasingly important.

References 

[1] Lingard L., et al. Communication Failures in the Operating Room: An Observational Classification of Recurrent Types and Effects. Quality and Safety in Health Care 2004; 13. DOI:10.1136/qshc.2003.008425.  

[2] Hu Y.-Y., et al. Deconstructing Intraoperative Communication Failures. Journal of Surgical Research 2012; 177: 1. DOI:10.1016/j.jss.2012.04.029.  

[3] Bodor R., et al. We Are Going to Name Names and Call You Out! Improving the Team in the Academic Operating Room Environment. Annals of Plastic Surgery 2017; 78: 5. DOI:10.1097/SAP.0000000000001092.  

[4] Brodzinsky L., et al. What’s in a Name? Enhancing Communication in the Operating Room with the Use of Names and Roles on Surgical Caps. The Joint Commission Journal on Quality and Patient Safety 2021; 47: 4. DOI:10.1016/j.jcjq.2020.11.012.  

[5] Bobb M. R., et al. Key High-efficiency Practices of Emergency Department Providers: A Mixed-methods Study. Academic Emergency Medicine 2018; 25. DOI:10.1111/acem.13361.  

[6] Grade M. M., et al. Attending Surgeons Differ From Other Team Members in Their Perceptions of Operating Room Communication. Journal of Surgical Research 2019; 235: 1. DOI:10.1016/j.jss.2018.09.030.  

[7] Webster, J. L., and Cao, C. G. L. Lowering Communication Barriers in Operating Room Technology. Human Factors 2006; 48: 4. DOI:10.1518/001872006779166271.