Abstract
Objective: To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination.
Background: Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals
Methods: Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode.
Results: Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%).
Conclusion: The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.
The Institute of Medicine (IOM) estimates that between 44,000 and 98,000 Americans die each year as the result of medical error. 1 Communication or the lack of it has been shown to be a major contributor to these errors in healthcare. 2-4 Donchin et al 3 found that 37% of errors in a critical care unit were associated with verbal exchanges between nurses and physicians. In a retrospective review of adverse events in 28 hospitals in Australia, Wilson et al 2 discovered that communication errors were the leading cause and were associated with twice as many deaths as clinical inadequacy. An examination of 419 adverse incidents in New Zealand recovery rooms revealed that communication deficits were the second most common reason for error. 5
Part of the reason for communication-related errors may be how communication is accomplished. While communicating information concerning patient care, health care providers are frequently interrupted and forced to carry out multiple communication tasks simultaneously. 6 Such disruptions can cause an individual to forget to carry out an intended act, even when only 10 seconds separates the intention from the interruption. 7 In a study of communication loads in emergency departments, Coiera et al 8 found that nearly a third of the communications were interrupted, with an interruption rate of 11 per hour.
Technological applications have the capability to change system processes to improve communication, thus enhancing patient safety. However, technology introduced to enhance communication may have a negative impact on care processes. Messaging devices such as paging systems, 9 telephones, 10 and instant messaging 11 can disrupt current activities. The successful design and use of technological applications relies on an understanding of information types and communication patterns among healthcare professionals. 12