TECHNOLOGY
The case for better OR communication
Technology-led procedures have an important role to play in improving patient outcomes. However, they also present challenges in terms of the quality and timing of essential team communication. Tom Downes reports.
The rapid evolution of technology, not least robotics, is inspiring the next generation of ergonomic design to better understand the human / technology interaction. Within the OR, the development of 3D imagery, precise robotics, even protective garments with in-built air supply, are changing not only the type of procedures that can be considered but also the processes and the need for effective interaction between multi- skilled teams. From situational awareness to decision making, teamwork and coping with stress, in an increasingly technology dominated OR, team members’ cognitive and social skills are recognised to contribute to safe and efficient task performance. However, as surgical teams are increasingly reporting, while the innovation is compelling, technology led procedures are raising challenges – not least with the quality and timing of essential team communication.1 With a growing reliance on data, imagery, graphics and cameras, individuals are rarely looking at each other or even directly at the patient. Indeed, many individuals are moving around within, but also in and out of, the OR. Not only are they blind to the progress of the procedure, but they can also struggle to share essential information with the rest of the team. Furthermore, as technology takes an increasingly dominant role, there is a risk that clinical teams feel they have only a supportive role and potentially lose engagement. In his study Improving communication in robotic-assisted laparoscopic surgery, Ziv Tsafrir makes it clear: “Unlike the conventional OR setting, robotic surgeons must rely primarily on auditory means of communication, unaided by visual cues. In addition, studies have shown that increased noise during surgery was associated with a greater risk for postoperative complications.” This latter point is due to the increase in ambient noise within the OR; clearly, the potential implications for errors, impaired safety and efficiency are very concerning. David Sweetnam, senior orthopaedic surgeon
SEPTEMBER 2020
Effective communication in theatres can be aided by the use of headsets.
at the Schoen Clinic Orthopaedic and Spinal Hospital, London, who now uses wireless headsets during procedures when the clinical team wear personal isolation suits, agrees: “Safety is about good communication. The six to eight people involved in every procedure are working at a distance: three around the table, the anaesthetist at their own workstation, runners and other prep staff often in other rooms. Keeping everyone fully informed is not easy.”
Never Events
Indeed, there is strong evidence pointing to the importance of effective communication and teamwork in patient safety in the OR more generally.2
Deficiencies in teamwork
and communication contribute to adverse events, thus demonstrating that non- technical skills are as important as technical surgical skills in preventing adverse patient outcomes.3
A further study discovered that
surgical errors increased significantly with increased disruptions and that teamwork and communication problems were the strongest predictors of surgical errors.4
Since 2012, the NHS has evaluated a number of Never Events (patient safety incidents that are considered preventable) to understand both the contributory factors and changes required to prevent such events from occurring again.
While, of course, there are multiple issues that can lead to these events, again and again communication – from quality and clarity, to the culture of speaking up – has been highlighted.
Bad communication is often the backdrop to a serious problem. Yet with multi- disciplinary teams needing to work together over extended periods and often across a wide area, including radiology, control and equipment rooms, there are far too
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