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TECHNOLOGY


many opportunities for miscommunication. Concentration can also lapse in a sterile OR environment, especially for those individuals taking a passive rather than active role at any time during the procedure. As analysis of reports into Never Events from across England has revealed, it can be easy for a critical question to be misunderstood – or missed entirely. Previous analysis identified a radiographer whose questioning regarding the positioning of a stent in the wrong side was heard by the nursing staff, but not the surgeon, and his concerns were not addressed, leading to the incorrect procedure.


While the lack of high-quality


communication was clearly to blame for the surgeon not hearing the valid concern, the report also highlighted poor OR culture: in this case, the nursing staff heard but felt too intimidated to interrupt.


How can a surgeon ensure everyone within a multi-disciplinary team – including a lead surgeon, registrar, anaesthetist, radiographer, surgeon’s assistant, scrub nurse, and equipment runner – is fully engaged throughout an extended period? How can all team members be confident that they have heard accurately, especially when moving between the OR, prep rooms and equipment stores?


Right First Time To address these challenges in effective teamwork and communication within the OR, the “Improving communication in robotic-assisted laparoscopic surgery” study set out to evaluate the effect of using a wireless audio headset device on communication, efficiency and patient outcome in robotic surgery. The controlled trial of individuals


participating in gynaecologic and urologic robotic procedures, evaluated the quality of communication, performance, teamwork and mental load. The study also measured ambient noise levels throughout the duration of the procedures. Participants reported better overall communication in cases where headsets were used; while there was also a measurable impact on reducing the ambient noise level when headsets were deployed. The report confirms, “Our study shows that the use of wireless headsets improves communication in the robotic OR. In addition, the percentage of time above a peak sound level of 70 dB is reduced while using headsets.” These findings are backed up by the experiences of surgeons in the UK. Paul Harnett, consultant trauma and orthopaedic surgeon at King’s College Hospital and Orpington Hospital, is among a growing body of surgeons using audio headsets within the OR to ensure every team member can communicate effectively throughout a procedure. Harnett says: “Audio headsets make a significant improvement in communicating to everyone involved.” Linking up every team member via headsets fosters an essential level of collaboration. It supports training by empowering junior doctors, for example, to ask questions without feeling they are interrupting the procedure. It also helps to create an environment in which everyone feels empowered to speak up and contribute.


Infectious disease units These same communication challenges are ever more relevant today, with the NHS and healthcare systems globally struggling to cope with the level of


54 l WWW.CLINICALSERVICESJOURNAL.COM


demand COVID-19 has presented. In the US, the virus is shining a spotlight on the economics of the health system, exposing “inefficiencies and inadequacies” which are only going to get worse over the coming weeks and months. In the UK, the army has been drafted in to help get deliveries of protective equipment to frontline staff and almost 4,000 NHS workers signed a letter in the Sunday Times calling on the prime minister to “protect the lives of the life-savers” and resolve the “unacceptable shortage of protective equipment”. Personal protective equipment (PPE) is key in protecting patients and healthcare workers by acting as a barrier between infectious materials such as viral and bacterial contaminants and the skin, mouth, nose, or eyes (mucous membranes). The barrier has the potential to block transmission of contaminants from blood, body fluids, or respiratory secretions. PPE may also protect patients who are at high risk for contracting infections through a surgical procedure or who have a medical condition, such as, an immunodeficiency, from being exposed to substances or potentially infectious material brought in by visitors and healthcare workers. However, while critical, full body protective or personal isolation suits place constraints on healthcare workers’ ability to communicate. According to Dr. Ziv Tsafrir: “Protective suits afford no ability to communicate, so people resort to using sign language. When that doesn’t work, fewer members of staff wear the suits, which risks exposing them to the virus.” Clearly, finding a way of improving communication without compromising healthcare workers’ own health and safety, is critical.


SEPTEMBER 2020


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