L. L. Frasier1, S. R. Pavuluri Quamme1, Y. Ma1, D. A. Wiegmann1,2, E. H. Dugoff3, G. Leverson1, C. C. Greenberg1,2 1University Of Wisconsin,Surgery,Madison, WI, USA 2University Of Wisconsin,Engineering,Madison, WI, USA 3University Of Wisconsin,Population Health,Madison, WI, USA
Background: Communication is implicated in many adverse events in the operating room (OR). Although familiar OR teams have fewer communication- and teamwork- related failures, working with unfamiliar providers is the norm rather than the exception. Providers in focus groups indicated that increased verbal communication could compensate for team unfamiliarity. We tested the resulting hypothesis that there is an inverse correlation between familiarity and communication frequency between provider pairs (dyads) in the OR.
Methods: Ten open operations were audio-video recorded over 13 months. We asked six providers (anesthesiology attending, in-room anesthetist, circulator, scrub, surgery attending, surgery resident) about the number of shared cases with each other and assigned familiarity scores to dyads. We identified communication events, coded for dyad(s) involved, calculated dyad communication rates and evaluated the relationship between dyad familiarity score and communication rate using Poisson regression.
Results: We generated 48 hours of footage (mean case length, 4.8 hours; range, 3.3 to 6.7 h). There were 2574 communication events (range, 137 to 510 per case). Seventy events (2.7%) could not be coded for content and/or dyad and were excluded. On average, 58.0 communication events occurred per hour (range, 29.4 – 76.1) resulting in a communication event every 62 seconds. Overall, the mean communication rate for provider dyads was 6.8 events / hour of shared room time.
Fifty-four of 59 participants returned questionnaires (91% response rate). Fifty-four percent of participants were male (25% nursing, 79% anesthesia, 60% surgery). For 51% of participants, the recorded operation represented the first shared case with another provider in a week; for 22% of participants, it represented the first shared case in a month. Evaluating total shared cases ever, 11% reported that this was the first ever shared case with another provider, while nearly a third reported sharing 40 or more cases.
In multivariable analysis, dyad familiarity score was not significantly associated with communication rate (p=0.69). The only significant predictor of communication rate was cross-disciplinary status (p<0.001). Compared to intra-disciplinary dyads, which averaged 10.0 communication events/ hour of shared room time, nursing-surgery, anesthesiology-surgery, and anesthesiology-nursing dyads have communication rates of 5.8, 5.2, and 2.8 events per hour of shared room time, respectively.
Conclusion: Despite provider perceptions of increased communication frequency when working with unfamiliar team members, we found no relationship between familiarity and verbal communication rates in the operating room. Our results suggest the persistence of traditional disciplinary silos in the OR. Given the prevalence of multi-disciplinary teams with limited familiarity, these findings represent a critical gap for improving communication and safety in the operative setting.