Safety Blog post: Team Communication part1

Safety blog posts: Blog post Number 3

“Team” members in the operating room.
Who are these people and what do they do?

I recently attended the Society of Endoscopic and Gastrointestinal Surgeons (SAGES) annual meeting. During one of the slide presentations, the words team and expert appeared on the screen. We all expect those who render care to us in the operating room to be experts and to be members of a team. To further refine the use of these terms, the patient expects not a team of experts, but an expert team.

Few surgeons have the good fortune to operate with the same team members every time they operate. I think of the situation as being akin to a pickup baseball game of my youth. When you showed for the game you had a good idea of the skills of the potential team members and how well they performed as a team member. The surgeon usually does not pick the team members for a given operation any given day. An anesthesiologist assigns anesthesia coverage for the room and a nurse makes nursing and the surgical tech assignments for the operation.

I listed the job silos above as team members from different disciplines: anesthesia, nursing, surgery (the surgeon), the surgical technician, and the surgeon’s assistant(s). Verbal communication with this team has traditionally been open loop communication. The military use closed loop communication. The difference: the person to whom a request is directed verbally acknowledges hearing the request during or just before execution of the request. I consider myself to be very lucky when I get to work with a surgical tech or any other team OR team member who communicates using closed loop communication. The surgeon’s gentle command assumes that the person to whom the request is directed is actually in the operating room. Team members who leave to fetch something, go on any type of break, etc. rarely announce their departure nor does the person who assumes responsibility for the leaving team member announce their name and assumption of duty.

Now the tradition of using open loop communication can really cause confusion. Let’s say that the surgeon requests that the anesthesiologist named “Randy” who started the operation do something like raise the height of the operating table. The surgeon directs the request to Randy who has unbeknownst to the surgeon been relieved by Samantha. The request to Randy by name to change the operating table height may go unheeded, especially if the request goes to Randy. This leads to impersonal commands such as “Anesthesia, please raise the height of the operating room table 6 inches” that may make Samantha feel a bit affronted.

What does a surgical tech do? The short answer: the surgical tech performs many of the tasks that a scrub nurse of the past used to do such as hand the surgeon instruments and sutures upon request. For most operations, scrub techs scrub with the surgeon while the nurse assigned to the patient’s operation “circulates” in the room. The circulating nurse is a registered nurse and has education, skills, and knowledge of an RN. The nurse functions as a patient advocate in addition to the other assigned responsibilities. Only the RN, not the surgical tech can enter data into the patient’s record.

More information at the link below.
Failures in communication and information transfer across the surgical care pathway: interview study Original research The British Medical Journal