The myth of communication in Operative room By USAMA ELSAYED
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Transcript of The myth of communication in Operative room By USAMA ELSAYED
The myth of communication in OR
ByUSAMA ELSAYED
Lecturer of anesthesia and intensive care
Outlines
• Skills needed for Anesthetists
• Effective communication skills in OR
• Communication failure in OR
For Anaesthetists
• Scientific background
Technical skills
Non technical skills
ANTS
ANTS• Two categoriesCognitive &mental skills: planning, situational awareness &decision making
Social &interpersonal skills :coordinated team work, communication &leadership
Task management
• Planning &preparation
• Prioritisation
• Identifing &utilising resources
• Providing & maintaining standards
Situational awareness
Gathering information
Recognizing & understanding
Anticipating
Situational awareness
Reduces level of monitoring becauseof distractions
Does not ask questions to orient selfto situation during hand-over
Decision making
• Identifying options
• Balancing risks & benefits
• Re evaluation
Causes of error in anesthesia primarily related to deficiencies in nontechnical skills, rather than a lack of technical expertise.
• Surgeons v. Anaesthetists : Why the Tensions?
• The Anaesthetists is often called the 'captain of the ship,' but the surgeon has a crucial role in how smooth the sailing is.
Why Is This Needed?
• We as anesthesiologists sensed a need for improvement in mutual communication skills
• Poor teamwork and communication are key factors responsible for medical errors
Team communication in OR
Safe: communication reduces morbidity and mortality
Accessible: communication skills can be demonstrated by all team members
Team communication in OR
Feasible: communication can be accomplished with practice but without difficulty.
Effective: communication improves team function(s).
Right: communication saves not only lives but also time and money
Can Communication Be Taught?• Communication skills is natural ability and cannot be t
aught .
• Some might say “you can’t teach an old dog new tricks,”
we enter medical school knowing that communication is important, but it seems to be lost on us later in our training
How to improve communication in OR ?
• Have mutual respect• Mutual respect between the two specialists is
the number one way to reduce friction in the OR
• Egos need to be checked in at the door, avoid talking-down to the OR team
How to improve communication in OR ?
A good surgeon will also respect an
anesthestist’s instructions inside the O.R.
when safety is at issue.
The command is not personal; the patient’s
safety is at issue; and no surgeon wants a
patient coding on the table.
Explain potential issues
Both surgeon and anesthetist need to be assertive and
preemptive when explaining potential issues, whether it's
during, immediately prior to or even days before the surgical
procedure
Get to know each other.
• "Say hi, shake hands, express your appreciation for working together today and ask the surgeon if there are any issues about this particular patient, this particular case
• The first communication of the day should never be 'the blood pressure is falling'."
• The more comfortable the surgeon and anesthesiologist are with each other, the more likely they will be to address their thoughts and concerns about the procedure in an open manner.
• Getting to know each other personally outside the OR can help surgeons and anesthesiologists develop that comfort level.
• "Learn something about the physician — where they live, kids, hobbies and remember it for future interactions. Who knows, you may make a lifelong friend,
SharingActive involvement in the progress of the operation by the anaesthetic, nursing and surgical crews that make up the OperatingRoom team. This involvement should include, atminimum, the anaesthetic crew being able to see over the ‘ether screen’ and communicate easily with the surgeon. In turn, the surgical crew should be able to see the anaesthetic monitors
Closed loop communication
Don't forget the goal
• It's essential that both physicians remember why they are in the operating room in the first place — to ensure the best care for the patient
• Over time, faith develops between the two and both trust that the other is doing their best for the patient."
Communication ptterns
• Jokes• Stories• Commands• Questions• Social chat• Rebukes• Silences.• Nonverbal signals (nodding, gesturing, facial
movements such as eyes rolling)
Communication topics
• Time (room turnover, patient cancellation, sending for the next patient),
• ▪ Resources (equipment allocation and distribution, personnel distribution),
• ▪ Roles (responsibilities, constraints) and relationships,
• Safety and sterility (aseptic technique), and• Situation control (temperature regulation,
recording activities).
Communication and Conflict
• Breakdowns in communication are one of the most frequent causes of conflict in health care
• The OR is at risk for conflict because:– There are many different professionals with overlapping
and sometimes poorly delineated responsibilities– Two physicians sharing equal responsibility for patient– Complex, high-pressure work environment– Sleep deprivation and stress affect interactions– Ethical conflicts and conflicts of interest may emerge
Surgeon anesthetist conflict
Hospital or patient pressure on surgeons
Lack of regard to anesthesiologists’ instructions
Patients’ unawareness of the role of anesthesiologists
Surgeon anesthetist conflict
Decision about the urgency of operations
Lack of an out-patient anesthesia clinic
Shortage of work facilities
Conflict Resolution in General
• Five basic mechanisms of conflict resolution– Avoidance – unlikely to be useful in the OR because
conflict is prevalent in this environment– Yielding – one side acquiesces to the other; appropriate
when one party recognizes that they are in error– Collaboration – the preferred approach, which focuses
on achieving goals together and is a “win-win” system– Compromise – both sides make trade-offs– Competition – conflict is seen as a zero-sum game that
is won by one party and lost by the other
• The surgeon and anesthesiologist also set the
tone in the operating room If they remain calm
when things go wrong and discuss the issue in a
rational manner, the nurses, technicians and
other members of the OR staff will feel at ease
and perform their job better. But if they are
hostile or passive aggressive, it makes for a
more difficult work environment.
How to De-Escalate Aggression
• Stay calm and respectful
• Approach in a warm, friendly,
open manner and avoid
closed body language (crossed
arms, standing too close)
• Speak softly and clearly in
short sentences while
avoiding taiking down
• Avoid distracting activities
such as writing or looking at
the computer
• Maintain nonthreatening eye
contact
• Use facial expressions or
nodding to convey
attentiveness & understanding
Communication failure
Communication failure
• Occasion
• Suboptimal timing of an information exchange such that information was requested or provided too late to be maximally useful
• The staff surgeon asks the anesthesiologist whether the antibiotics have beenadministered. At the point of this question, the procedure has been underway for overan hour.
Communication failure
• Content
• Relevant information was missing or inaccurate information was
exchanged
• The anesthesia fellow asks the staff surgeon if the patient has an ICU bed.
The staff surgeon replies that the ‘‘bed is probably not needed, and there
isn’t likely one available anyway, so we’ll just go ahead.’
Communication failure
• Purpose
Communication events in which purpose is unclear, not achieved, or inappropriate
During a living donor liver resection, the nurses discuss whether ice is needed in the basin they are preparing for the liver.
Communication failure
Audienceabsence of a key team member during the communication event, most frequently the absence of a surgical representative indiscussions regarding the preparation for surgery such as the set up of equipment and the positioning and draping of the patient
Effects of communication failure
• Tension: Emotional responses to a communication failure;
Failure of communication among surgeon , scrub nurse and circulating nurse about equipements preparation make all irritated and frustration spread among all
Effects of communication failure
Delay:
Communication failure results in a delay in the surgical procedure
In instances in which the surgical staff or resident has not been present
for discussions of positioning or draping, these activities occasionally
need to be redone to accommodate the particular needs of the
surgical team.
Effects of communication failure
• Resource waste:
Communication failure results in the use ofequipment or personnel that is not requiredA cell saver kit opened then discovered it is a cancer case
Effects of communication failure
• Procedural error:
• Insertion of an inappropriate line necessitating removal and reinsertion, each step of which raises the risk to the patient.
Example of communication failure
After the patient has been anesthetized, the nurse tells the
surgeon that the consent form used an abbreviation instead of
the full procedure name, and adds that this is against regulations.
The surgeon responds: ‘‘The key is, do you think he knew what he
was coming for this morning ?’’ The nurse assures: ‘‘Well, we
didn’t delay the case because of it
Silence in OR• Fear of exposing a lack of knowledge is one possible motivation for some silences
observed in the OR
• After the patient has arrived in the OR, the anesthesiologist asks thesurgical resident if the surgical team will want the patient’s arms to betucked in for the surgery.Surgical resident says he does not know, but will ask, and then leavesthe room.Circulating nurse: ‘Arms out?’Anesthesiologist: ‘He said he didn’t know’.After the patient is anesthetized the surgical resident returns to theroom and begins catheter insertion. He does not report back aboutarm positioning
Messages
• Take a time-out before every case• Communicate constantly during the
procedure• If u have been asked if u are concerned
about anything don’t always say GOOD
GOOD unless if really good احناكويسين احنا كويسين
TO SUM UPCommunication among OR team
members should be subtle and complex not like the openly combative style that is the stuff of OR myth.
The goal of effective communication in OR is to reduce tension