Davis W Austin, Jones Seth, Crowell-Kuhnberg Adrianna M, O'Keeffe Dara, Boyle Kelly M, Klainer Suzanne B, Smink Douglas S, Yule Steven
Center For Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Surgery. 2017 May;161(5):1348-1356. doi: 10.1016/j.surg.2016.09.027. Epub 2016 Nov 30.
Ineffective communication among members of a multidisciplinary team is associated with operative error and failure to rescue. We sought to measure operative team communication in a simulated emergency using an established communication framework called "closed loop communication." We hypothesized that communication directed at a specific recipient would be more likely to elicit a check back or closed loop response and that this relationship would vary with changes in patients' clinical status.
We used the closed loop communication framework to code retrospectively the communication behavior of 7 operative teams (each comprising 2 surgeons, anesthesiologists, and nurses) during response to a simulated, postanesthesia care unit "code blue." We identified call outs, check backs, and closed loop episodes and applied descriptive statistics and a mixed-effects negative binomial regression to describe characteristics of communication in individuals and in different specialties.
We coded a total of 662 call outs. The frequency and type of initiation and receipt of communication events varied between clinical specialties (P < .001). Surgeons and nurses initiated fewer and received more communication events than anesthesiologists. For the average participant, directed communication increased the likelihood of check back by at least 50% (P = .021) in periods preceding acute changes in the clinical setting, and exerted no significant effect in periods after acute changes in the clinical situation.
Communication patterns vary by specialty during a simulated operative emergency, and the effect of directed communication in eliciting a response depends on the clinical status of the patient. Operative training programs should emphasize the importance of quality communication in the period immediately after an acute change in the clinical setting of a patient and recognize that communication patterns and needs vary between members of multidisciplinary operative teams.
多学科团队成员之间的无效沟通与手术失误及抢救失败相关。我们试图使用一种名为“闭环沟通”的既定沟通框架，在模拟紧急情况下测量手术团队的沟通情况。我们假设针对特定接收者的沟通更有可能引发确认回复或闭环响应，并且这种关系会随患者临床状态的变化而不同。
我们使用闭环沟通框架，对7个手术团队（每个团队由2名外科医生、麻醉师和护士组成）在应对模拟的麻醉后护理单元“蓝色代码”时的沟通行为进行回顾性编码。我们识别出呼叫、确认回复和闭环事件，并应用描述性统计和混合效应负二项回归来描述个体及不同专业的沟通特征。
我们共编码了662次呼叫。沟通事件发起和接收的频率及类型在临床专业之间存在差异（P <.001）。外科医生和护士发起的沟通事件较少，接收的较多，而麻醉师则相反。对于普通参与者，在临床情况发生急性变化之前的时间段内，定向沟通使确认回复的可能性增加了至少50%（P = 0.021），而在临床情况发生急性变化之后的时间段内则没有显著影响。
在模拟手术紧急情况下，沟通模式因专业而异，定向沟通引发响应的效果取决于患者的临床状态。手术培训项目应强调在患者临床情况发生急性变化后立即进行高质量沟通的重要性，并认识到多学科手术团队成员之间的沟通模式和需求各不相同。
