Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):383-391. doi: 10.1053/j.semtcvs.2018.12.001. Epub 2018 Dec 8.
Verbal communication during coronary artery bypass graft (CABG) procedures is essential for safe and efficient cardiac surgery, yet sensitive to failure due to a current lack of standardization. The goal of this study was to improve communication during CABG by identifying critical items in verbal interaction between surgeons, anesthetists, and perfusionists. Based on 6 video recordings, a list was assembled containing items of communication in CABG procedures. Personal interviews and a consecutive focus group meeting with surgeons, anesthetists, and perfusionists revealed which of these items were considered critical. Afterward, the recordings were systematically analyzed on the communication of these critical items. Practitioners considered 64 items to be critical to verbally communicate for safe CABG surgery. On average, these critical items were verbalized in 4.4 out of 6 recorded CABGs. Observations also show that the surgical subteam is the most verbally active subteam and the initiator of the majority of all exchanges. The exchange type involved was mainly "direction" and "status." The majority of communication during critical events is between 2 subteams and occurs in the form of call-back loops. Over half of the call-backs are substantive and communication is rarely directed at a specific team member by name. In this study, a list was developed containing 64 items that practitioners unanimously considered critical to verbalize during a CABG procedure. It forms the foundation of a quality standard for verbal communication during cardiopulmonary bypass (CPB) and can increase safety and efficiency of cardiac surgery.
在冠状动脉旁路移植术（CABG）过程中，口头交流对于心脏手术的安全和高效至关重要，但由于目前缺乏标准化，这种交流容易出现失误。本研究旨在通过确定外科医生、麻醉师和灌注师之间口头交流中的关键项目，来改善 CABG 过程中的沟通。基于 6 段视频记录，我们列出了 CABG 手术中口头交流的项目清单。对外科医生、麻醉师和灌注师进行个人访谈和连续焦点小组会议，揭示了这些项目中哪些被认为是关键项目。之后，我们系统地分析了这些关键项目的交流情况。临床医生认为，有 64 项沟通内容对于安全的 CABG 手术至关重要。平均而言，这些关键项目在 6 次记录的 CABG 中有 4.4 项得到了口头传达。观察结果还表明，外科手术小组是最活跃的小组，也是大多数交流的发起者。所涉及的交流类型主要是“指示”和“状态”。关键事件期间的交流主要发生在两个小组之间，并且以回调循环的形式进行。超过一半的回调是实质性的，很少有以特定团队成员的名字命名的交流。在这项研究中，我们制定了一份清单，其中包含 64 项临床医生一致认为在 CABG 过程中需要口头传达的关键项目。这为体外循环（CPB）期间的口头沟通制定了质量标准，有助于提高心脏手术的安全性和效率。
