Stanford University School of Medicine, Stanford, California.
Department of Surgery, Stanford University School of Medicine, Palo Alto, California; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE).
J Surg Res. 2019 Mar;235:105-112. doi: 10.1016/j.jss.2018.09.030. Epub 2018 Oct 25.
The Joint Commission has repeatedly recognized inadequate communication as a top contributing factor to medical error in the operating room (OR). The goal of this qualitative study was to develop a deeper and more nuanced understanding of OR communication dynamics, specifically across different interdisciplinary roles and to recommend specific interventions based on these findings.
We performed a two-phase qualitative study at one academic institution to explore contributors and barriers to optimal OR communication. The first phase consisted of interviews with OR team members, including surgery and anesthesiology attending faculty and residents, medical students, and OR staff. We qualitatively analyzed the transcripts of these interviews using a deductive approach. We additionally verified the findings through subsequent focus groups.
Most OR team members, independent of role, noted that team familiarity, clear role expectations, and formal communication are vital for effective OR communication. There was a disconnect between attending surgeons and the rest of the OR team: Whereas the majority of team members noted the importance of procedural-focused discussions, team hierarchy, and the attending surgeon's mood as major contributors to successful OR communication, the attending surgeons did not recognize their own ability to contribute to optimal OR communication in these regards.
Although team familiarity was important to all participants in the OR, we noted that attending surgeons differed in their perceptions of OR communications from other members of the team, including attending anesthesiologists, residents, medical students, and nurses. Our findings support the need for (1) improved awareness of the impact of a team members's content and character of communication, particularly by attending surgeons; and (2) targeted initiatives to prioritize team familiarity in OR scheduling.
联合委员会多次将沟通不充分确认为手术室（OR）医疗差错的首要促成因素。本定性研究的目的是深入了解 OR 沟通动态，特别是不同跨学科角色之间的沟通动态，并根据这些发现提出具体的干预措施。
我们在一家学术机构进行了两阶段的定性研究，以探索 OR 沟通的促成因素和障碍。第一阶段包括对 OR 团队成员（包括手术和麻醉科主治医生和住院医生、医学生和 OR 工作人员）的访谈。我们使用演绎法对这些访谈的文字记录进行了定性分析。我们还通过随后的焦点小组验证了这些发现。
大多数 OR 团队成员，无论角色如何，都指出团队熟悉度、明确的角色期望和正式沟通对于有效的 OR 沟通至关重要。主治医生和其他 OR 团队成员之间存在脱节：尽管大多数团队成员指出程序焦点讨论、团队层级和主治医生的情绪对成功的 OR 沟通很重要，但主治医生并没有意识到他们自己在这些方面对最佳 OR 沟通的贡献。
尽管团队熟悉度对 OR 中的所有参与者都很重要，但我们注意到主治医生对 OR 沟通的看法与团队的其他成员（包括主治麻醉师、住院医生、医学生和护士）不同。我们的研究结果支持需要（1）提高对团队成员沟通内容和性格的影响的认识，特别是主治医生；以及（2）有针对性的举措，优先考虑 OR 排班中的团队熟悉度。
