Communication failures in the operating room: an observational classification of recurrent types and effects
Communication failures in the operating room: an observational classification of recurrent types and effects
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DOI：
10.1136/qshc.2003.008425
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发表时间：
2004-10-01
影响因子：
--
通讯作者：
Grober, E
中科院分区：
文献类型：
--
作者：
Lingard, L;Espin, S;Grober, E
背景：无效的团队沟通往往是医疗差错的根源。本研究的目的是描述在手术室（OR）的通信故障的特点，并对其影响进行分类。这项研究是一个更大的项目，以开发一个团队的清单，以提高沟通的OR.Methods：训练有素的观察员记录了90小时的观察，在48个外科手术。94名团队成员参加了麻醉（16名工作人员，6名研究员，3名住院医生），外科（14名工作人员，8名研究员，13名住院医生，3名办事员）和护理（31名工作人员）。记录程序相关的通信事件的现场说明进行了分析，使用的框架，认为内容，受众，目的和交流的场合。一个沟通失败被定义为一个事件，是有缺陷的一个或多个这些dimensions.Results：421沟通事件，其中129被归类为沟通失败。失败的类型包括：时机不佳的“回避”（45.7%）;信息缺失或不准确的“内容”（35.7%）;问题未得到解决的“目的”（24.0%）;以及关键人物被排除在外的“受众”（20.9%）。36.4%的故障导致系统流程，包括效率低下，团队紧张，资源浪费，变通办法，延迟，病人的不便和程序error.Conclusion：在OR的通信故障表现出一组常见的问题，在可见的影响。它们发生在大约30%的团队交流中，其中三分之一导致认知负荷增加，中断常规和增加手术室紧张局势，从而危及患者安全。
Background: Ineffective team communication is frequently at the root of medical error. The objective of this study was to describe the characteristics of communication failures in the operating room ( OR) and to classify their effects. This study was part of a larger project to develop a team checklist to improve communication in the OR.Methods: Trained observers recorded 90 hours of observation during 48 surgical procedures. Ninety four team members participated from anesthesia ( 16 staff, 6 fellows, 3 residents), surgery ( 14 staff, 8 fellows, 13 residents, 3 clerks), and nursing ( 31 staff). Field notes recording procedurally relevant communication events were analysed using a framework which considered the content, audience, purpose, and occasion of a communication exchange. A communication failure was defined as an event that was flawed in one or more of these dimensions.Results: 421 communication events were noted, of which 129 were categorized as communication failures. Failure types included "occasion'' (45.7% of instances) where timing was poor; "content'' (35.7%) where information was missing or inaccurate, "purpose'' (24.0%) where issues were not resolved, and "audience'' (20.9%) where key individuals were excluded. 36.4% of failures resulted in visible effects on system processes including inefficiency, team tension, resource waste, workaround, delay, patient inconvenience and procedural error.Conclusion: Communication failures in the OR exhibited a common set of problems. They occurred in approximately 30% of team exchanges and a third of these resulted in effects which jeopardized patient safety by increasing cognitive load, interrupting routine, and increasing tension in the OR.