From research to practice

As part of my Fellowship, I am developing a training model for operating theatre professionals. It is important for me to try and improve these workplace interactions by working with the new generation of nurses, surgeons and ODP’s, who are still in training, but also with those who are already in service. It’s offering something back to the professional groups I have been observing.

A prototype of the training model is already in place. On the basis of our findings in the “Transient Teams” project, we organised training days for student nurses and ODP’s at a Health and Social Care department in a London university. We developed scenarios on the basis of the examples we encountered in our video data. These represented real communication issues during surgical operations, ranging from dealing with distractions (e.g., loud music) to verbally responding to calls for assistance. I’ll illustrate the latter with an example:

Consider that a surgeon is busy operating and then calls out that he or she needs particular supplies, which are not readily available in the theatre. On hearing this request, it would be good practice for a nurse (often the circulator or “runner” nurse) to verbally acknowledge it before nipping out to the store room. coming up

Sounds obvious? You respond when something has been asked from you. Well, we found that quite often there is a lack of verbal responsiveness to colleagues, especially if the request involves something mundane. Like retrieving sutures, turning the gas on, or switching green lights on for the surgeon. That is, although people are busy doing what has been asked of them, verbal responses or updates are often left out. And that can become problematic.

Sometimes we have witnessed lengthy halts to operations because of these “silences”: the surgeon believes no one has heard them, stops operating, and turns around to look for a nurse. Clearly, nurses and surgeons are all busy. Interactions don’t always work as ideally as we’d like them to, especially when people are immersed in their work. And circulating nurses are routinely multitasking, attending to several concerns at once, assisting not only surgeons but also the scrub nurse.

The key is to consider how we often take communication for granted. Can we develop solution strategies for practices that clearly are not working? In the training program, we simulate these examples with students and discuss them openly in debriefing sessions. Using examples of our (research) video data, we offer the students an opportunity to observe how these examples unfold in real operations: what happens when a nurse does not respond verbally to a surgeon, and what happens when they do respond. Importantly, the training model is not based on hypothetical scenarios, but on real routine-like practice.

Communication in the Operating Theatre

Communication in the Operating Theatre. Weldon, S-M., Korkiakangas, T., Bezemer, J. & Kneebone, R. (2013).
 British Journal of Surgery, 100(13), 1677-1688.

Background: Communication is extremely important to ensure safe and effective clinical practice. A systematic literature review of observational studies addressing communication in the operating theatre was conducted. The focus was on observational studies alone in order to gain an understanding of actual communication practices, rather than what was reported through recollections and interviews.

Methods: A systematic review of the literature for accessible published and grey literature was performed in July 2012. The following information was extracted: year, country, objectives, methods, study design, sample size, healthcare professional focus and main findings. Quality appraisal was conducted using the Critical Appraisal Skills Programme. A meta-ethnographic approach was used to categorize further the main findings under key concepts.

Results: Some 1174 citations were retrieved through an electronic database search, reference lists and known literature. Of these, 26 were included for review after application of full-text inclusion and exclusion criteria. The overall quality of the studies was rated as average to good, with 77 per cent of the methodological quality assessment criteria being met. Six key concepts were identified: signs of effective communication, signs of communication problems, effects on teamwork, conditions for communication, effects on patient safety and understanding collaborative work.

Conclusion: Communication was shown to affect operating theatre practices in all of the studies reviewed. Further detailed observational research is needed to gain a better understanding of how to improve the working environment and patient safety in theatre.