Communication failure across the perioperative pathway: implications for person-centered healthcare

Abstract

Objectives: The objectives of this study were systematically to examine communication patterns across the perioperative pathway, to investigate factors associated with communication failure and to examine the consequences of communication failure and its implications for person-centered healthcare.Methods: Structured observations were made of healthcare professionals to record specific attributes of communication and identify communication failure across the perioperative pathway, comprising pre-operative, intra-operative and post-operative domains in 3 Australian public hospitals. Generalised linear mixed models with communication failure as a binary outcome were fitted. First, using single explanatory variables and second with combinations of explanatory variables.Results: Over 90 hours, 3,021 communication events and 328 individuals were observed. The odds of communication failure when overlapping communication occurred were over 4 times higher than when it did not (odds ratio (OR) = 4.05, 95% CI: 1.81 to 9.19, p <0.001). For post-anaesthetic care nurses, the odds of failure were 2.6 times greater when multitasking than when not (OR = 2.61, 95% CI: 1.76 to 3.85, p<0.001). In contrast, the odds of failure were lower for theatre staff when multitasking than when not (OR = 0.60, 95% CI: 0.36 to 0.98, p = 0.042). Of the healthcare professionals followed, the odds of failure for nurses, surgeons and coordinators were 3 to 4 times higher than the odds of failure for the anaesthetist. The 3 most frequent consequences of communication failure were increased communication interactions, missing information in communication and increased workload.Conclusions: Communication failure occurs regularly within the perioperative environment. Particular attributes of communication events were associated with communication failure and multiple visible consequences across the perioperative pathway. These findings have direct implications for the person-centeredness of clinical services.