Abstract
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.
Highlights
Proper and clear communication is essential in any medical specialty to avoid error, but especially in cardiac surgery, where room for error is very small and communication is challenged by the introduction of a third party
The main result of this study is the conception of a list of 64 items that are critical to communicate during coronary artery bypass graft (CABG) procedures, which facilitates a thorough description of the current status of communication during cardiopulmonary bypass procedures
The analysis showed that the surgical subteam is the most verbally active subteam and the initiator of the majority of exchanges
Summary
Proper and clear communication is essential in any medical specialty to avoid error, but especially in cardiac surgery, where room for error is very small and communication is challenged by the introduction of a third party. To the surgeon and anesthesiologist, the perfusionist is a vital player in team communication. Coordination of activities between all 3 main team members is essential. Since they receive different information from different sources, most communication is shared verbally and is susceptible to failure. It has been appreciated that verbal communication is responsible for most minor failures and major adverse events during cardiac surgery.[1,2] One of the mechanisms allowing communication failure is ADULT À QUALITY STANDARD FOR COMMUNICATION DURING CABG communication inconsistency, which has been shown to be widely present during general and cardiac surgery.[3,4] Standardization of communication in the operating room (OR)
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