The Elephant in the Room: Nurses' Views of Communication Failure and Recommendations for Improvement in Perioperative Care (original) (raw)

Perioperative communication failures endanger patient safety and may reduce efficiency. The objective of our phenomenological research study was to determine the reasons for and consequences of perioperative communication failures and to seek recommendations for improvement. Fourteen perioperative nurses participated in this study. We conducted in-depth interviews with a semi-structured questionnaire following Colaizzi's seven-step methodology to extract themes. We organized the themes into categories: causes, consequences, and recommendations for preventing communication failure. Some themes for causes were inadequate time for preoperative preparation, lack of personnel, and disruptive behaviors of physicians. Consequences of communication failure were decreased staff retention, avoidance of colleagues, threats to patient safety, and intra-team violence. Two recommendations included enforcing institutional regulations and creating team spirit. The study revealed that nurses believe that institutional regulations should not only be present but enforced. Further, nurses believe that strengthening employees' interpersonal skills is essential to preventing communication issues. C ommunication failures are responsible for approximately one-third of unwanted events and medical errors. 1-3 Perioperative teams are particularly at risk for miscommunication because professionals from multiple disciplines are involved in a patient's fast-paced care. Rare consequences can be as severe as patient death or wrong-side or wrong-site surgery. More frequently, consequences can include • cancellations of surgical procedures; • unnecessary diagnostic interventions; • compromised anesthesia risk management; • surgical count failures; • prolonged anesthesia induction; • prolonged waiting time for patients and their relatives; • increased workload; and • procedure delays, which have been associated fundamentally with communication failure. 4-6 Communication failures can occur during all phases of surgical care. 4,5,7 In a 2013 study, researchers examined ratings of safety culture in 22 hospitals by 53 surgeons, 102 nurses, and 29 OR administrators. Serious complication rates were significantly lower among hospitals that received an excellent culture of safety rating from nurses. The rates of complications were prominently linked to coordination and communication between hospital units. 1 In a prospective study, Thiels et al 8 examined procedural never events (ie, retained foreign object, wrong-site or wrong-side procedure, wrong implant, wrong procedure) from 2009 to 2014. Staff member-related factors were