title: Operative team communication during simulated emergencies: Too busy to respond?
abstract: Ineffective communication among members of a multidisciplinary team is associated with operative error and failure to rescue. We sought to measure operative team communication in a simulated emergency using an established communication framework called "closed loop communication." We hypothesized that communication directed at a specific recipient would be more likely to elicit a check back or closed loop response and that this relationship would vary with changes in patients' clinical status.
  
  
  
  We used the closed loop communication framework to code retrospectively the communication behavior of 7 operative teams (each comprising 2 surgeons, anesthesiologists, and nurses) during response to a simulated, postanesthesia care unit "code blue." We identified call outs, check backs, and closed loop episodes and applied descriptive statistics and a mixed-effects negative binomial regression to describe characteristics of communication in individuals and in different specialties.
  
  
  
  We coded a total of 662 call outs. The frequency and type of initiation and receipt of communication events varied between clinical specialties (P < .001). Surgeons and nurses initiated fewer and received more communication events than anesthesiologists. For the average participant, directed communication increased the likelihood of check back by at least 50% (P = .021) in periods preceding acute changes in the clinical setting, and exerted no significant effect in periods after acute changes in the clinical situation.
  
  
  
  Communication patterns vary by specialty during a simulated operative emergency, and the effect of directed communication in eliciting a response depends on the clinical status of the patient. Operative training programs should emphasize the importance of quality communication in the period immediately after an acute change in the clinical setting of a patient and recognize that communication patterns and needs vary between members of multidisciplinary operative teams.
authors.affiliation: Center For Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: wadavis@partners.org.
authors.forename: W Austin
authors.initials: WA
authors.lastname: Davis
authors.affiliation: Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Seth
authors.initials: S
authors.lastname: Jones
authors.affiliation: Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Adrianna M
authors.initials: AM
authors.lastname: Crowell-Kuhnberg
authors.affiliation: National Surgical Training Centre, Royal College Of Surgeons Of Ireland, Dublin, Ireland.
authors.forename: Dara
authors.initials: D
authors.lastname: O'Keeffe
authors.affiliation: Department of Nursing, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Boyle
authors.affiliation: Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Klainer
authors.affiliation: Center For Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Smink
authors.affiliation: Center For Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yule
mesh_terms: D003142:Communication; D004630:Emergencies; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D016544:Patient Simulation; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016526:Workload