Communication in the Cardiac OR

‘Closed loop’ and ‘structured’ communication are descriptors for some of the types of communication you will learn in the cardiac OR. In essence, these styles specifically confirm receipt of the information and verify content. Communication and miscommunication between providers is a complex entity – breakdown occurs due to issues in timing, content, purpose or audience. However, when we get it right, good communication is the foundation for strength in basically every aspect of teamwork including coordination, cooperation, coaching, conflict resolution and cognition (essentially high level group performance). Examples of effective communication in the cardiac OR are below:

Example 1: Closed loop communication
Surgeon: “Give the protamine”
Anesthesia: “Giving the protamine” – administers and flushes 1mL (10mg) protamine
Anesthesia: “Test dose protamine is in”
Perfusion: “Total dose of protamine will be 200mg”
Anesthesia: “Total dose 200mg. I will let you know when we’re at one-third”

Example 2: Structured communication
Perfusionist: “Total heparin dose will be 35 thousand”
Anesthesia: “Total dose thirty-five, three-five thousand”

Other key components of perioperative communication include the pre-anesthesia and pre-incision time out, and postoperative SBAR to ICU or PACU teams. There are many aspects of communication and teamwork that are beyond the scope of this summary – select references below can provide more insight.

The reason for emphasis on communication in the cardiac OR is simple – the stakes are high, and fostering of communication (as well as teamwork and situational awareness) is absolutely necessary. The risk for interruptions, errors, and adverse events is elevated, with up to a 4-fold increase in cardiac surgery patients vs non-cardiac patients (12% vs 3%). Operative disruptions (teamwork breakdown or interruption in surgical flow) occurs as frequently as 11-17 times per hour in the cardiac OR. These disruptions are strongly predictive of surgical errors, increase operative duration, decrease team ability to compensate for major errors, and are significantly associated with both death and near misses.

Be cognizant of the issues introduced here. Be vigilant. Be a clear, assertive communicator. Nobody comes to work with the intention of miscommunicating or making an error. Like technical skills, non-technical skills require effort and practice to perfect.

References
1. Wahr, J. et al. Circulation. 2013;128:1139-1169
2. Guru, V. et al. Circulation. 2008;117:2969-2976
3. Martinez, EA. et al. Anesthesia and Analgesia. 2011;112:1061-1074