Surgical Preference Cards
By: Jason Harris, MD, CEO
Published: February 2, 2019
“Communication failures are a well characterized source of errors in the operating room.” Staff communication in the operating room affects staff satisfaction, staff retention, and patient outcomes. There is often great variability in the surgical team due to a variety of factors including: hospital staffing shortages, required staff breaks, new team members requiring additional training, etc. One study found that in a six-week period, surgeons worked with approximately seventeen different nurses. Inefficient communication, such as disruptive behavior, adversely affect team dynamics, communication, collaboration, information exchange, and patient outcomes. Constrained communication by surgical support staff not familiar with the case manifests as: absence of communication, not responding to queries or requests, and speaking quietly. 60% of “Never” events and 57% of “Sentinel” events can be traced to communication failures between physicians and nurses or staff orientation and training respectively. Multiple studies which review Never events have recommended augmenting communication as a tool to improve the safety of patients. Many adverse events are thought to be preventable and due to disruptive behavior, another example of poor communication.
Preference cards have been used as a standardized communication tool for the needs of the surgeon in the operating room. Research shows that outdated preference cards increase frustration for surgeons who do not have the instruments needed to complete a particular surgery efficiently. Nurses then proceed in opening additional articles, often un-needed, that they incorrectly anticipate will be used. This leads to additional waste, effort, and frustration. This frustration leads to staff turnover which logically leads to further frustration with the remaining staff and problems with morale. In the United States, turnover costs for hospital nursing staff are approximately $1.4 to 2.1 billion, which are mediated by satisfaction, organizational commitment, job market, and intent.
A number of interventions for the operating room have been reviewed in an effort to investigate how to improve surgical team communication given its potential impact on hospital finances and personnel satisfaction. Team huddles prior to and after cases have been found to reduce surgical delays and reduce operating room time. Working with the same surgical team has also been found to reduce case time. Intraoperative breaks every 30 minutes for 5 minutes reduce surgeon stress and decreases adverse outcomes, but obviously at the expense of increasing case time.
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