Archive May 2017 XVIII, No. 5

If You See Something, Say Something

Every member of the surgical team has a responsibility to speak up when patients might be harmed.

Daniel Cook, Executive Editor

communication TALKING POINT The quality of communication in the OR impacts complication rates and surgical outcomes.

Things weren't adding up, remembers Jeanie Brown, BSN, RN, CNOR, perioperative manager at Parkwest Medical Center in Knoxville, Tenn. The consent form indicated the left knee was to be operated on, but the schedule said it was the right knee that needed repair. That's when one of her circulating nurses issued a hard stop, discussed the surgical site with the patient and called in the surgeon to resolve the laterality issue. There was no way a wrong-site surgery was happening on the nurse's watch. "Conversations about patient safety must be constant," says Ms. Brown. "If you communicate ineffectively or fail to communicate at all, you're setting patients up for harm and your colleagues up for failure."

There's a clear correlation between case outcomes and how well the surgical team discusses key safety concerns, the critical stages of surgery and the progress of the procedure, says E. Patchen Dellinger, MD, a general surgeon at the University of Washington Medical Center in Seattle.

The simple explanation of ineffective communication in the OR can be traced to the traditional staffing hierarchy in which the demanding surgeon controls the room with little to no input from the nurses and surgical techs. Research has supported this belief, says Dr. Dellinger, who adds complications are more likely to occur during cases performed by surgeons who are poor communicators.

Ask different members of your surgical team if they feel comfortable speaking up when something seems amiss in the OR. Nurses and techs rarely express the same self-assured confidence as surgeons, so it's not surprising that studies show surgeons are much more likely than the team members they work with to voice concerns about patient care, says Dr. Dellinger.

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