Publish Date: January 10, 2018
If your team is looking for ways to improve communication together, AORN’s Mary Fearon, MSN, RN, CNOR, recommends focusing on these three perioperative communication episodes:
- Preoperative Briefing
- Postoperative Debriefing
- Second (or subsequent) Safety Pause
“We have seen the Time Out become hardwired into practice. If teams can achieve that same level of tailored standardization with these communication episodes, they will achieve a number of goals that are so important in today’s OR, including safety, efficiency and a stronger foundation for collaboration with their team members,” Fearon suggests.
Unlike the Time Out, there is no set trigger for these communications and timing is really dependent on the flow of the schedule and how team members work together. “The key element to success is ensuring all team members participate together, visually and verbally, through a tailored communication checklist,” Fearon explains. This is according to a strong body of evidence cited in AORN’s new “Guideline for Team Communication,” which Fearon co-authored.
Share the Evidence
Fearon acknowledges, “there is always the concern that building steps into practice will take time and feel inefficient, but it’s so important to remember the efficiencies these communication episodes will create, which are supported by the evidence, including less distractions, less interruptions and shorter surgery duration.”
She highlights several studies cited in the AORN guideline that support key elements of these three team communications:
AORN recommends this briefing occur prior to the procedure (but separate from the preprocedure verification) and can even occur at the beginning of the day.
This briefing is when the team comes together to establish a shared mental model for the procedure, according to a study by Wahr et al.1, Fearon says. “This concept of a shared mental model comes from safety work done in aviation and some other high-risk areas. Researchers have found that if the team briefs together on what they are going to do, they work so much better together.”
The briefing should cover the following:
- Introduce team members
- Identifying the patient and confirm signed consent
- Explain the planned procedure
- Share the procedure goal
- Define anything unusual for the patient
- Plan for any equipment needed such as positioning devices
AORN recommends the debriefing occur immediately after the procedure and include all members of the team, including the surgeon, to take a collective look at what went well and what didn’t go well so the team can improve for the next patient. This process is well-defined in a study by Van Herzeele et al.2, Fearon shares
She says the debriefing also provides a mechanism to discuss key safety concerns such as the count to ensure accuracy and specimen management to ensure correct labeling.
Second Safety Pause
This episode is less well-known, but has emerged through work in robotic surgery as an important safety practice for the perioperative team to be prepared for, according to a study by Song et al.3 This pause is incorporated as part of the team’s operative checklist and creates a process and timeline for any team member to call a pause in the case to check-in as a team. This check-in provides time for the team to assess the status of the procedure and the patient in case changes such as patient positioning or patient fluid levels needs to be adjusted.
“To establish, standardize and optimize each of these communication episodes, you have to get your stakeholders together and create a system that is reinforced by leadership as part of a strong safety culture,” Fearon stresses. To start, she suggests tackling two key challenges:
- Determine who needs to participate in the communication episode, and
- Have these participants agree on the cue that will bring them together for each episode.
1 Wahr JA, Prager RL, Abernathy JH, et al. Patient safety in the cardiac operating room: Human factors and teamwork: A scientific statement from the American Heart Association. Circulation. 2013;128(10):1139-1169.
2 Van Herzeele I, Sevdalis N, Lachat M, Desender L, Rudarakanchana N, Rancic Z. Team training in ruptured EVAR. J Cardiovasc Surg. 2014;55(2):193-206.
3 Song JB, Vemana G, Mobley JM, Bhayani SB. The second "time-out": A surgical safety checklist for lengthy robotic surgeries. Patient Saf Surg. 2013;7(1):19.
Read AORN’s new “Guideline for Team Communication” to review more evidence and recommendations for dialing-in team communications in the