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Role of requests and communication breakdowns in the coordination of teamwork: a video-based observational study of hybrid operating rooms.

Artikel i vetenskaplig tidskrift
Författare Jonas Ivarsson
Mikaela Åberg
Publicerad i BMJ Open
Volym 10
Nummer/häfte 5
ISSN 2044-6055
Publiceringsår 2020
Publicerad vid Institutionen för pedagogik, kommunikation och lärande
Institutionen för tillämpad informationsteknologi (GU)
Språk en
Länkar dx.doi.org/10.1136/bmjopen-2019-035...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord communication; patient safety; quality improvement; safety culture; teamwork
Ämneskategorier Tvärvetenskapliga studier, Kommunikationsvetenskap, Anestesiologi, Kärlkirurgi

Sammanfattning

This study investigated the functional role of 'requests' in the coordination of surgical activities in the operating room (OR). A secondary aim was to describe, closely, instances of potential miscommunication to scrutinise how so-called conversational repairs were used to address and prevent mistakes.Non-participant video-based observations.Team coordination around image acquisitions (digital subtraction angiography) done during endovascular aortic repair (EVAR) procedures in a hybrid OR.The study followed and documented a total of 72 EVAR procedures, out of which 12 were video-recorded (58 hours). The results were based on 12 teams operating during these recorded surgeries and specifically targeted all sequences involving controlled apnoea. In total, 115 sequences were analysed within the theoretical framework of conversation analysis.The results indicated a simple structure of communication that can enable the successful coordination of work between different team members. Central to this analysis was the distinction between immediate requests and pre-requests. The results also showed how conversational repairs became key in establishing joint understanding and, therefore, how they can function as crucial resources in safety management operations.The results suggest the possibility of devising an interactional framework to minimise problems with communication, thereby enabling the advancement of patient safety. By making the distinction between different types of requests explicit, certain ambiguities can be mitigated and some misunderstandings avoided. One way to accomplish this practically would be to tie various actions to clearer and more distinct forms of expression.

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