Cardiac Anesthesia Resident Rotation
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 noncardiac
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
- Wahr, J. et al. Circulation. 2013;128:1139-1169
- Guru, V. et al. Circulation. 2008;117:2969-2976
- Martinez, EA. et al. Anesthesia and Analgesia. 2011;112:1061-1074
Jessica Brodt, MD; Stanford Cardiac Anesthesia, 2017
