The document discusses effective communication skills for anesthesiologists in the operating room (OR). It outlines that both technical and non-technical skills are important, with a focus on the non-technical ANTS skills of task management, situational awareness, decision making, and teamwork. Poor communication is a leading cause of errors in the OR. The document provides tips for improving communication between surgeons and anesthesiologists such as developing mutual respect, explaining issues upfront, and focusing on the shared goal of patient care. Barriers to communication like tensions, misunderstandings, and silence are also examined.
6. ANTS
• Two categories
Cognitive &mental skills: planning, situational
awareness &decision making
Social &interpersonal skills :coordinated team
work, communication &leadership
14. • The Anaesthetists is often called the
'captain of the ship,' but the surgeon has a
crucial role in how smooth the sailing is.
15. Why Is This Needed?
• We as anesthesiologists sensed a need for
improvement in mutual communication skills
• Poor teamwork and communication are key
factors responsible for medical errors
16. Team communication in OR
Safe: communication reduces morbidity
and mortality
Accessible: communication skills can be
demonstrated by all team members
17. Team communication in OR
Feasible: communication can be
accomplished with practice but without difficulty.
Effective: communication improves team
function(s).
Right: communication saves not only lives but
also time and money
18. Can Communication Be Taught?
• Communication skills is natural ability and cannot
be taught .
• Some might say “you can’t teach an old
dog new tricks,”
we enter medical school knowing that
communication is important, but it
seems to be lost on us later in our
training
19. How to improve communication in
OR ?
• Have mutual respect
• Mutual respect between the two specialists is
the number one way to reduce friction in the
OR
• Egos need to be checked in at the door, avoid
talking-down to the OR team
20. How to improve communication in
OR ?
A good surgeon will also respect an
anesthestist’s instructions inside the O.R.
when safety is at issue.
The command is not personal; the patient’s
safety is at issue; and no surgeon wants a
patient coding on the table.
21. Explain potential issues
Both surgeon and anesthetist need to be assertive and
preemptive when explaining potential issues, whether it's
during, immediately prior to or even days before the surgical
procedure
22. Get to know each other.
• "Say hi, shake hands, express your
appreciation for working together today and
ask the surgeon if there are any issues about
this particular patient, this particular case
• The first communication of the day should
never be 'the blood pressure is falling'."
23. • The more comfortable the surgeon and
anesthesiologist are with each other, the more
likely they will be to address their thoughts
and concerns about the procedure in an open
manner.
24. • Getting to know each other personally outside
the OR can help surgeons and
anesthesiologists develop that comfort level.
• "Learn something about the physician —
where they live, kids, hobbies and remember
it for future interactions. Who knows, you may
make a lifelong friend,
25. Sharing
Active involvement in the progress of the
operation by the anaesthetic, nursing and
surgical crews that make up the Operating
Room team. This involvement should include, at
minimum, the anaesthetic crew being able to
see over the ‘ether screen’ and communicate
easily with the surgeon. In turn, the surgical
crew should be able to see the anaesthetic
monitors
27. Don't forget the goal
• It's essential that both physicians remember
why they are in the operating room in the first
place — to ensure the best care for the
patient
• Over time, faith develops between the two
and both trust that the other is doing their
best for the patient."
28. Communication ptterns
• Jokes
• Stories
• Commands
• Questions
• Social chat
• Rebukes
• Silences.
• Nonverbal signals (nodding, gesturing, facial
movements such as eyes rolling)
29. Communication topics
• Time (room turnover, patient cancellation,
sending for the next patient),
• ▪ Resources (equipment allocation and
distribution, personnel distribution),
• ▪ Roles (responsibilities, constraints) and
relationships,
• Safety and sterility (aseptic technique), and
• Situation control (temperature regulation,
recording activities).
30. Communication and Conflict
• Breakdowns in communication are one of the most
frequent causes of conflict in health care
• The OR is at risk for conflict because:
– There are many different professionals with overlapping
and sometimes poorly delineated responsibilities
– Two physicians sharing equal responsibility for patient
– Complex, high-pressure work environment
– Sleep deprivation and stress affect interactions
– Ethical conflicts and conflicts of interest may emerge
31. Surgeon anesthetist conflict
Hospital or patient pressure on
surgeons
Lack of regard to anesthesiologists’
instructions
Patients’ unawareness of the role of
anesthesiologists
33. Conflict Resolution in General
• Five basic mechanisms of conflict resolution
– Avoidance – unlikely to be useful in the OR because
conflict is prevalent in this environment
– Yielding – one side acquiesces to the other;
appropriate when one party recognizes that they are
in error
– Collaboration – the preferred approach, which
focuses on achieving goals together and is a “win-win”
system
– Compromise – both sides make trade-offs
– Competition – conflict is seen as a zero-sum game
that is won by one party and lost by the other
34. • The surgeon and anesthesiologist also set the
tone in the operating room If they remain
calm when things go wrong and discuss the
issue in a rational manner, the nurses,
technicians and other members of the OR staff
will feel at ease and perform their job better.
But if they are hostile or passive aggressive, it
makes for a more difficult work environment.
35. How to De-Escalate Aggression
• Stay calm and respectful
• Approach in a warm, friendly,
open manner and avoid closed
body language (crossed arms,
standing too close)
• Speak softly and clearly in short
sentences while avoiding taiking
down
• Avoid distracting activities such
as writing or looking at the
computer
• Maintain nonthreatening eye
contact
• Use facial expressions or nodding
to convey attentiveness &
understanding
37. Communication failure
• Occasion
• Suboptimal timing of an information exchange
such that information was requested or
provided too late to be maximally useful
• The staff surgeon asks the anesthesiologist
whether the antibiotics have been
administered. At the point of this question,
the procedure has been underway for over
an hour.
38. Communication failure
• Content
• Relevant information was missing or inaccurate
information was exchanged
• The anesthesia fellow asks the staff surgeon if the patient
has an ICU bed. The staff surgeon replies that the ‘‘bed is
probably not needed, and there isn’t likely one available
anyway, so we’ll just go ahead.’
39. Communication failure
• Purpose
Communication events in which
purpose is unclear, not achieved, or
inappropriate
During a living donor liver resection,
the nurses discuss whether ice is
needed in the basin they are preparing
for the liver.
40. Communication failure
Audience
absence of a key team member during the
communication event, most frequently the
absence of a surgical representative in
discussions regarding the preparation for
surgery such as the set up of equipment and the
positioning and draping of the patient
41. Effects of communication failure
• Tension: Emotional responses to a
communication failure;
Failure of communication among surgeon ,
scrub nurse and circulating nurse about
equipements preparation make all irritated and
frustration spread among all
42. Effects of communication failure
Delay:
Communication failure results in a delay in
the surgical procedure
In instances in which the surgical staff or resident has
not been present for discussions of positioning or
draping, these activities occasionally need to be redone
to accommodate the particular needs of the surgical
team.
43. Effects of communication failure
• Resource waste:
Communication failure results in the use of
equipment or personnel that is not required
A cell saver kit opened then discovered it is a
cancer case
44. Effects of communication failure
• Procedural error:
• Insertion of an inappropriate line
necessitating removal and reinsertion, each
step of which raises the risk to the patient.
45. Example of communication failure
After the patient has been anesthetized, the nurse tells the
surgeon that the consent form used an abbreviation instead of
the full procedure name, and adds that this is against
regulations. The surgeon responds: ‘‘The key is, do you think he
knew what he was coming for this morning ?’’ The nurse assures:
‘‘Well, we didn’t delay the case because of it
46. Silence in OR
• Fear of exposing a lack of knowledge is one possible
motivation for some silences observed in the OR
• After the patient has arrived in the OR, the anesthesiologist asks the
surgical resident if the surgical team will want the patient’s arms to be
tucked in for the surgery.
Surgical resident says he does not know, but will ask, and then leaves
the room.
Circulating nurse: ‘Arms out?’
Anesthesiologist: ‘He said he didn’t know’.
After the patient is anesthetized the surgical resident returns to the
room and begins catheter insertion. He does not report back about
arm positioning
47. Messages
• Take a time-out before every case
• Communicate constantly during the
procedure
• If u have been asked if u are concerned
about anything don’t always say GOOD
GOOD unless if really good كويسين احنا
كويسين احنا
48. TO SUM UP
Communication among OR team
members should be subtle and
complex not like the openly
combative style that is the stuff of
OR myth.
The goal of effective
communication in OR is to reduce
tension
