Characterization of Non-Technical Skills in Paediatric Cardiac Surgery: Communication Patterns

OBJECTIVES:

The management of non-technical skills in complex surgical domains, such as paediatric cardiac surgery, is being recognized as a major factor for both performance and safety. Communication patterns are very relevant for safety and were analysed in this human-factor observational study.

METHODS:

One behaviour observer taped and video-recorded the communication patterns for 10 consecutive paediatric open-heart cases, at a university institution, performed by variable, informal teams. Records were analysed for communication frequency, direction, type, content and pattern on the one hand, and on the other hand for factors influencing communication.

RESULTS:

A total of 10 167 communication flows were read, with an average of 1017 ± 170.9 per procedure over an average duration of 136.15 ± 19.52 min. The frequency of communication was maximal between the main surgeon and the scrub nurse (16% of all communications), followed by the main surgeon to the first surgical assistant (13.8%) and the main surgeon to the perfusionist (12.4%). Communication between the main surgeon and the anaesthetist was not more than 5%. Types of communication varied from requests, questions, answers, statements, informations and explanations, and being different for distinct staff roles: the main surgeon to the scrub nurse involved 84.2% requests, the main surgeon to the first surgical assistant 59.9% statements and the perfusionist to the main surgeon 65.4% answers. Communication patterns varied, being ‘closed-loop’ (with feedback and double-check) only between the main surgeon and the perfusionist, and mostly open among other team members. Communication-disturbing factors such as noise, technology-related events, resource-based problems and supervisory and training-related issues were also found.

CONCLUSIONS:

Communication is very frequent in paediatric cardiac surgery and shows a complex pattern. There is room for improvement, namely by a more formal and standardized communication flow structure that can be achieved with the help of behavioural, technological and organizational initiatives.