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Effective Information transfer and Communication is one of the key aspects of good medical practice and essential for surgical safety. High reliability organisations such as aviation have highlighted the importance of communication for safety and regularly provide communication skills training to their team members via Crew resource management (CRM) module. This report discusses important aspects of communication research in high-risk environments and confers its application in surgery. It analyses the nature and scope of communication failures in surgical field. The thesis has taken bottom-up approach unlike other research in this field, which has taken a top-down approach. First we have mapped and analysed the communication failures across the entire surgical pathway. Analysis of full pathway is critical as communication failures are not discrete events; information loss in one phase of care can potentially compromise safety in a subsequent phase. After the analysis, user-centred interventions were developed and implemented to enhance the information transfer and communication in the postoperative handover phase. Results show that information transfer and communication failures are ubiquitous and distributed across the continuum of surgical care. These findings indicate that there is a room for improvement for enhancing ITC in surgical care. There is an imminent need for standardizing and structuring communication through use of checklists, proformas, care pathways and information technology. Subsequently we have demonstrated that standardization of ITC process through the implementation of postoperative handover proforma has improved the information transfer and decreased the ITC errors. It is hoped that this thesis provides a first step towards understanding, assessing and improving information transfer and communication through entire surgical care pathway, which in a long run will improve surgical safety. |
