Вы находитесь на странице: 1из 7

REVIEW

CURRENT
OPINION How to communicate between surgeon
and intensivist?
Giovanni Misseri, Andrea Cortegiani, and Cesare Gregoretti

Purpose of review
Communication and teamwork are essential to enhance the quality of care, especially in operating rooms
and ICUs. In these settings, the effective interprofessional collaboration between surgeons and intensivists
impacts patients’ outcome. This review discusses current opinions and evidence for improving
Downloaded from https://journals.lww.com/co-anesthesiology by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3hIW04IhZ9AvNyXiDskTJpGAYXztNG71dMzsxvxmZhgI= on 04/12/2020

communication strategies and the relationship between surgeons and intensivists/anesthesiologist.


Recent findings
Effective teamwork has been demonstrated to improve patient outcome and foster healthier relationships
between professionals.
With the expansion of new medical superspecialist disciplines and the latest medical developments, patient
care has been put through a progressive fragmentation, rather than a holistic approach. Operating theaters
and ICU are the common fields where surgeons and anesthesiologists/intensivists work. However,
communication challenges may frequently arise. Therefore, effective communication, relational
coordination, and team situation awareness are considered to affect quality of teamwork in three different
phases of the patient-centered care process: preoperatively, intraoperatively, and postoperatively.
Summary
Although limited, current evidence suggests to improve communication and teamwork in patient
perioperative care. Further research is needed to strengthen the surgeon–intensivist relationship and to
deliver high-quality patient care.
Keywords
anesthesiology, communication, patient-centered care, perioperative care, surgeon–intensivist relationship,
teamwork

INTRODUCTION actions improving interprofessional dynamics in


Odi et amo. Quare id faciam fortasse requiris. Nescio, sed patient perioperative care.
fieri sentio et excrucior [I hate and I love. Why I do this
perhaps you ask. I know not, but I feel it happening TEAMWORK AND COMMUNICATION
and I am tortured] [1]. In this conflicting declaration WITHIN HEALTHCARE PROFESSIONALS
of emotions, Catullus poetically expresses his
Acute care and critical illness have to be considered a
contradictory feelings for his beloved Lesbia. &&
continuum of connected events [2 ]. Critical situa-
Long-lasting relationships, such as the one between
tions are usually preceded by a series of undetected
intensivist and surgeon, are permeated with alter-
changes in vital and clinical signs. Once emergency
nating agreements, disagreements, spirit of cooper-
is identified, the patient undergoes multiple
ation, or obstruction to communication. Therefore,
teamwork and communication are critical elements,
and a favorable working environment is fundamen- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.),
Section of Anesthesia, Analgesia, Intensive Care and Emergency, Poli-
tal to improve surgical team performance, quality of
clinico Paolo Giaccone, University of Palermo, Palermo, Italy
care, and patient safety and satisfaction.
Correspondence to Cesare Gregoretti, Department of Surgical, Oncol-
Although the science of teamwork and commu- ogical and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analge-
nication has witnessed a great ascent in medical sia, Intensive Care and Emergency, Policlinico Paolo Giaccone,
literature, information on teamwork implementa- University of Palermo, via del vespro 129, 90127 Palermo, Italy.
tion and communication between intensivists and E-mail: c.gregoretti@gmail.com
surgeons is either lacking or of poor quality. We Curr Opin Anesthesiol 2020, 33:170–176
review hereby the existing evidence and propose DOI:10.1097/ACO.0000000000000808

www.co-anesthesiology.com Volume 33  Number 2  April 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


How to communicate between surgeon and intensivist? Misseri et al.

communication and leadership skills, workload, and


KEY POINTS stress management improve teamwork efficiency [11].
 Safe and high-quality care demands reliable teamwork Although extensively recognized, healthcare team
and effective collaboration, especially in operating training has not been yet uniformly adopted and only
theaters and in intensive care settings. a small number of healthcare providers regularly
undergo specific training [12]. Ineffective communi-
 Although not fully explored, effective communication
cation is one of the leading causes of medical errors
and relationship between surgeons and intensivists/
anesthesiologists improve perioperative outcomes. [13,14], being the casual factor in 82% of adverse
events or close-call reports [15] and considered respon-
 Effective communication, relational coordination, sible for 60% of adverse events by the Joint Commis-
and team situation awareness influence the surgeon/ sion on Accreditation of Healthcare Organizations.
intensivist relationship in three different phases of the
Different studies have highlighted the importance
multidisciplinary patient-centered approach:
preoperative, intraoperative, and postoperative. of effective communication in the whole surgical care
pathway, especially in operating rooms where mis-
 Communication and nontechnical skills should be communication is more likely to happen [16,17].
trained (using high-fidelity simulation, didactics, Interaction between members of anesthesia, surgical,
crisis-resource management) to study team dynamics
and ICU teams has received less attention than com-
and improve teamwork.
munication between healthcare professionals and
patients or their relatives. Surgeon and anesthesiolo-
gist/intensivist are the key players inside and outside
interventions to prevent further deterioration. In the operating room, and their communication skills
this context, patients’ outcome is profoundly are essential to achieve patients’ recovery and good
affected by appropriate management. Effective col- outcome. Interpersonal interactions take advantage of
laboration among different professionals is aimed at verbal and nonverbal communication. Although ver-
patient care, recovery, and rehabilitation. With the bal skills are based on honesty in thought and speech,
expansion of new medical superspecialist disci- consistency in expression, and clarity in delivering the
plines, patients’ care has turned from a holistic message, facial expressions, body language, and the
approach to a progressive fragmentation, thus ability to listen to others are the cornerstones of
resulting in errors and impairing outcomes. Effec- nonverbal communication skills [18]. The entire sur-
tive teamwork and communication could therefore gical process (from preoperative assessment to post-
address this problem and maintain an integrated operative care) is affected by poor communication
approach to patients’ illnesses [3]. Teamwork refers strategies. Miscommunication is much more present
to the leadership, decision-making, communica- during preoperative assessment and superficiality
tion, and coordination behavior used by multi- seems to be the main issue. However, uncertain distri-
disciplinary team members to provide patient bution of responsibilities and leadership may contrib-
care. Effective teamwork has been demonstrated ute to the emergence of errors. Lack of standardized
to improve quality-of-care, patient outcome, and communication models, leading to missing or excess
to foster healthier relationships between all profes- of information, has been related to postoperative
sionals involved [4]. Interprofessional care refers to mistakes [19]. Interestingly, most misunderstandings
actions of healthcare providers with overlapping originate from verbal communication, particularly
expertise working together to achieve a common when surgeons are involved [20].
goal. From this perspective, interdisciplinarity is
based on sharing roles and responsibilities regardless
&
of the specific individual expertise [5 ]. On the other SURGEON AND INTENSIVIST:
side, multidisciplinary or interdisciplinary care are PERSONALITIES AND STEREOTYPES
the terms used when team members work in parallel Striving to provide the best quality-of-care, surgeons
maintaining more strict disciplinary boundaries [6]. and anesthesiologists/intensivists have to face differ-
Team behavior can simultaneously cause and pro- ent gaps between their practice and chances to
tect against errors. To understand team performance improve patients’ outcomes. Beyond limits imposed
and causes underlying active and latent failures [7], it by the suboptimal adoption of shared evidence-based
is important to consider psychology concepts as health interventions and guidelines [21], there are
decision-making, leadership, team cohesion, team often psychological factors hampering interprofes-
mental models, and team climate [8]. Besides, sional communication. Teamwork dynamics are
fatigue and nontechnical skills may have a profound affected by stereotypes, which are a disruptive psy-
impact on teamwork performances [9,10]. As in the chological state experienced when feeling at risk for
case of the aviation model, periodical training on confirming a negative, fixed, and simplified image or

0952-7907 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. www.co-anesthesiology.com 171

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


Intensive care and resuscitation

idea of a person, about his/her social identity [22]. decision-making, and resource management skills
The overabused orthopedics–anesthesiologist gag [29]. The leader is anyone who influences the activi-
Patient’s got a broken bone. . .I’ve to fix it, and the ties of an organized group in its efforts toward goal
forever-eternal triad coffee–anesthesia–newspaper setting and achievement, providing a vision for the
(recently replaced by coffee–anesthesia–smartphone) future, a direction for change, and a sense of clear
are simplifications of stereotypes’ role, often influ- purpose [30]. Surgeon and intensivist/anesthesiolo-
&&
encing team’s dynamics. Although the stereotype of gist share, yield, or compete for leadership [31 ],
the abrasive surgeon no longer applies to many mod- influencing teamwork effectiveness. Although
ern professionals, this concept continues to influence leadership is usually attributed to the surgeon,
patients’ expectations and surgeons’ interactions intensivists/anesthesiologists are deeply involved
with their colleagues [23]. Fortunately, the image in maintaining the efficiency of the surgical service
of surgeon and anesthesiologist/intensivist has and may have a more complete vision of the oper-
evolved at the same rate of medical progress. The ating theater organization, thus bringing a valuable
surgeon’s personality is mainly characterized by deci- management perspective. Trauma care and trauma
siveness, control, and confidence. The surgical pro- teams are perfect examples of cross-disciplinary
cedure acquires the dignity of a ‘covenant to cure’, leadership models [3]. It has been demonstrated
and surgeons often reject all the actions undermining that if emergency physicians and surgeons share
this belief (such as requesting the collaboration of leadership roles by collaborating (cross-disciplin-
other professionals, losing control over clinical deci- ary) care is delivered faster if each physician makes
sions, and proposals on limiting ineffective treat- decisions independently (parallel decision-making)
ments) [24–26]. This intransigence may play a [29]. Therefore, the leadership cross-disciplinary
confusing factor, both for patients and families and model and appropriate task delegation may likely
among acute care team itself. In contrast, anesthesi- sort positive effects on the surgeon–intensivist/
ologists/intensivists perspectives are considered to be anesthesiologist perioperative collaboration.
more holistically. Dedicated intensivists for surgical
critically ill patients appear to improve outcomes,
and the reason for this is not well known. However, SURGEON AND INTENSIVIST: HOW TO
intensivist-directed teams may identify and treat COMMUNICATE?
problems in time before irreversible complications The impact of human factors in surgical patient
occur [25]. safety has been extensively revised, and in particu-
Poor team communication and stereotypes con- lar, it has been highlighted how quality and effi-
tribute to professionals’ disruptive behavior, a term ciency of surgical procedures are contingent on
used to describe a range of unacceptable clinician high-quality communication and shared knowl-
actions, including incivility, bullying, and harassment edge, which is challenging to achieve because of
[27], which decreases the well-being of clinicians and the interdependence, time constraints, and uncer-
&&
undermines the quality-of-care [28]. Intrapersonal, tainty of the surgical context [32,33,34 ]. The need
organizational, and interpersonal factors have been for developing a patient-centered approach for sur-
attributed to its development. Clinicians with under- gical care has contributed to the relational coordina-
lying depression, addiction, fatigue, and burnout tion theory success, which is a mutually reinforcing
are more prone to act disruptively, especially when process of communicating and relating across areas
psychological pressures are worsened by adverse work- of expertise to achieve task integration [35]. The
ing conditions (personnel and supply shortage, orga- process by which people acquire information,
nizational inefficiencies, long working hours, and understand, and utilize it to comprehend and be
insufficient rest). In particular, surgeons and anes- aware of the dynamic situation is often referred to as
thesiologists/intensivists are more likely at risk of situation awareness [36]. In this light, clear, accurate,
stress and exhaustion being at the forefront of emer- and problem-solving communication acquires
gency care. Lack of communication, as well as poor strength and impacts on the performance of health-
team collaboration and leadership weaknesses, have care professionals, particularly under unexpected
been attributed to the interpersonal limitations bring- circumstances and time constraints, which charac-
ing to behavioral disruption. terize surgical and acute care. Studies have demon-
strated that relational coordination is related to
higher quality levels, job satisfaction, work engage-
SURGEON AND INTENSIVIST: WHO IS THE ment, and surgical outcomes (lower postoperative
LEADER? pain, lower rate of infections complications, and
Leadership is a multidimensional, complex behavior shorter hospital length-of-stay) [37]. Good commu-
that includes effective communication, efficiency, nication patterns are experienced when each

172 www.co-anesthesiology.com Volume 33  Number 2  April 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


How to communicate between surgeon and intensivist? Misseri et al.

professional perceives to be involved in a shared THE THREE PHASES OF SURGEON–


challenge and when individual’s expertise is valued INTENSIVIST COMMUNICATION
by each member. On the counterpart, bad commu- Effective communication, relational coordination,
nication emerges in case the interdisciplinary team and team situation awareness affect the quality of
does not maintain a unitary vision, and when exper- teamwork in three different phases of the patient-
tise is not valued or given weight in decision-making centered care process (Fig. 1).
[38]. As a result, team members perceive that
patients are receiving inappropriate care.
Preoperative communication
As surgery has progressed, the function of anesthe-
Communication modes
tists/intensivists has evolved adding to the provision
Formal and informal communications may be of optimal perioperative conditions a more invasive
applied in surgeon–intensivist/anesthesiologist support of vital functions. Leaving the narrowness of
relationship. The former are based on communica- operating room’s workflow, intensivists have gradu-
tion following institutions’ directives (clinical docu- ally gained the figure of comprehensive perioperative
ments, medical records, morning rounds, checklists, consultants aiming to a synergistic relationship with
and team hierarchy), while the latter on personal surgeons and other professionals [40]. This has been
contacts excluding preset institutional structures. implemented with the introduction of Enhanced
Medical records and documents are the primary Recovery After Surgery (ERAS) bundles, designed to
formal modes by which team members communi- cover the entire continuum of perioperative patient
cate. Yet, unstructured written communication is care. With the aim to reduce mortality rates, improve
the most common form of interaction in daily prac- recovery and shorten the length-of-stay after major
tice, despite being prone to misunderstandings. surgery, ERAS protocols include a multimodal and
Although indispensable for patient care, written integrated evidence-based approach, including
notes (whether article or web-based) are often preoperative risk assessment, surgical procedures,
unwelcome both for intensivists and for surgeons, anesthesia plan, therapies optimization, pain man-
who often perceive them as isolated documents agement, and postoperative goals [41]. Short-term
mandatory by law. Implementation of simple outcomes and long-term survival are both improved
checklists has contributed to teamwork satisfaction by increased compliance to ERAS protocols. Preoper-
and effectiveness of handovers for surgical patients. ative briefings between surgical team members are
Electronic medical records are progressively replac- essential to discuss and prepare for a given case. The
ing written documentation. Fillable communica- implementation of surgical safety checklists has
tion tools to accompany the daily progress notes greatly reduced morbidity and mortality [42,43].
could better ensure high compliance and interdisci- Besides, perioperative briefing and debriefing have
&
plinary work efficiency [39 ]. Morning rounds improved the team climate and the efficiency of their
may be the only occasion of direct interaction work, especially for surgical teams with alternating
between the surgeon, intensivist/anesthesiologist, members’ composition [44]. Although studies [45,46]
and patients. They can take place both preopera- have demonstrated that most differences in percep-
tively and postoperatively and involve trainees and tions of teamwork and communication among team
attendings from the surgical and anesthesia team. members exist mostly between surgeons and nurses,
These ‘bedside’ times may promote a multidisciplin- it seems that anesthesiologists perceive larger areas for
ary preoperative assessment and set patient-tailored improvement and that preoperative communication
management strategies and shared postoperative across groups could be enhanced. Potential reasons
goals. Informal strategies are mainly based on new for suboptimal ratings of preoperative communica-
communication technologies, such as text messag- tion across groups are differing expectations for the
ing and emails. Even if preferred for their immedi- timing or content of interprofessional discussions,
acy, some concerns on patients’ health-related data disparate perceptions of team members’ roles, several
protection may arise. Face-to-face communication organizational barriers. These findings may be used to
is usually welcomed by the majority of healthcare promote future research on preoperative communi-
professionals. However, these interactions are cation and to adopt quality improvement measures to
unplanned in most of the cases, especially when enhance effective surgical teamwork [47 ].
&

occurring outside the operating room. When asked,


professionals prefer communication with colleagues
with whom they have more familiarity, even if in Intraoperative communication
some occasions, this hampers good communication Surgical team members must discuss the plan
[38]. of action and establish a shared mental model to

0952-7907 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. www.co-anesthesiology.com 173

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


Intensive care and resuscitation

FIGURE 1. Improving communication between surgeons and intensivists/anesthesiologists. Infographics on strategies to


improve communication between surgeons and intensivists/anesthesiologists.

coordinate professionals toward the aimed goal. Postoperative communication


Briefing, exchange of reflections, and debriefing Postoperative goals-of-care should be discussed
are needed several times during operations and planned to determine patients’ priorities in a
[48,49]. Team’s adaptive capacity may be subjected multidisciplinary way. However, often clinicians
&
to additional stressing factors when different team perceive barriers to communicate [52 ]. More than
members alternate during their shifts, as lack of 40% of surgeons who routinely perform high-risk
knowledge about one another may increase mis- operations report conflict with intensivists and
communications and interruptions during surgical nurses regarding the goals-of-care for their patients
procedures. For these reasons, leadership and team with poor postoperative outcomes [53], especially
coordination are needed. Ethnographic studies have when practicing in a ‘intensivist care model’ ICU
identified four different communication patterns in that hinders surgeon’s decision-making autonomy.
operating theaters, strictly connected to the level of Recent evidence suggests that patient-centered
&&
complexity of surgical procedures [34 ]. However, interdisciplinary bedside rounds in ICU provide a
more studies are needed to analyze the relationship greater efficiency, communication, satisfaction, and
between surgeon and anesthesia team. Training, consistent teaching among healthcare providers
high-fidelity simulations, and crisis resource [54]. Exclusion of surgery and intensive care resi-
management ensure improved operating room’s dents (the so-called resident-bypass) from the deci-
teamwork and communication, as revealed by sion-making process should be avoided and efforts
a retrospective study showing 18% reduction of are needed to develop their communication skills
postoperative complications in the annual surgical and competence [55]. Handovers checklists and
mortality of institutions promoting team-training multidisciplinary daily communication tools have
&
programs [50,51 ]. demonstrated to improve effective communication

174 www.co-anesthesiology.com Volume 33  Number 2  April 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


How to communicate between surgeon and intensivist? Misseri et al.

10. The Association of Anaesthesists of Great Britain and Ireland, The Royal
between surgeons and ICU teams [38]. Therefore, an College of Anaesthesists, The Faculty of Intensive Care Medicine. Joint
interprofessional shared decision-making model of statement: tackling the effects of fatigue on the NHS workforce,
March 2018. https://www.ficm.ac.uk/sites/default/files/joint_statement_-_
care should be adopted to provide high-quality final_-_05_march_2018.pdf; Accessed 20 September 2019.
&&
treatments [56 ,57]. 11. O’Connor P, Campbell J, Newon J, et al. Crew resource management training
effectiveness: a meta-analysis and some critical needs. Int J Aviat Psychol
2008; 18:353–368.
12. Gaba D, Rogers J. Have we gone too far in translating ideas from aviation to
CONCLUSION patient safety? BMJ 2011; 342:198–199.
13. Lingard LS, Espin S, Whyte G, et al. Communication failures in the operating
The surgeon–intensivist relationship is essential for room: an observational classification of recurrent types and effects. Qual Saf
Healthcare 2004; 13:330–334.
organizational efficiency in operating theaters and 14. Dingley C, Daugherty K, Derieg MK, Persing R. Improving patient safety
ICU. Different actions should be implemented to through provider communication strategy enhancements. In: Henriksen K,
Battles JB, Keyes MA, et al., editors. Advances in patient safety: new
achieve better interprofessional collaboration and directions and alternative approaches (vol. 3: performance and tools). Rock-
high-quality patient care. Teamwork training ville, MD: Agency for Healthcare Research and Quality; 2008.
15. Awad SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the
and a patient-centered multidisciplinary approach operating room with medical team training. Am J Surg 2005; 190:770–774.
may help ensure better communication. Further 16. Ha JF, Longnecker N. Doctor–patient communication: a review. Ochsner J
2010; 10:38–43.
research is needed to understand the interpersonal 17. St Pierre M, Hofinger G, Buerschaper C. Crisis management in acute care
underlying dynamics influencing patients’ safety settings: human factors and team psychology in a high stakes environment.
Heidelberg: Springer; 2008; 152.
and clinical outcomes. 18. Goyal R. Surgeons and anesthesiologists: need to communicate? J Anaes-
thesiol Clin Pharmacol 2013; 29:297–298.
19. Nagpal K, Vats A, Ahmed K, et al. An evaluation of information transfer through
Acknowledgements the continuum of surgical care: a feasibility study. Ann Surg 2010;
None. 252:402–407.
20. Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of commu-
nication breakdowns resulting in injury to surgical patients. J Am Coll Surg
Financial support and sponsorship 2007; 204:533–540.
21. Telem DA, Dimick J, Skolarus TA. Dissecting surgeon behavior: leveraging the
None. theoretical domains framework to facilitate evidence-based surgical practice.
Ann Surg 2018; 267:432–434.
22. Aronson J, Burgess D, Phelan SM, Juarez L. Unhealthy interactions: the role of
Conflicts of interest stereotype threat in health disparities. Am J Public Health 2013; 103:50–56.
23. Logghe HJ, Rouse T, Beekley A, et al. History of medicine: the evolving
There are no conflicts of interest. surgeon image. AMA J Ethics 2018; 20:492–500.
24. Wilcox ME, Chong CA, Niven DJ, et al. Do intensivist staffing patterns
influence hospital mortality following ICU admission? A systematic review
and meta-analyses. Crit Care Med 2013; 41:2253–2274.
REFERENCES AND RECOMMENDED 25. Penkoske PA, Buchman TG. The relationship between the surgeon and the
intensivist in the surgical intensive care unit. Surg Clin N Am 2006;
READING 86:1351–1357.
Papers of particular interest, published within the annual period of review, have 26. Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care
been highlighted as: units: why, where what, who, when, how. BMC Anesthesiol 2018; 18:106.
& of special interest 27. Hutchinson M, Jackson D. Hostile clinician behaviours in the nursing work
&& of outstanding interest
environment and implications for patient care: a mixed-methods systematic
review. BMC Nurs 2013; 12:25.
1. Valerius Catullus C. Poem 85. Carmina. Perseus Project; https://www. 28. Villafranca A, Hamlin C, Enns S, et al. Disruptive behaviour in the perioperative
perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.02.0006%3A- setting: a contemporary review. Can J Anesth/J Can Anesth 2017; 64:128–140.
poem%3D85. [Accessed 16 September 2019]. 29. Ford K, Menchine M, Burner E, et al. Leadership and teamwork in trauma and
2. Vincent JL. The continuum of critical care. Crit Care 2019; 23(Suppl 1): resuscitation. Western J Emerg Med 2016; 17:549–556.
&& 122. 30. Agnoletti V, Gambale G, Meineri M, Macario A. Operating room leadership:
In this review, the author suggests to consider critical illness as a continuous who is the one? J Anesth Clin Res 2015; 6:576.
sequence of events, from in-hospital admittance, through ICU stay, ending with 31. Cooper JB. Critical role of the surgeon–anesthesiologist relationship for
recovery and rehabilitation. Therefore, healthcare should be delivered through && patient safety. Anesthesiology 2018; 129:402–405.
integrated pathways, where effective communication, teamwork, and collaboration Recent article exploring functional and dysfunctional aspects of the relationship
are fundamental for a patient-centered process of care. between surgeon and anesthesiologist. Interestingly, six main actions are sug-
3. Dietz AS, Pronovost PJ, Mendez-Tellez PA, Wyskiel R, et al. A systematic gested to improve and optimize teamwork and to address future research.
review of teamwork in the intensive care unit: what do we know about 32. Gittell JH, Fairfield KM, Bierbaum B, et al. Impact of relational coordination
teamwork, team tasks, and improvement strategies? J Crit Care 2014; on quality of care, postoperative pain and functioning, and length of stay: a
29:908–914. nine-hospital study of surgical patients. Med Care 2000; 38:808–819.
4. Reader T, Flin R, Mearns K, Cuthbertson B. Developing a team performance 33. Mitchell L, Flin R. Nontechnical skills of the operating theatre scrub nurse:
framework for the intensive care unit. Crit Care Med 2009; 37:1787–1793. literature review. J Adv Nurs 2008; 63:15–24.
5. Donovan AL, Aldrich JM, Gross AK, Barhas DM, et al. Interprofessional care 34. Tørring B, Gittel JH, Laursen M, et al. Communication and relationship
& and teamwork in the ICU. Crit Care Med 2018; 46:980–990. && dynamics in surgical teams in the operating room: an ethnographic study.
This is one of the few published articles highlighting the importance of integrated BMC Health Serv Res 2019; 19:528.
actions on multiple domains of care toward patients and their families admitted in Ethnographic study based on the relational coordination theory exploring com-
intensive care units. Interprofessional initiatives to improve quality of care are here munication and relationship dynamics in multidisciplinary surgery teams. The
reviewed and proposed. authors identified four different patterns of communication strategies, examples
6. Columbia Center for teaching and learning: glossary of healthcare team of which are provided in the study.
models; http://ccnmtl.columbia.edu/projects/sl2/pdf/glossary.pdf. [Ac- 35. Gittell JH. Relationships between service providers and their impact on
cessed 16 September 2019]. customers. J Serv Res 2002; 4:299–311.
7. Reason J. Human error: models and management. BMJ 2000; 320:768–770. 36. Parush A, Kramer C, Foster-Hunt T, et al. Communication and team situation
8. Weiner E, Kanki B, Helmreich RL, editors. Cockpit resource management. awareness in the OR: implications for augmentative information display.
San Diego, CA: Academic Press; 1993. J Biomed Inform 2011; 44:477–485.
9. Caldwell JA, Caldwell JL, Thompson LA, Lieberman HR. Fatigue and 37. Havens D, Vasey J, Gittell JH. Relational coordination among nurses and other
its management in the workplace. Neurosci Biobehav Rev 2019; 96: providers: impact on the quality of patient care. J Nurs Manage 2010;
272–289. 18:926–937.

0952-7907 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. www.co-anesthesiology.com 175

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.


Intensive care and resuscitation

38. Haas B, Conn LG, Rubenfeld GD, et al. ‘Its parallel universes’: an analysis of 48. Nawaz H, Edmondson AC, Tzeng TH, et al. Teaming: an approach to the
communication between surgeons and intensivists. Crit Care Med 2015; growing complexities in healthcare. J Bone Joint Surg 2014; 96:e184.
43:2147–2154. 49. Kaldheim HK, Slettebø A. Respecting as a basic teamwork process in the
39. Turner CJ, Haas B, Lee C, et al. Improving communication between surgery operating theatre: a qualitative study of theatre nurses who work in inter-
& and critical care teams: beyond the handover. Am J Crit Care 2018; disciplinary surgical teams of what they see as important factors in this
27:392–397. collaboration. Nordisk Sygeplejeforskning 2016; 6:49–64.
Pre and postintervention survey study to evaluate communication interventions 50. Neily J, Mills PD, Young-Xu Y, et al. Association between implementation
(checklist and daily communication tool) between surgeons and intensivists to of a medical team training program and surgical mortality. JAMA 2010;
improve postoperative handovers and avoid miscommunication issues. 304:1693–1700.
40. Gregory AJ. Editorial enhanced recovery after cardiac surgery: more than a 51. Etheringtone N, Wu M, Cheng-Boivin O, et al. Interprofessional communica-
buzzword. J Cardiothorac Vasc Anesth 2019; 33:1495–1497. & tion in the operating room: a narrative review to advance research and
41. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care practice. Can J Anesth/J Can Anesth 2019; 66:1251–1260.
in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Recent review summarizing relevant evidence on interprofessional communication
society recommendations: 2018. World J Surg 2019; 43:659–695. issues between operating room team members.
42. Lingard L, Regehr G, Orser B, et al. Evaluation of a preoperative checklist and 52. Udelsman BV, Lee KC, Traeger LN, et al. Clinician-to-clinician communication
team briefing among surgeons, nurses, and anesthesiologists to reduce & of patient goals of care within a surgical intensive care unit. J Surg Res 2019;
failures in communication. Arch Surg 2008; 143:12–18. 240:80–88.
43. van Klei WA, Hoff RG, van Aarnhem EE, et al. Effects of the introduction of the Study exploring physicians’ perspectives on barriers and facilitators of interprofes-
WHO ‘Surgical Safety Checklist’ on in-hospital mortality: a cohort study. Ann sional communication in shared decisions on patients’ goal of care.
Surg 2012; 255:44–49. 53. Olson TJ, Brasel KJ, Redman AJ, et al. Surgeon-reported conflict
44. Leong KB, Hanskamp-Sebregts M, van der Wal RA, et al. Effects of perio- with intensivists about postoperative goals of care. JAMA Surg 2013;
perative briefing and debriefing on patient safety: a prospective intervention 148:29–35.
study. BMJ Open 2017; 7:e018367. 54. Cao V, Tan LD, Horn F, et al. Patient-centered structured interdisciplinary
45. Carney BT, West P, Neily J, et al. Differences in nurse and surgeon percep- bedside rounds in the medical ICU. Crit Care Med 2018; 46:85–92.
tions of teamwork: implications for use of a briefing checklist in the OR. AORN 55. Gotlib Conn L, Haas B, Rubenfeld GD, et al. Exclusion of residents from
J 2010; 91:722–729. surgery-intensive care team communication: a qualitative study. J Surg Educ
46. Makary MA, Sexton JB, Freischlag JA, et al. Operating room teamwork among 2016; 73:639–647.
physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 56. Michaelsen A, Long AC, DeKeyser Ganz F, et al. Interprofessional shared
2006; 202:746–752. && decision-making in the ICU: a systematic review and recommendations from
47. Cruz SA, Idowu O, Ho A, et al. Differing perceptions of preoperative com- an expert panel. Crit Care Med 2019; 47:1258–1266.
& munication among surgical team members. Am J Surg 2019; 217:1–6. Systematic review and proposal of five recommendations for implementation of
Survey analyzing barriers to preoperative communication among surgical team mem- interprofessional shared decision-making in intensive care units.
bers. The study revealed a different perception of perioperative communication among 57. Cortegiani A, Russotto V, Raineri SM, et al. Attitudes towards end-of-life
anesthesiologists and surgeons: anesthesiologists feel more dissatisfied than surgeons issues in intensive care unit among Italian anesthesiologists: a nation-wide
and perceive the need for improvements in communication between team members. survey. Support Care Cancer 2018; 26:1773–1780.

176 www.co-anesthesiology.com Volume 33  Number 2  April 2020

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Оценить