Use and effectiveness of directed, closed-loop communication in the operating theatre: mixed methods analysis of simulated clinical emergencies.

Abstract

Effective team performance requires clear communication. Closed-loop communication has improved outcome measures across a range of clinical contexts. We explored the use and effectiveness of directed, closed-loop communication in the operating theatre. We hypothesised that directed, closed-loop communication would increase the proportion of requested actions that were completed. We explored actions completed with closed-loop and directed communication, request type, communication efficiency, and professional differences. The study involved a mixed methods conversational analysis of eight operating theatre emergency simulations. Of 150 requests for action, 12% used closed-loop and directed communication together and were associated with higher action completion rates than when neither or one strategy alone was used (100% vs 81%, P=0.030), 19% used closed-loop (with or without directed) communication and were associated with higher action completion rate than when closed-loop was not used (97% vs 80%, P=0.023), and 45% used directed (with or without closed-loop) communication and were not associated with a significant difference in action completion rate compared with when not used (86% vs 81%, P=0.256). We identified inefficiencies in response to requested tasks, including in time-critical tasks, such as no verbal response, repetition of request, or an initial response but no action. Directed, closed-loop communication in simulated operating theatre emergencies was associated with increased task completion but was infrequently used. Inefficiencies and dropped requests have implications for team performance and patient safety. Our findings support implementing context-specific interventions to improve task management in operating theatre emergencies through improved communication clarity.