What is the best approach to improve communication among the surgical team during and after surgery to prevent errors and ensure patient safety?

Best Approach to Improve Surgical Team Communication

The best action is to prepare structured communication between the team pre- and post-operatively (Option B), as preoperative briefings and structured handoffs have the strongest evidence for reducing adverse events, improving team performance, and decreasing mortality and morbidity.

Why Structured Pre- and Post-Operative Communication is Superior

Preoperative Briefings Reduce Adverse Events

Preoperative team briefings improve team performance, favor a healthy safety climate, reduce delays, and decrease the rate of adverse events during procedures. 1 These sessions are:

• Short (2-4 minutes at most) and well-accepted by medical teams 1
• Establish collective awareness through sharing of a mental model, including action plans, activation of specific procedures, and determination of each professional's role 1
• Reduce communication failures from a mean of 3.95 per procedure to 1.31 per procedure (P < .001) 2
• Most effective when performed as early as possible before the patient arrives in the operating room 1

Structured Communication Tools Prevent Errors

The most frequent cause of incorrect surgical procedures (wrong patient, side, site, procedure, or implantable device) is faulty communication. 1 Structured tools address this:

• Closed-loop communication (where verbal repetition confirms understanding) reduces morbidity and mortality (OR 4.82, CI95% 1.30-17.87) and limits adverse events 1, 3
• SBAR/SAED/SCAR frameworks structure oral communication to be clear, concise, and exhaustive, improving teamwork and safety climate while reducing unplanned intensive care admissions 1, 3, 4
• Systematic cross-checks reduce adverse events by 40% in emergency settings 3

Postoperative Handoffs Are Critical

Explicit handovers must occur when transferring to PACU and thereafter to the ward, including communication of postoperative risks and specific concerns. 1 This includes:

• Direct surgical handover to PACU and/or ward nurses to enhance staff awareness and improve patient safety 1
• WHO surgical safety checklist sign-out to highlight concerns for postoperative complications through cascaded handovers 1
• Standardized handover processes with targeted checklists reduce hypoxemic events in post-anesthesia care 3

Why Daily Postoperative Meetings Alone (Option A) Are Insufficient

While postoperative communication is important, daily meetings alone do not address the critical preoperative phase where most communication failures can be prevented. The evidence overwhelmingly supports that:

• Preoperative briefings are where team mental models are established and roles clarified 1
• Communication failures during the procedure itself are best prevented by preoperative preparation, not retrospective daily meetings 2
• Immediate postoperative handoffs (not delayed daily meetings) are what guidelines recommend for safety 1

Implementation Algorithm

Before Surgery:

1. Conduct a preoperative briefing 2-4 minutes before patient arrival 1
2. Use a structured checklist covering patient identity, procedure, site, roles, anticipated challenges, and equipment needs 1, 5
3. Employ closed-loop communication where team members verbally confirm understanding 1, 3, 5
4. Ensure surgeon-anesthesiologist communication about airway concerns, monitoring needs, and patient-specific risks 1

During Surgery:

1. Perform formal timeout with closed-loop verification of patient identity, procedure, and site 5
2. Use critical language skills and standardized phrases to signal potential problems 3
3. Maintain closed-loop communication for all critical information exchanges 1

After Surgery:

1. Conduct WHO surgical safety checklist sign-out highlighting postoperative concerns 1
2. Direct surgical handover to PACU staff with explicit communication of bleeding risks and complications 1
3. Structured handover to ward using SBAR or similar framework 1, 3, 4

Common Pitfalls to Avoid

• Don't skip briefings for "routine" cases - crises can occur in routine situations (e.g., cardiac arrest during anesthetic induction) 1
• Avoid briefings that mask knowledge gaps or perpetuate hierarchy - 15% of briefings can have paradoxical negative effects if not conducted properly with shared objectives 1
• Don't rely on informal communication - standardization is key to reducing the 40% of adverse events attributable to communication failures 3
• Never assume understanding - always use closed-loop communication with verbal confirmation 1, 3

Evidence Quality Considerations

The 2023 Anaesthesia guidelines on human factors represent the most recent, high-quality evidence specifically addressing surgical team communication 1. These guidelines synthesize multiple studies showing that structured preoperative briefings improve team performance and reduce adverse events. The supporting research demonstrates significant reductions in communication failures (67% reduction) 2 and improvements in both communication and teamwork scores (p < .001 and p = .003 respectively) 6.