Abstract
Introduction
Patient safety has become a global priority to support reducing harm associated with healthcare delivery.1 In Canada, patient safety incidents (PSI) are the third leading cause of death behind heart disease and stroke and are associated with an additional cost to the healthcare system of $2.75 billion each year.2 PSIs occur across the healthcare continuum, but over half are associated with surgical care, which consists of preoperative, intraoperative and postoperative care.3 4 Globally, four main threats to surgical safety have been identified: (1) insufficient recognition of safety as a public health concern, (2) lack of available data related to surgical outcomes, (3) the inconsistent implementation of existing safety practices, and (4) the complexity of the surgical setting.5 The WHO Guidelines for Safe Surgery, published in 2009, have increased and highlighted the importance of surgical safety worldwide. However, key gaps related to complexity of surgical processes still remain to be addressed. A leading cause of these events is communication failure between care providers during surgical care, and between transition points during ‘hand-offs’ or ‘handovers’.6 Information shared at these transition points is required to facilitate continuity of information and patient care, and to prevent medical errors.7 This has resulted in national organisations, such as the Canadian Patient Safety Institute (CPSI), identifying surgical safety as a key priority.
In a joint review by the Canadian Medical Protective Association (CMPA) and the Healthcare Insurance Reciprocal of Canada (HIROC), data from 2004 to 2013, which consisted of 2974 legal cases, were reviewed and nearly half of the incidents occurred due to system-level factors, rather than physician or healthcare provider (HCP)-level factors.8 A frequent
system-level issue was lack of adherence to protocols, such as use of the surgical safety checklist (SSC), which is intended to improve team communication.8 9 In addition to incidents that cause patient harm, PSIs also include events that do not lead to patient harm as well as near-miss events.10 Hamilton and colleagues report that near misses and adverse events are under-reported, particularly within the operating room (OR) setting suggesting that exploration of how teams communicate in all phases of surgical care is necessary.11
The purpose of this narrative review is to identify and summarise leading practices, tools and resources for effective communication and teamwork during surgical care including the immediate preoperative, intraoperative and postoperative phases.12 This review addressed the following questions:
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What practices, processes and tools are currently being used to improve communication and teamwork during surgical care?
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How are these practices, processes and tools being implemented into surgical practice?
Methods
We conducted a narrative review to explore existing practices, processes, tools and resources available to improve communication and teamwork during all phases of surgical care.13 14 We searched the databases PubMed, MEDLINE and CINAHL using a variety of search terms associated with preoperative, intraoperative and postoperative care (table 1). Online supplementary file 1 provides detailed information related to the search strategy.