Call me Ishmael: addressing the white whale of team communication in the operating room with labelled surgical caps at an academic medical centre

Nicole Hamilton Goldhaber; Shivani Mehta; Christopher A Longhurst; Elizabeth Malachowski; Melissa Jones; Bryan M Clary; Robin L Schaefer; Michael McHale; Lisa P Rhodes; Kristin L Mekeel; J Jeffery Reeves

doi:10.1136/bmjoq-2023-002453

Call me Ishmael: addressing the white whale of team communication in the operating room with labelled surgical caps at an academic medical centre

BMJ Open Qual. 2024 Apr 8;13(2):e002453. doi: 10.1136/bmjoq-2023-002453.

Affiliations

¹ Department of Surgery, University of California San Diego, La Jolla, California, USA nhgoldhaber@health.ucsd.edu.
² School of Medicine, University of California San Diego, La Jolla, California, USA.
³ Department of Pediatrics, Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA.
⁴ Perioperative Services, University of California San Diego, La Jolla, California, USA.
⁵ Department of Surgery, University of California San Diego, La Jolla, California, USA.
⁶ Department of OBGYN, University of California San Diego, La Jolla, California, USA.

Abstract

Introduction: Effective communication in the operating room (OR) is crucial. Addressing a colleague by their name is respectful, humanising, entrusting and associated with improved clinical outcomes. We aimed to enhance team communication in the perioperative environment by offering personalised surgical caps labelled with name and provider role to all OR team members at a large academic medical centre.

Materials and methods: This was a quasi-experimental, uncontrolled, before-and-after quality improvement study. A survey regarding perceptions of team communication, knowledge of names and roles, communication barriers, and culture was administered before and after cap delivery. Survey results were measured on a 5-point Likert Scale; descriptive statistics and mean scores were compared. All cause National Surgical Quality Improvement Project (NSQIP) morbidity and mortality outcomes for surgical specialties were examined.

Results: 1420 caps were delivered across the institution. Mean survey scores increased for knowing the names and roles of providers around the OR, feeling that people know my name and feeling comfortable communicating without barriers across disciplines. The mean score for team communication around the OR is excellent was unchanged. The highest score both before and after was knowing the name of an interdisciplinary team member is important for patient care. A total of 383 and 212 providers participated in the study before and after cap delivery, respectively. Participants agreed or strongly agreed that labelled surgical caps made it easier to talk to colleagues (64.9%) while improving communication (66.0%), team culture (60.5%) and patient care (56.8%). No significant differences were noted in NSQIP outcomes.

Conclusions: Personalised labelled surgical caps are a simple, inexpensive tool that demonstrates promise in improving perioperative team communication. Creating highly reliable surgical teams with optimal communication channels requires a multifaceted approach with engaged leadership, empowered front-line providers and an institutional commitment to continuous process improvement.

Keywords: communication; continuous quality improvement; human factors; safety culture; teamwork.

MeSH terms

Academic Medical Centers
Animals
Beluga Whale*
Communication
Humans
Operating Rooms*
Postoperative Complications