Miscommunication associated with flow disruptions in the robotic operating room.

backgroundMiscommunication in the robotic operating room occurs up to 3 times per hour and is a significant contributor to patient harm. In robotic surgery, environmental distractors exacerbate miscommunication and flow disruptions, elevating the risk of patient harm.

methodsWe directly observed 75 robotic surgeries and assessed miscommunication associated with flow disruptions using a custom observational instrument. Observers collected data on speech communication interferences and their event evidence, contextual data, staff involvement in the event, communication flow, and flow disruption time. Data from each observed case was aggregated into case-level events and analyzed with a weighted Pearson correlation analysis.

resultsCorrelation coefficients for contextual and event-based weighted correlates demonstrate the strongest relationships between overlapping conversations and no responses during a miscommunication and the surgeon leaning out of the console and clarifications. Contextual and staff-based correlates showed strong relationships between the frequency of clarifications, multitasking, and the involvement of all staff. Finally, evidence of event- and staff-based correlates showed the strongest relationships between the frequency of loud machines and the medical student; the frequency of the surgeon leaning out of the console and the surgical resident, attending surgeon, and scrub tech. Multiple near misses associated with miscommunication were observed.

conclusionMiscommunications and flow disruptions increase case length and the risk of misunderstanding and patient harm. The surgeon often leans out of the console to clarify messages. The surgical resident, certified registered nurse anesthetist, and scrub tech often mediate messages. Loud machines are associated with higher rates of no response, and medical students often request clarifications.