A Human Factors Approach to Mitigating Speech Communication Interference in the Operating Room

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surgical machinery coupled with intensified layers of simultaneous relevant and irrelevant conversations. These sources cause a specific type of miscommunication: Speech Communication Interference (SCI), impeding the team’s ability to communicate with each other, distracting from monitoring patient safety, and interfering with maintaining a safe care environment. There is a critical need to examine the larger context of the OR sound environment that leads to miscommunication. We propose groundbreaking research in surgical error prevention by applying Human Factors principles to OR miscommunication, including carefully selected evidence-based interventions from other industries. Our overall mission is to use a Human Factors approach to study the impact of the sound environment on communication in the OR and the execution of tasks necessary for monitoring patient safety. We will use the findings to develop and evaluate interventions to enhance overall communication in the OR. Using video and audio recordings, we will create detailed timelines surrounding Communication Interference events and interview the participants in that failed communication. Applying Human Factors frameworks will provide a rich understanding of the impact of overlapping conversations and environmental noises on patient safety. We will guide a team of content experts, including surgeons, anesthetists, nursing staff, and hospital leaders in the development and testing of interventions to improve OR communication. Outcomes will be measured, both pre-intervention and post-intervention, at three levels: the individual, process and system and will include important clinical outcomes such as hemorrhage and desaturation. We will use acoustical methods to predict noise interference and listener testing, for validation. Finally, we will test the interventions at a second hospital to ensure generalizability. The study will occur at University Health Medical Center and Childrens Mercy Hospital, providing care to underserved patients, many without commercial insurance. Our lab has years of experience videorecording in the OR, creating timelines, and conducting interviews, finding that they have an unparalleled ability to uncover near misses. This project will result in a set of innovative interventions, grounded in a systems approach, to prevent, mitigate, and recover from miscommunication, and will lead to a multi-center trial to test the effect of our OR communication interventions on patient safety in diverse OR settings.