Team interaction during surgery: a systematic review of communication coding schemes

Abstract

Background: Communication problems have been systematically linked to human errors in surgery and a deep understanding of the underlying processes is essential. Although a number of tools exist to assess nontechnical skills, methods to study communication and other team-related processes are far from being standardized, making comparisons challenging. We conducted a systematic review to analyze methods used to study events in the operating room (OR) and to develop a synthesized coding scheme for OR team communication.

Materials and methods: Six electronic databases were accessed to search for articles that collected individual events during surgery and included detailed coding schemes. Additional articles were added based on cross-referencing. That collection was then classified based on type of events collected, environment type (real or simulated), number of procedures, type of surgical task, team characteristics, method of data collection, and coding scheme characteristics. All dimensions within each coding scheme were grouped based on emergent content similarity. Categories drawn from articles, which focused on communication events, were further analyzed and synthesized into one common coding scheme.

Results: A total of 34 of 949 articles met the inclusion criteria. The methodological characteristics and coding dimensions of the articles were summarized. A priori coding was used in nine studies. The synthesized coding scheme for OR communication included six dimensions as follows: information flow, period, statement type, topic, communication breakdown, and effects of communication breakdown.

Conclusions: The coding scheme provides a standardized coding method for OR communication, which can be used to develop a priori codes for future studies especially in comparative effectiveness research.

Keywords: Communication coding schemes; Medical errors; Nontechnical skills; Surgery; Team communication; Teamwork.