• Comparative effectiveness research
• communication
• checklists
• duty hours/work hours
• leadership

Gillespie and colleagues have reported on their structured observations in operating rooms to help us understand which factors (interruptions, communication failures, team familiarity and the unpredictability of unplanned cases) prolong the length of an operation and lead to inefficiency and increased costs. All of us feel intuitively that a well-orchestrated operation is best for everyone involved—the patient, the surgeon, the anaesthesiologist, the nurse and the hospital's bottom line. Communication failures have been identified by Makary and others to cause the majority of errors in the operating room as reviewed retrospectively.1–3 This paper is one of the very first to observe communication failures in real time and connect those communication failures to a longer than expected operating time.

In order to improve communication, many operating room teams have expanded the perioperative …