Communication failure categories and their definitions, frequency of occurrence and illustrative exemplars of each type
| Communication failure category | Definition | n (%) | Illustrative exemplar | Analytical notes |
| Experience | A lack of knowledge and/or understanding of the specialised language and verbal/non-verbal communication used in surgery. | 54 (30.9) | Surgeon requests a ‘pledget’ [small swab]; the novice instrument nurse raises her shoulders and intently searches her immediate working area and looks to the circulating nurse who also appears not to know. Clarification with the surgeon is not sought from either nurse. Moments pass and the surgeon, who now appears slightly irritated, repeats the request. | Miscommunication ensued because of the nurses' apparent lack of familiarity with the term and the experience to make explicit interpretations from implicit information. Additionally, the nurse did not seek clarification. |
| Occasion | The physical and temporal context of the information or request was too late to be of maximum use. | 46 (26.3) | During wound closure the surgeon, not taking his eyes off the surgical field, requests the next patient on the list to be transferred from the ward to the OR. | The lateness of this request resulted in a substantial time delay before the next patient arrived to the OR. To avoid a delay in the list, timing of this request is crucial as in this facility it often takes 45 min for the patient to be transferred from the wards to the OR. |
| Content | Insufficient quality, accuracy or amount of information given during the communication. | 35 (20.0) | Surgeon requests a ‘dissector’ during a neurosurgical procedure, the instrument nurse passes him the particular dissector that he was previously using believing this is the one required. He states, “No, the Penfield's Number 5”. | In neuro surgery, there are specific types of dissectors used during the different stages of surgery. The type of dissector chosen is also based on the surgeon's personal preference. Insufficient information was given in relation to the type of dissector required. |
| Purpose | The goals and/intent of the communication were not met. | 23 (13.1) | The orthopaedic registrar, not looking at anyone in particular, requests another instrument, “would you have a K-wire driver on your set?” The circulating nurse goes outside and brings one in and announces, “I have a K-wire driver tray, would you like it opened?” The surgeons continue working. The instrument nurse asks the surgeon three more times but his questions do not elicit a response from either surgeon. There is no further mention of the K-wire driver during the procedure. | The purpose of the exchange is not achieved. |
| Audience | Key participants were not present or involved in the communication. | 17 (9.7) | The circulating nurse and anaesthetic registrar discuss the positioning of the patient for orthopaedic surgery without the surgeon being present and the patient is subsequently positioned. Minutes later, the surgeon arrives and requests for the patient to be repositioned. | The surgeon is integral to this discussion as decisions made in his/her absence lead to renewed discussion and repositioning of the patient. |
| Total | 175 (100) |
OR, operating room.