Table 2

Definitions of types of communication failure with illustrative examples and notes

Failure	Definition	Illustrative example and analytical note (in italics)
Occasion failures	Problems in the situation or context of the communication event	The staff surgeon asks the anesthesiologist whether the antibiotics have been administered. At the point of this question, the procedure has been underway for over an hour.
		Since antibiotics are optimally given within 30 minutes of incision,²¹the timing of this inquiry is ineffective both as a prompt and as a safety redundancy measure.

Content failures	Insufficiency or inaccuracy apparent in the information being transferred	As the case is set up, the anesthesia fellow asks the staff surgeon if the patient has an ICU (intensive care unit) bed. The staff surgeon replies that the “bed is probably not needed, and there isn’t likely one available anyway, so we’ll just go ahead.”
		Relevant information is missing and questions are left unresolved: has an ICU bed been requested, and what will the plan be if the patient does need critical care and an ICU bed is not available? [Note: this example was classified as both a content and a purpose failure.]

Audience failures	Gaps in the composition of the group engaged in the communication	The nurses and anesthesiologist discuss how the patient should be positioned for surgery without the participation of a surgical representative.
		Surgeons have particular positioning needs so they should be participants in this discussion. Decisions made in their absence occasionally lead to renewed discussions and repositioning upon their arrival.

Purpose failures	Communication events in which purpose is unclear, not achieved, or inappropriate	During a living donor liver resection, the nurses discuss whether ice is needed in the basin they are preparing for the liver. Neither knows. No further discussion ensues.
		The purpose of this communication—to find out if ice is required—is not achieved. No plan to achieve it is articulated.