Information Transfer and Communication in Surgical Care
Author(s)
Nagpal, Kamal
Type
Thesis
Abstract
Effective Information transfer and Communication is one of the key aspects of good
medical practice and essential for surgical safety. High reliability organisations such
as aviation have highlighted the importance of communication for safety and
regularly provide communication skills training to their team members via Crew
resource management (CRM) module. This report discusses important aspects of
communication research in high-risk environments and confers its application in
surgery. It analyses the nature and scope of communication failures in surgical field.
The thesis has taken bottom-up approach unlike other research in this field, which has
taken a top-down approach. First we have mapped and analysed the communication
failures across the entire surgical pathway. Analysis of full pathway is critical as
communication failures are not discrete events; information loss in one phase of care
can potentially compromise safety in a subsequent phase. After the analysis, user-centred
interventions were developed and implemented to enhance the information
transfer and communication in the postoperative handover phase. Results show that
information transfer and communication failures are ubiquitous and distributed across
the continuum of surgical care. These findings indicate that there is a room for
improvement for enhancing ITC in surgical care. There is an imminent need for
standardizing and structuring communication through use of checklists, proformas,
care pathways and information technology. Subsequently we have demonstrated that
standardization of ITC process through the implementation of postoperative handover
proforma has improved the information transfer and decreased the ITC errors. It is
hoped that this thesis provides a first step towards understanding, assessing and
improving information transfer and communication through entire surgical care
pathway, which in a long run will improve surgical safety.
medical practice and essential for surgical safety. High reliability organisations such
as aviation have highlighted the importance of communication for safety and
regularly provide communication skills training to their team members via Crew
resource management (CRM) module. This report discusses important aspects of
communication research in high-risk environments and confers its application in
surgery. It analyses the nature and scope of communication failures in surgical field.
The thesis has taken bottom-up approach unlike other research in this field, which has
taken a top-down approach. First we have mapped and analysed the communication
failures across the entire surgical pathway. Analysis of full pathway is critical as
communication failures are not discrete events; information loss in one phase of care
can potentially compromise safety in a subsequent phase. After the analysis, user-centred
interventions were developed and implemented to enhance the information
transfer and communication in the postoperative handover phase. Results show that
information transfer and communication failures are ubiquitous and distributed across
the continuum of surgical care. These findings indicate that there is a room for
improvement for enhancing ITC in surgical care. There is an imminent need for
standardizing and structuring communication through use of checklists, proformas,
care pathways and information technology. Subsequently we have demonstrated that
standardization of ITC process through the implementation of postoperative handover
proforma has improved the information transfer and decreased the ITC errors. It is
hoped that this thesis provides a first step towards understanding, assessing and
improving information transfer and communication through entire surgical care
pathway, which in a long run will improve surgical safety.
Date Issued
2011
Date Awarded
2011-08
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Moorthy, Krishna
Vincent, Charles
Creator
Nagpal, Kamal
Publisher Department
Surgery and Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)