Processes and tools to improve teamwork and communication in surgical settings: a narrative review

Patient safety has become a global priority to support reducing harm associated with healthcare delivery.1 In Canada, patient safety incidents (PSI) are the third leading cause of death behind heart disease and stroke and are associated with an additional cost to the healthcare system of $2.75 billion each year.2 PSIs occur across the healthcare continuum, but over half are associated with surgical care, which consists of preoperative, intraoperative and postoperative care.3 4 Globally, four main threats to surgical safety have been identified: (1) insufficient recognition of safety as a public health concern, (2) lack of available data related to surgical outcomes, (3) the inconsistent implementation of existing safety practices, and (4) the complexity of the surgical setting.5 The WHO Guidelines for Safe Surgery, published in 2009, have increased and highlighted the importance of surgical safety worldwide. However, key gaps related to complexity of surgical processes still remain to be addressed. A leading cause of these events is communication failure between care providers during surgical care, and between transition points during ‘hand-offs’ or ‘handovers’.6 Information shared at these transition points is required to facilitate continuity of information and patient care, and to prevent medical errors.7 This has resulted in national organisations, such as the Canadian Patient Safety Institute (CPSI), identifying surgical safety as a key priority. In a joint review by the Canadian Medical Protective Association (CMPA) and the Healthcare Insurance Reciprocal of Canada (HIROC), data from 2004 to 2013, which consisted of 2974 legal cases, were reviewed and nearly half of the incidents occurred due to system-level factors, rather than physician or healthcare provider (HCP)-level factors.8 A frequent system-level issue was lack of adherence to protocols, such as use of the surgical safety checklist (SSC), which is intended to improve team communication.8 …