Normal readback orders have been recommended as a patient safety initiative for physicians, surgeons, and staff in order to reduce the incidence of perioperative complications that can result from verbal communication breakdowns. “Many hospitals nationwide have started to implement readbacks as a mandatory protocol, but progress in adopting this strategy has been slow,” says Philip F. Stahel, MD, FACS. “Few studies have assessed the feasibility and acceptability of readbacks among operating room (OR) staff.”
Perceptions & Barriers to Readback Implementation
In BMC Surgery, Dr. Stahel and colleagues had a study published that aimed to understand the perceptions of and barriers to implementing readbacks from the viewpoint of OR personnel. “We also wanted to determine the willingness of OR personnel to attend future training modules and specific scenarios in which readbacks may be effective,” Dr. Stahel says. Results were then compared between surgery and anesthesia departments and between specific staff roles, including attending or midlevel providers, resident physicians, and nursing staff.
“Our results showed that respondents overwhelmingly believed readbacks help reduce communication errors and improve patient safety,” says Dr. Stahel. “Most respondents—both from surgery and anesthesiology departments—strongly agreed that participating in readback training programs would be beneficial. Resident physicians, however, were less likely to feel that readbacks reduced communication errors when compared with other providers and nursing staff. They were also less willing to attend short training modules on readbacks.”
Overall, readbacks were believed to have an important role in patient handoffs, patient orders regarding critical results, counting and verifying surgical instruments, and delegating multiple perioperative tasks. “The biggest challenge in implementation, however, appeared to revolve around determining what kind of communication would be appropriate given the time constraints in the OR,” explains Dr. Stahel. “While these concerns are understandable, many studies have shown that communication safety strategies can actually help prevent unexpected delays and communication failures.”
Examining Implications on Perioperative Safety
Medical errors continue to receive great attention throughout medicine, leading national organizations to endorse the adoption of systems that foster what Dr. Stahel calls a patient safety culture. “The aviation industry has used readbacks for years, with great success. Adapting these concepts to the OR has great potential, but the key is to gain agreement and support from institutional leadership and staff that readbacks indeed are important to improving perioperative safety.”
More work is needed to determine the specific tasks and scenarios in which readbacks would be most helpful in preventing communication errors, according to Dr. Stahel. “Department-specific focus groups may help explain why some members of surgical teams would be reluctant to integrate readbacks into their communication strategy.
We hope data from our analysis can be used to develop acceptable and effective training modules for perioperative personnel on how to appropriately use readbacks to improve patient safety.”
Readings & Resources (click to view)
Prabhaker H, Cooper JB, Sabel A, Weckbach S, Mehler PS, Stahel PF. Introducing standardized “readbacks” to improve patient safety in surgery: a prospective survey in 92 providers at a public safety-net hospital. BMC Surg. 2012;12:8. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418160/.
Stahel PF. Learning from aviation safety: a call for formal “readbacks” in surgery. Patient Saf Surg. 2008;2:21.
Hoover EL. Patient safety and surgeons – why the resistance? Arch Surg. 2007;142:1127-1128.
Mehler PS, Colwell CB, Stahel PF. A structured approach to improving patient safety: Lessons from a public safety-net system. Patient Saf Surg. 2011;5:32.
O’Connor T, Papanikolaou V, Keogh I. Safe surgery, the human factors approach. Surgeon. 2010;8:93-95.