Governing the surgical count through communication interactions: implications for patient safety

Area of Science:

• Healthcare communication
• Surgical safety
• Qualitative research

Background:

• Retained surgical items are an infrequent but serious complication.
• Poor communication is a known factor influencing surgical outcomes.
• Surgical counts are a critical safety procedure to prevent retained items.

Purpose of the Study:

• To explore power dynamics in nurse-surgeon communication.
• To understand how these dynamics affect the surgical count process.
• To identify communication barriers impacting patient safety during surgery.

Main Methods:

• Qualitative ethnographic study in three Australian operating departments.
• Participant observation of 11 operating room nurses (230 hours).
• Interviews with nurses and analysis of diary entries.

Main Results:

• Clinicians use discursive practices to control surgical counts.
• Key issues include judging count accuracy, normalizing deviations, and prioritizing tasks.
• Power imbalances influence adherence to protocols.

Conclusions:

• Power relationships and balancing policy with professional judgment are complex.
• Increased accountability and better time management are needed.
• Technological solutions should supplement manual surgical counts.