OTA 2005 Posters

Scientific Poster #23 Polytrauma/Injury Prevention

:Communication between Intraoperative Orthopaedic Surgeons and Orthopaedic Floor Nurses: Direct Cellular versus Indirect Pager Communication: A Prospective, Randomized Comparison

Gil R. Ortega, MD, MPH (n); Dieter Lindskog, MD (n);

Sudeep Taksali, MD (n); Rahul Shah, MD (n); Michael R. Baumgaertner, MD (n);

Yale University Department of Orthopaedics, New Haven, Connecticut, USA

Hypothesis: Wireless cellular communication improves communication between intraoperative orthopaedic surgeons and floor nurses and minimizes intraoperative interruption when compared to pager communication.

Methods: Both communication types occurred while the surgeon was scrubbed in the operating room (OR) without breaking sterile technique. Indirect communication occurred when the pager call was answered by the OR circulating nurse with communication between the surgeon, circulating nurse, and floor nurse. Direct communication consisted of cell phone and Jabra Bluetooth wireless ear piece used by the surgeon. The surgeon answered the floor nurse's cellular call by phone ring-activated automatic answering. The study was conducted during a period of scheduled orthopaedic procedures. An independent observer measured time variables with a stopwatch while orthopaedic nurses randomly called via pager or cell phone. The nurses asked for patient caregiver confirmation and answers to 30 different patient care questions. The equipment used included a pager, Samsung i700 cell phone, Jabra Bluetooth BT200 earpiece, and Verizon service.

Results: Sixty trials were performed with 30 cell and 30 page communications. Direct cellular communication showed a better response rate than indirect page (Cell 100%, Page 73%). When compared to pager communications, cellular communications showed statistically significant improvements in mean time intervals in response time (Cell=11 s, Page=211 s), correct patient identification (Cell=5 s, Page=172 s), patient problem and solution time (Cell=13 s, Page=189 s), and total communication time (Cell=32 s, Page=250 s) (s=seconds, all P< 0.0001). Floor nurse satisfaction ratings (dependent on communication times and/or difficulties) were improved with direct cellular communication (Cell=29 excellent, Page=11 excellent). Intraoperative case interruptions (defined as delaying surgical progress) were more frequent with indirect page communication (10 page versus 0 cell). During the study, there were no cellular electronic interferences with patient monitoring devices including both anesthesia and spinal monitoring.

Conclusion/Significance: Our study displays evidence that direct cellular intraoperative communication improves communication times, communication accuracy, and communication satisfaction, and minimizes intraoperative case interruption. As a result of this study, we hope to transition to direct cellular intraoperative orthopaedic communication to reduce medical errors, improve patient care, and enhance both orthopaedic surgeon and nursing efficiencies.