Todd M. Clayman, RN: No financial relationships to disclose
Learning Outcome: At the conclusion of this session, all learners will report an increase in knowledge about the challenges faced by novice nursing staff and the robotic OR. Similarly, they will return to their institution with novel ideas on how to help those novice nurses adjust to communication barriers and improve their ability to communicate in the robotic OR.
Overview/Abstract: The robotic operating room is a loud sound environment in which communication is challenged due to loud machines, and physical separation of team members. As nursing staff turnover increases, and hospitals add additional robots to their fleets, more and more nurses must be oriented to the robotic operating room. Even the most experienced nursing staff can be challenged by being introduced to the robotic operating room. We must help new nurses orient and adjust to the sound environment in the operating room.
At University Health - Kansas City, we have spent years studying the sound environment, noting the challenges to effective interdisciplinary communication and generating solutions. In this interactive session, we will begin with an entertaining skit, demonstrating communication challenges to nursing staff in the robotic operating room. We will host a live poll to learn how other operating rooms deal with communication barriers and orient their nursing staff. We will share the skills we have mastered and brainstorm with the audience on other ways to orient nursing staff to the communication environment in the robotic operating room. By the end of this session, attendees will report an increase in knowledge about the challenges faced by novice nursing staff and the robotic OR. Similarly, they will return to their institution with novel ideas on how to help those novice nurses adjust to communication barriers and improve their ability to communicate in the robotic OR.
Description of Current State: As staff turnover increases, we must continually orient new nurses and other staff to our robotic operating rooms. Miscommunication is a leading cause of surgical error and patient injury (1), and novices are particularly susceptible to environmental sound distractors, communication barriers, and miscommunications in the operating rooms. (2,3) In the Robotic Operating Room, this is exacerbated by the spacing of team members and the loudness of the equipment. (4) At University Health Kansas City, we have measured the sound environment, including decibel levels of common robotic equipment; we have documented approximately three miscommunication events per hour in General Surgery, Gynecology and Urology robotic cases. (5) We have worked with nursing, anesthesia, hospital administration and surgical staff to develop potential interventions to improve the sound environment in the robotic OR. We bring our data and our approach to this audience in order to help them navigate the robotic OR in terms of orienting novice nursing staff
Description of Desired/Achievable State: By the end of this session, attendees will be poised to identify communication barriers in their robotic OR and effectively orient new nursing staff by providing insight and practical strategies to address these challenges.
Audience Engagement: We will begin the session with a brief entertaining skit showing nursing, anesthesia, and surgical staff miscommunicating in the robotic OR due to the loud sound environment and other communication barriers. We will show a brief PowerPoint demonstrating our measurement of sound levels and data collected on communication barriers in our Robotic Operating Room. We will quickly transition to an audience engagement session in which audience members answer polling questions and are able to view responses live. Answers will populate into a word dynamic cloud that will shift as answers populate. We suspect that their experiences with miscommunication in the robotic OR will be similar to ours and share data on each sound source and communication barrier. We will then share with them a set of skills to transmit to new nursing staff during orientation, in order to help them adjust more quickly to the sound environment of the robotic OR. We will follow that with a question and answer session in which audience members can suggest skills they suggest to their new nursing staff during orientation
Additional Information:
Learning Objectives: Understanding Barriers in Communication in a Robotic Operating Room
1. Identify common communication barriers specific to robotic-assisted surgical environments, including physical separation of team members, reduced non-verbal cues, and reliance on technology. 2. Describe the impact of spatial layout and technology (e.g., console location, robotic arms, noise from equipment) on communication flow among surgical team members. 3. Differentiate between human factors (e.g., hierarchy, fatigue, distractions) and technological factors (e.g., microphone clarity, latency, interface issues) that hinder effective communication. 4. Analyze case studies or simulated scenarios to recognize communication breakdowns in robotic OR settings and their potential consequences on patient safety and workflow efficiency. 5. Demonstrate effective communication strategies such as closed-loop communication, structured team briefings, and the use of communication tools tailored for robotic surgery settings. 6. Identify and describe safe decibel levels in the operating room. Recognize the impact of excessive noise on patient and staff safety and clinical outcomes. 7. Describe the damaging effects of excessive noise in the operating room and the impact it has on surgical performance and outcomes. 8. Assess the importance of interdisciplinary teamwork training (e.g., simulation-based exercises, debriefings) in improving communication in robotic OR teams.
Content/Topics: Content and Topics 1. Robotic Operating Room 2. Orientation of new nursing staff 3. Miscommunication in the operating room 4. Interdisciplinary communication and teamwork 5. Patient safety
References: References 1. Greenberg CC, Regenbogen SE, Studdert DM, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204:533e540. 2. Mentis HM, Chellali A, Manser K, Cao CG, Schwaitzberg SD. A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Surg Endosc. May 2016;30(5):1713-24. 3. Keller S, Tschan F, Beldi G, Kurmann A, Candinas D, Semmer NK. Noise peaks influence communication in the operating room. An observational study. Ergonomics. Dec 2016;59(12):1541-1552. 4. Clanahan JM, Awad MM (2023) How does robotic-assisted surgery change or safety culture? AMA J Ethics 25(8):E615–E623. https://doi.org/10.1001/amajethics.2023.615 5. Sutkin G, Steele C, Brommelsiek M, Simonson RJ, Chan YR, Davies A, Catchpole K. Speech communication interference in the robotic operating room. J Robot Surg. 2024 Nov 11;18(1):406. doi: 10.1007/s11701-024-02157-5. PMID 39527346.
