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Ann Thorac Surg. 2019 Jun 26. pii: S0003-4975(19)30882-3. doi: 10.1016/j.athoracsur.2019.04.116. [Epub ahead of print]

"Nobody told me": Communication issues affecting Australian cardiothoracic surgery patients.

Author information

1
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, South Australia. Electronic address: justin.chan@adelaide.edu.au.
2
Faculty of Health and Medical Sciences, University of Adelaide, South Australia.
3
Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia.
4
Faculty of Health and Medical Sciences, University of Adelaide, South Australia; Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, Adelaide, Australia.
5
Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia.
6
Faculty of Health and Medical Sciences, University of Adelaide, South Australia; Basil Hetzel Institute, Woodville South, South Australia.

Abstract

BACKGROUND:

Failure of communication can have potentially severe results in cardiothoracic surgery. Previous literature regarding patient safety highlighted communication as a common area for improvement. This study utilised a qualitative approach to analyse a national mortality audit dataset to identify and describe communication issues which could potentially contribute to patient mortality following cardiothoracic surgery.

METHODS:

We utilised a peer reviewed audit of surgical deaths following cardiothoracic surgery in Australian hospitals from 2009 to 2015 via the Australian and New Zealand Audit of Surgical Mortality. Cases were identified with clinical management issues then individual analysis of cases highlighting communication issues was undertaken. A total of 91 reports from surgeons and assessors were analysed using a thematic analytic approach.

RESULTS:

Nine-hundred and eight cases of potentially avoidable mortality were identified as being associated with clinical management issues, and communication issues were identified in 91 (10%) of these cases, which served as the basis for this analysis. The study found that failure to achieve shared decision making was the most common theme (n=38, 41.8%), followed by failure to notify patient deterioration (n=22, 24.1%), misreporting of patient condition (n=10, 11.0%) and issues related to informed consent (n=9, 10.0%). The most frequent communication issues occurred between surgeons and the intensive care unit.

CONCLUSIONS:

Poor communication was identified in patients who died following cardiothoracic surgery. Communication is an important modifiable factor in patient mortality. Efforts to address teamwork and communication have the potential to improve safety and quality of care for patients undergoing cardiothoracic surgery.

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