Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence

Abstract

Purpose: Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia. Methods:We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts. Results:We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake. Conclusion

Review article: The influence of psychology and human factors on education in anesthesiology

“…27,28 These have been focused largely on doctor-patient relationships, but we are now beginning to develop a better understanding regarding how to communicate effectively with colleagues. 29,30 Techniques such as SBAR (Situation, Background, Assessment, Recommendation) 31 and closed-loop communication 32 This section clearly follows the previous one. Effective communication is key to good team work, but good team work is more than good communication.…”

Ethnographic research applied to anesthesia

“…1,2 Since evidence for best practices is derived from both quantitative and qualitative sources, 3 it is worthwhile to explore some of the intellectual and methodological foundations of ethnographic studies like Smith et al's paper in this issue, "Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence". 4 I will begin with a discussion of the foundations of ethnographic research, then will highlight specific indicators of quality found in their paper. This introduction is intended to draw attention to a growing body of ethnographies that illuminate expert practice in anesthesia.…”

“…In their paper, Smith et al 4 argue that the ethnographic approach is ideal for illuminating the tacit knowledge developed by professionals in the practice world, and their study presents some intriguing insights into communication during induction and emergence. The authors have taken an original approach to the issue of communication by seeking to reveal patterns of communication in everyday practice.…”

“…dans leur article du présent numéro, Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence. 4 Nous discuterons d'abord des fondements de la recherche ethnographique et présenterons des indicateurs spécifiques de la qualité découverts dans l'article. Cette introduction à l'approche ethnographique veut attirer l'attention sur une composante de l'ethnographie en pleine évolution qui éclaire la pratique spécialisée de l'anesthésie.…”

“…4 soutiennent que l'approche ethnographique est idéale pour mettre en lumière le savoir tacite développé par les professionnels dans le monde de la pratique. Leur étude présente certains aspects curieux de la communication qui a lieu pendant l'induction de l'anesthésie et le retour à la conscience.…”