The ‘go-between’ study: a simulation study comparing the ‘Traffic Lights’ and ‘SBAR’ tools as a means of communication between anaesthetic staff

Abstract

SummaryCommunicating non-urgent, urgent and frank emergency requests for assistance between anaesthetists in theatre often requires a 'go-between' -frequently a non-anaesthetic healthcare professional -to transmit information. We compared the currently recommended situation, background, assessment, recommendation (SBAR) tool with a newly devised Traffic Lights tool ('red alert', 'amber assist' and 'green query') in a simulation study to assess communication quality using 12 validated clinical scenarios of varying urgency. Compared to SBAR, Traffic Lights was used more consistently ('very clear' or 'clear' Traffic Lights 94% vs SBAR 69%); transferred information better (two or three pieces of information correctly transferred Traffic Lights 85%, SBAR 44%; and was judged to lead to greater clarity (all p < 0.0001). Message delivery time was significantly reduced (Traffic Lights 20.5 s vs SBAR 45.5 s, median (95% CI) difference 25 (19-30) s, p < 0.001). Users rated the Traffic Lights system as significantly more useful than SBAR, with 96% of participants preferring the Traffic Lights tool. Results were independent of go-between training. We recommend the adoption of this communication tool as standard practice for anaesthetic teams.

‘Help! I need somebody’: getting timely assistance in clinical practice

“…Good communication is rightly regarded as critical to safe anaesthetic practice [2] and poor communication is almost universally identified as a contributing factor in cases of avoidable morbidity and mortality [1]. Given this finding, it is perhaps surprising that formal teaching on handover is inconsistent [3,4].…”

“…Given this finding, it is perhaps surprising that formal teaching on handover is inconsistent [3,4]. Rather, communication appears to often be part of the 'tacit knowledge' of medical practice and learned informally through observation of professional interactions during training [1].…”

“…The authors found a higher incidence of complications in patients who received a caudal block (24.5%), compared with those who received a general anaesthetic only (15.1%) [1]. Their study was limited to only one surgical technique.…”

“…An article in this month's Anaesthesia compares postoperative surgical complications in children undergoing urethroplasty under general anaesthesia accompanied by a caudal epidural block with general anaesthesia alone [1]. The authors reported a higher incidence of postoperative surgical complications in children who received a caudal block, despite the fact that patients in this group had superior postoperative analgesia.…”

“…Kim et al [1] reported a retrospective review of complications following primary single stage tubularised incised plate hypospadias repair between 2010 and 2014. The authors found a higher incidence of complications in patients who received a caudal block (24.5%), compared with those who received a general anaesthetic only (15.1%) [1].…”