Ineffective communication among members of operating room teams can lead to medical error, so identifying the reasons for poor communication are vital, says a University of Toronto researcher.

"The literature has suggested an association between team communication and error but, until now, there was no empirical evidence about what communications problems occurred regularly for the purpose of being able to intervene and improve things," says Lorelei Lingard, a professor at the U of T Wilson Centre for Research in Education and Department of Pediatrics.

Lingard and fellow U of T researchers identified these problems in a study published in the October issue of Quality & Safety in Health Care. They studied 421 communications events, such as requests for antibiotic administration and discussions about patient positioning. Researchers found communications failures occurred in 30 per cent of such exchanges. One-third of these failures, or 10 per cent of the total number of events, resulted in circumstances that could jeopardize patient safety by increasing memory load, by interrupting routine or by increasing the tension in the operating room.

The communications problems are "strikingly straightforward," says Lingard. They fall into four categories: