A recent work experience in which inter-professional collaboration and communication was wanting occurred in my facility’s surgical theater. As is common practice, the theater board had a myriad of patients scheduled to undergo surgery for various indications that day. The ear, nose, and throat surgeon I was assisting for the day was handling the case of a patient who was suffering from recurrent tonsillitis. The mainstay of treatment in this case is usually tonsillectomy (the excision of both tonsils). A patient was then wheeled in by the theater nurses and put under general anesthesia by the anesthetist on call for that day, while we were scrubbing in preparation for the surgery. Upon arrival, the surgeon gloved up and set up the surgical site in readiness to make the first incision. Something peculiar caught the surgeon’s eye as he inspected the patient’s oral cavity, however. While the mouth of the patient is wide open, tonsillitis that is severe enough to warrant tonsillectomy is always discernible on inspection. The tonsils are usually hypertrophied to or beyond the level of the tonsillar pillars, which are formed by the muscle tissue that constitutes the anterior and posterior borders of the tonsillar fossa. In severe cases, the inflammation is so great that they may extend to the midline, possibly obstructing swallowing and breathing. In this patient, however, all that could be visualized was the anterior tonsillar border, which is formed by the palatoglossus muscle covered by the oral mucosa. There was no erythema, calcification of debris (as is the case with tonsillar stones, another indication for tonsillectomy), or any grade of enlargement. This patient’s tonsils appeared entirely normal to all those present, which made us question whether this was indeed the patient for whom the procedure was intended.
One of the obstacles that existed within that scenario was the fact that the anesthetist had put the patient under without confirming details such as the patient’s name. If we had come in while the patient was still awake, we would have been able to verify personal details from the patient himself. The nurses who had brought him in from the surgical ward were also unavailable as they had left soon after bringing him in to tend to other patients requiring pre-operative and post-operative care. The surgeon had not seen the patient prior to his being brought to theater as he had been seen in the outpatient clinic by another medical practitioner in the ENT department, who had booked him for surgery. The former was therefore not familiar with the patient. In addition, none of the staff at the reception had been at the desk to receive the patient’s file. Therefore, it was impossible to confirm the patient’s particulars and indications for surgery without the assistance of the nurses who brought him in.
In a bid to solve the problem, the first step I took was to recommend that the patient be woken up from sedation to clarify the situation. I then performed a full physical examination of the patient, which revealed crepitus, swelling, and an obvious deformity on the right lower limb, all of which indicated a fracture. I came to the conclusion that the patient was likely to be in theater for an orthopedic procedure. I then left to find the surgical nurse wards, who came in to identify the patient’s files and sort out the mix-up. The right patient was found in the adjacent theater, and the procedure was then carried out flawlessly.
In conclusion, an organized health care provision team, particularly in the surgical setting, is important to achieving optimum outcomes for the patient. Poor nurse-physician communication threatens to sabotage patient care (Colombo, 2009). It undermines the functionality of a collaboration-dependent organizational culture within a health facility (Crawford, Omery, & Seago, 2012). A study by O’Connor et al. (2016) attributed the majority of hospital cases of poor team function to low quality of collaboration. Both physicians and nurses are tasked with ensuring that the patient achieves optimum levels of care (Huber, 2014). A failure in communication between the nurses and the surgeon could have resulted in unnecessary surgery on a patient in this case, an outcome that was luckily averted.
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References
Colombo, C. (2009). Nurse–physician summit: Fostering communication, collaboration and commitment. Nursing for Women’s Health, 13(6), 511-514.
Crawford, C. L., Omery, A., & Seago, J. A. (2012). The challenges of nurse–physician
communication: A review of the evidence. JONA: The Journal of Nursing Administration, 42(12), 548-550.
Huber, D. L. (2014). Leadership and nursing care management (5th ed.). St. Louis, MO:
Saunders/Elsevier.
O’Connor, P., O’dea, A., Lydon, S., Offiah, G., Scott, J., Flannery, A., … Byrne, D. (2016). A
mixed-methods study of the causes and impact of poor teamwork between junior doctors and nurses. International Journal for Quality in Health Care, 28(3), 339-345.