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Book: Communication in Surgical Practice

Chapter: Chapter 10 “Coming Up!”: Why Verbal Acknowledgement Matters in the Operating Theatre

DOI: 10.1558/equinox.26854


In the operating theatre, communication problems are the leading cause of patient harm. Yet, relatively little is known about the actual interactions that take place in surgical operations between surgeons and nurses. The aim of the present study was to examine, in detail, nurses’ responses to surgeon’s requests, and to identify what kinds issues occur in these exchanges. A video-based study examining team communication was conducted in a major UK teaching hospital. A total of 20 general surgical operations were observed and video-recorded. In total, approximately 68 hours of video data were reviewed. A subsample of 9 operations (13 h 40 mins in total) has been analysed using interactional analysis developed within the social sciences. Distributional analysis of the response practices was also conducted. Theatre nurses responded to surgeons’ requests/questions either through (1) “action” (i.e. physical activity) or (2) “talk+action” (i.e. verbal acknowledgement + physical activity). Scrub nurses responded to requests significantly more through action only, and circulators used significantly more talk+action responses. Occasionally, nurses did not respond verbally and it became interactionally problematic. The conditions affecting the effectiveness of these responses were the immediacy and visual noticeability of responding. A verbal acknowledgement has an important role when a request cannot be fulfilled immediately, and when a surgeon has no visual access to the addressee of their request, such as a circulating nurse. The study has practical implications for training of simple communication practices that can impact on situational awareness and patient safety.

Chapter Contributors

  • Terhi Korkiakangas ( - korkiakangas) 'Department of Surgery and Cancer, Imperial College London'
  • Sharon-Marie Weldon ( - smweldon)
  • Jeff Bezemer ( - jbezemer)
  • Roger Kneebone ( - rkneebone)