Background: Communication failures are commonly accepted as the most important causative factor of adverse events during surgery. Cardiac surgery, especially, requires numerous professionals to communicate to each other. The aim of this study was to investigate communication errors in conventional on-pump coronary artery bypass grafting (CABG) operations, which is one of the most common open heart procedures in adult cardiac surgery, such that surgical staff are generally familiar with the procedure.  
Method: Observations were carried out on  50 elective on-pump CABG cases that were performed by multiple surgeons. The observations were taken by an anaesthetic fellow over a 3 month study period, at the National Heart Institute of Malaysia. All communication failure events during the “surgery period”, were documented1. “Surgery period” was defined from the administration of heparin to chest closure; where all team members were present in the operating theatre. The errors observed were then grouped by the seniority, and category, of the professionals involved in the error. The errors were then categorised into the type of communication error (purpose, omission, occasion, audience, and context)1, and also that of human error (mistake, lapse, slip, and violation)2.  
Result: A total of 119 communication error-related events were observed (mean; 2.38 errors per case). Surgeons were most involved in communication errors with 90 errors (75.6%), followed by perfusionists with 47 (39.5%), and anaesthetists with 45 (37.8%). Nurses were less involved with scrub nurses’ 17 (14.3%), and circulating nurses’ 14 (11.8%). Physicians (anaesthetists and surgeons) were involved in the most communication errors, while non-physicians (perfusionists and nurses) were involved in less (112 errors, 94.1% vs. 77, 64.7%). By seniority; the senior staff were involved in more errors than juniors (102 errors, 85.7% vs. 51, 42.9%). By communication error type; “purpose failures” (the intended outcome of the communication was not achieved) were seen the most at 80 events (67.2%). By human error type; “lapse” had the highest occurrence with 74 incidents (62.2%), followed by “slip” or “violation” with 27 (22.7%). 74.1% (20 events) of slip/violation errors were caused by physicians; junior members caused more of this type than seniors (56.5% vs. 43.5%). Two slip/violation errors, by non-physicians, could have caused serious intraoperative accidents. More than 80% of errors (93 incidents) happened with “standerdised” phrases in the CABG procedure. 
Conclusion: Communication errors were identified in most of on-pump CABG cases, and most of them were during routine work. Senior members and physicians were more involved, however, juniors and non-physicians were more likely to cause slip/violation errors, and which could be hazardous.     
References:
1.	Lingard, Lorelei, et al. Quality and Safety in Health Care 13.5 (2004): 330-334.
2.	 Reason, James. Human error. Cambridge university press, 1990.

Analysis of communication errors during on-pump coronary artery bypass grafting (CABG)