I was pleased to read the special article on communication skills for the anaesthetist, in the June edition of Anaesthesia, which suggested development of a framework for improving communication within anaesthesia, and which may be modified to facilitate interactions with surgeons, theatre nurses and other healthcare professionals. Using the World Health Organisation (WHO) Checklist Implementation Manual on communication and teamwork as a guide, I designed a 40-point audit pro-forma to assess which tasks were being addressed by members of the theatre team in a small district general hospital (DGH). Over a period of a month, data was collected for 28 cases from day surgery, in-patient surgery and emergency surgery, from six different theatres. 

Overall, communication between staff members of those issues raised by the WHO Checklist was poor. At 'sign in', the task of confirming the patient’s details was mostly addressed by the operating department practitioners.  Other tasks relevant to the anaesthetist at 'sign in', in particular assessment of airway difficulty and risk of blood loss, were not addressed by the anaesthetist or any other member of the team. There were no clear pauses that could be interpreted as a 'time out', and as may be expected in a small DGH where team members work together on a regular basis, and  so are familiar to each other, very rarely were introductions made. Once the patient was placed on the operating table, patient identity was verbally checked in only 8% of cases, and there were no recorded incidences of the surgeon addressing the anaesthetist regarding anticipated blood loss or the likelihood of any critical events. In addition, the need for antibiotics was discussed in only 7% of  all the cases, although the rate of administration was 39%. Furthermore, there were no clear pauses before the patient left the theatre, and in only 14% of cases was the anaesthetist made aware of the final procedure completed by the surgeon.

The results remain somewhat subjective due to the observational nature of this study. However, this does not detract from the overall conclusion drawn: that certain aspects of communication in the surgical setting are not routine, particularly communication between the anaesthetist and the surgeon. WHO Checklist implementation training may provide an excellent opportunity for the anaesthetist to establish clear and effective inter-professional communication, for which there is an increasing need.