Background:

Surgery is the archetypal team effort, with the combined skills of doctors, nurses, and technicians required to enable a successful outcome. In a high-stakes situation with little room for error, effective communication is key to ensuring that team members clearly understand exactly what needs to be done and when. In a cardiac catheterization room, for example, part of the team handles the surgical aspects of inserting the thin, flexible catheter tubing into the body and threading it through veins up into the heart. Others monitor the patient’s status and response to anesthetics. And still others operate devices such as the catheter itself, which may obtain diagnostic information and/or tissue samples in various parts of the heart, as well as the fluoroscopic equipment that the surgeon relies on to guide the catheter.

Issue:

Because much of the equipment used in a typical Cath Lab can be operated remotely, the facilities are typically organized into operating room/control room pairs, with part of the team in the operating room with the patient and part in the control room. The control room staff of nurses and technicians functions under the direction of the surgeon, operating various monitoring and control devices as well as logging data on the procedure as it unfolds. The staff in the control room needs to be able to hear what the surgeon says and also to communicate back to other operating room staff without distracting the surgeon.

Traditionally, communication from the operating to the control room is enabled with a fixed microphone (hanging or on-stand), but hard surfaces, ambient noise, and varying distances from the mic to the person speaking can all conspire to impair intelligibility, making clear communication a challenge. Meanwhile if the control room staff is communicating with operating room personnel via a talkback loudspeaker, everyone in the operating room will hear what’s being said, which can be needlessly distracting for the surgeon and others.

Solution:

To address the challenges of communicating between operating rooms and their associated control rooms, some hospitals and medical centers have begun adapting general purpose wireless intercom systems to the medical environment, improving intelligibility and thereby lessening the risk of miscommunication in critical settings. The Children's Hospital of Philadelphia (CHOP), for example, has successfully deployed a Telex/RTS wireless intercom in its three cardiac catheterization labs for nearly three years.

In the CHOP setup, each of the three control rooms is equipped with a BTR-800 two-channel UHF synthesized wireless intercom base station that is operated via an RTS KP-12 keypanel that includes a heavy-duty gooseneck microphone. Each BTR-800 provides full-duplex communications with up to four TR-800 two-channel wireless beltpacks in the control room’s corresponding operating room. Signal routing within each control room/operating room pair, as well as between the three control rooms, is handled by an RTS ADAM-CS advanced digital matrix.

During a procedure, the surgeon will wear a lavalier microphone connected to the intercom system via a wireless beltpack, allowing him or her to speak to the control room staff, but not to hear what’s being said in the control room. The operating room nurses, meanwhile, each wear a TR-800 belt-pack equipped with a PH-88 single-sided lightweight headset that features an earphone and a noise-canceling dynamic microphone, enabling two-way communication between them and the control room staff.

“The doctor is relaying instructions to the control room,” says the Systems Administrator at the CHOP Cath Lab, “and they are listening, entering data on a workstation and also communicating amongst themselves to assist the Physicians. The Physicians doesn’t need to hear all that chatter in the control room, which is why the doctors only wear a mic rather than a full headset.”

He adds that “if the Physicians request more equipment or supplies from various storage areas, for instance a different catheter, someone from the control room staff can retrieve the item, and if a particular device is not immediately available then that message can be immediately relayed back into the operating room and the Physician(s) can specify a substitute. Similarly, if a Physician(s) needs supplies — another device, for example — from one of the other operating rooms, one control room can call another control room via the intercom and that other room can respond back through the base station.”

Results:

The Systems Administrator reports that the use of a wireless intercom system has resulted in improved communication and facilitated greater operational efficiency during procedures. “The system gives the people that are supporting the Physician(s) a clear, instant way to communicate with each other,” he says. “And that has taken some tension out of the environment, because before — with hand-stand mikes in the rooms, and reverberation, and background noise —  they had to almost shout to be sure that everyone could hear what was going on. Now, assuming that the lavalier mic is correctly positioned on the surgeon, we have a very reliable way for everyone to communicate in a normal speaking voice. That adds up to better communication and more efficiency.”