In the operating room, everyone looks the same. Doctors, nurses and other caregivers are covered in protective gear from head to foot, and wear surgical masks that mostly obscure their faces.
So a team of Stanford Children's Health obstetricians led by Kay Daniels, MD, and Laura Brodzinsky, MD, decided to test whether communication during C-sections improved if everyone wore surgical caps labeled with their name and role. Labeled caps were a resounding success, their study showed. The findings appeared recently in The Joint Commission Journal on Quality and Patient Safety.
I spoke with Daniels and Brodzinsky about the project. This Q&A has been edited and condensed for clarity.
How did this project come about?
Daniels: Rob Hackett, MD, an anesthesiologist from Sydney, Australia, started this idea of wearing named surgical caps. In 2017, he created a Twitter hashtag, #theatercapchallenge, to see how many people would post photos with their names on their caps. It was wildly successful. I saw it and said, "This makes so much sense!"
When Laura and I started looking into it, Brittany Hasty, MD, a surgical fellow who was then at Stanford, was piloting the use of labeled caps in surgical simulations through Stanford's OR interCEPT program. Participants found labelled caps helpful for improving communication during simulated crises. We took the opportunity, because we had a grant, to see if it had value in real surgeries.
Set the stage a bit: What's it like to be in the operating room during a C-section?
Brodzinsky: You can't see our name badges or faces because we are wearing caps, masks and long gowns. I remember a time when I walked into the OR to help. Kay was scrubbed and in her full surgical gear, and I didn't recognize her. I asked, "Who are you?" and she said, "Laura, I'm Kay!" [Laughs.] We've known each other for years.
Surgeries usually start with a universal timeout, during which everyone introduces themselves and we state the patient's name, what they're there for and their risk factors. But even after that, it can be hard to recall everyone's name.
The obstetric OR, where C-sections are performed, has several different teams -- including surgeons, nurses, the anesthesia team, scrub techs, pediatricians -- coming in and out to take care of a mom and her baby. And our patients are awake and aware of what's going on, which is not the case for most types of operations. So we wanted to get data on whether wearing named caps made a difference to communication, and also see how patients and providers felt about it.
Tell me about what you did.
Daniels: We randomized 20 C-sections to have everyone use labeled or non-labeled surgical caps -- during half of the surgeries, all providers wore labelled caps, and in the others, none wore them. One or two observers watched each case. This was pre-COVID-19; it would be harder to bring observers into an operating room now.
The observers counted each use of names and tracked what percentage of communications were missed. For instance, if someone asked to have the operating table raised up and there was no response, that was recorded as a missed communication.
More of the providers in surgeries knew their colleagues' names (77.8% vs. 55%) and roles (92.5% vs. 78.3%) when labeled caps were used. Names were used more often -- and fewer communications were missed -- when everyone had labeled caps. We also surveyed everyone after each surgery and got subjective comments from them, which is what was most revealing.
What were some of the comments?
Brodzinsky: I like the ones that speak to caregivers' sense of relief at knowing their colleagues' names. Someone said, "I've been here for 14 years, and I still have trouble with names because we are always getting new residents and have different nurses coming in and out."
People also commented that it was really helpful to have labeled caps in emergency situations. Calling out someone's name is the most direct way to get their attention.
Patients really liked the caps, too. The patients said things like, "It decreased my anxiety" and "It helped me to understand who was in the room."
What happens next?
Daniels: When we did the study, we labeled caps with people's names and roles using surgical tape. But to thank people who participated in the study, we gave each of them a hat embroidered with their name, professional role and a Stanford Health Care logo.
It's been an interesting reaction: Several people who weren't part of the study saw the caps and wanted them, too. Some have since ordered their own caps, paying for them out of their own pockets. We feel like it's a great tool to help with communication in the OR, and think it should be part of our uniform.
Photo of Brodzinsky and OB technician Mary Ann Ramos wearing their labeled surgical caps courtesy of Laura Brodzinsky