Communicating Risk During Medical Crises: Lessons from Surgical and Anesthesia-Related Adverse Events

Abstract

Background: Effective risk communication is critical during medical crises, particularly in high-stakes surgical and anesthesia settings. Breakdowns in communication can escalate minor issues into major patient safety events. Although the literature highlights teamwork and communication as cornerstones of safe perioperative care, real-world data on how communication failures contribute to adverse events remain insufficiently explored.
Methods: We reviewed closed claim files and critical incident reports from two academic medical centers and one large community hospital between January 2012 and December 2021. Cases involving surgical or anesthesia-related adverse events were included. We extracted data on event type, communication processes (e.g., intraoperative handoffs, briefing/debriefing, closed-loop communication), team composition, and patient outcomes. Communication failures were categorized using established frameworks. Descriptive and inferential statistics were employed to identify factors associated with escalated crises.
Results: Of 374 events analyzed, 62% (n=232) involved at least one communication breakdown. These failures spanned all phases of care, from induction to emergence, and were most frequently related to unclear risk disclosure (41%) and lack of closed-loop verification (29%). Teams with standardized communication protocols and structured checklists had fewer catastrophic outcomes (p<0.01). Multivariable regression indicated that the presence of a preoperative briefing and a designated communication lead were independently associated with reduced severity of harm (adjusted OR: 0.58, 95% CI: 0.41–0.82; adjusted OR: 0.64, 95% CI: 0.46–0.89, respectively).
Conclusions: Communication breakdowns frequently contribute to the escalation of intraoperative and anesthesia-related crises. Implementing proactive risk communication strategies—such as structured preoperative briefings, consistent use of cognitive aids, and appointment of a communication lead—can mitigate adverse events and improve patient outcomes. These findings align with high-reliability principles and underscore the need for continued focus on communication training and systems-level interventions.