Effective communication is essential for patient safety. However, incivility in the operating room is a potential threat. This has previously been investigated in other industries but little has been done to explore this within a healthcare setting. This was explored in a recent study, published in British Medical Journal’s Quality and Safety. Researchers sought to determine how incivility influenced anaesthesiology resident performance during a standardised simulation scenario of occult haemorrhage.

This was a multicentre, prospective, randomised control trial from three academic centres: the Icahn School of Medicine at Mount Sinai in NYC, the University of North Carolina at Chapel Hill, and Ohio State University. A total of 76 anaesthesiology residents were randomly assigned to either a normal or ‘rude’ environment and experienced a validated simulated operating room crisis. Technical and non-technical performance domains including vigilance, diagnosis, communication and patient management were assessed.

Those exposed to incivility scored lower on every performance metric, including a binary measurement of overall performance with 91.2% in the control condition and 63.6% in the rude condition obtaining a satisfactory score. Interestingly, self-assessment scores were similar between groups, suggesting that the impact upon performance is unconscious. Findings highlight the importance of eliminating incivility within the operating room and the need for interpersonal communication in high-stress environments be incorporated into medical training.