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What’s in a Name? Names and Roles on Surgical Caps

04/09/2021

By Laura Brodzinsky, MD

When scrubbed into surgery in the operating room (OR), everyone looks similar. 

Facial features are obscured by masks and caps, and ID badges are not visible. How do you get someone’s attention if you don’t know who they are? And how does not knowing someone’s identity impact communication in the OR?

Recognizing team members by name shows respect, engenders a stronger work ethic and builds trust. Not knowing the names and roles of colleagues can:

  • create confusion and unclear expectations
  • lead to communication delays in critical situations
  • cause a sense of depersonalization that leads to disengagement from the rest of the OR team

In 2017, Rob Hackett, MD, an anesthesiologist from Sydney, Australia, promoted the idea of wearing surgical caps with the provider’s name on them to help identify personnel working in the OR. He created a Twitter hashtag #theatrecapchallenge asking for photos of people wearing labeled caps, and the idea of labeled caps became very popular. We were inspired by this idea and wanted to study how it would impact communications in our obstetric OR. 

Our study, “What’s in a name? Enhancing Communications in the Operating Room with the use of Names and Roles on Surgical Caps,” in the April issue of The Joint Commission Journal on Quality and Patient Safety, sought to assess provider’s acceptance of wearing labeled caps and study the impact labeled caps had on communication in the OR. We used these metrics to assess communication:

  • number of times proper names were used when giving commands or asking questions
  • number of commands that were unfulfilled or questions unanswered (missed communications)
  • provider recall of knowing the names and roles of others in the surgery

In addition, we asked for open comments from both providers and patients about the use of labeled surgical caps. When surveyed, providers:

  • agreed that wearing scrub attire made it difficult to identify others in the OR
  • felt comfortable with the concept of wearing a labeled surgical cap
  • rated intra-operative communication as “easy without barriers” more often (90% vs. 65%) when labeled caps were worn
  • recalled the names and roles of others more often with the use of labeled caps

There also was an increase in the absolute number of times proper names were used during commands and questions, and a decrease in the number of missed communications when labeled caps were worn. 

Our most striking findings were the comments written by staff participating in the study on how they felt about their experience in the OR when staff wore named caps. The comments show that wearing labeled caps helped our staff identify one another, even if they had already been introduced or knew each other. Being able to easily identify others by name made communication with team members easier; and, most importantly, staff felt that the labeled caps improved communication and patient care.

Comments from staff:

  • “There was a sense of relief to know names.”
  • “Even if you know most of the people in the room, it’s still nice to be able to see their names easily visible.”
  • “It makes a difference with knowing who everyone is.”
  • “I have been here for 14 years and still have trouble with everyone’s names since we are consistently getting new residents – this idea is excellent!”
  • “It would be great to see names on caps… I can never remember names and it is awkward to say ‘hey you there.’”
  • “It would greatly improve communication and role identification, especially during stressful or complex times.”
  • “It is hard to remember names even after introduction at time-out.” 

The use of surgical caps labeled with one’s name and role is a low-cost approach to improving communication in the OR. 

Laura Brodzinsky, MD, is a Clinical Associate Professor, Department of Obstetrics & Gynecology, School of Medicine, at Stanford University in Palo Alto, California.