What's in a Name? Enhancing Communication in the Operating Room with the Use of Names and Roles on Surgical Caps

Published:November 25, 2020DOI:


      A pilot study was conducted in a tertiary referral center to assess whether wearing caps labeled with providers’ names and roles has an impact on communication in the operating room (OR).


      Two obstetricians observed surgeries for name uses and missed communications. Following each case, all providers were given a short survey that queried their attitude about the use of labeled surgical caps, their ability to know the names and roles of other providers during a case, and the impact of scrub attire on identifying others. They were also asked to rate the ease of communication and their ability to recall name and roles of the personnel specific to the case. Patients were asked how they perceived the use of labeled caps by providers.


      Twenty scheduled cesarean deliveries were randomized to either labeled (10) or nonlabeled (10) surgical caps. A total of 129 providers participated in the study, with 117 providing responses to the survey. Providers reported knowing the names and roles of colleagues more often with labeled caps vs. nonlabeled caps (names: 77.8% vs. 55.0%, 95% confidence interval [CI] = 64.4%–88.0% vs. 41.6%–67.9%, p = 0.011; roles: 92.5% vs. 78.3%, 95% CI = 81.8%–98.0% vs. 65.8%–88.0%, p = 0.036). Name uses increased (43 vs. 34, p = 0.208), and missed communications decreased (16 vs. 20, p = 0.614) when labeled caps were worn. Providers and patients had an overwhelmingly positive response to labeled caps.


      This pilot study demonstrated that wearing labeled caps in the OR led to more frequent name uses and less frequent missed communications. Providers and patients embraced the concept of labeled caps and perceived wearing labeled caps as improving communication in the OR.
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        • Gaba D.M.
        • et al.
        Crisis Management in Anesthesiology.
        2nd ed. Elsevier, Philadelphia2014
        • Mishra A.
        • Catchpole K.
        • McCulloch P.
        The Oxford NOTECHS system: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre.
        Qual Saf Health Care. 2009; 18: 104-108
        • ElBardissi A.W.
        • Sundt T.M.
        Human factors and operating room safety.
        Surg Clin North Am. 2012; 92: 21-35
        • Hu Y.Y.
        • et al.
        Deconstructing intraoperative communication failures.
        J Surg Res. 2012; 177: 37-42
        • Gawande A.A.
        • et al.
        Analysis of errors reported by surgeons at three teaching hospitals.
        Surgery. 2003; 133: 614-621
        • Wiegmann D.A.
        • et al.
        Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.
        Surgery. 2007; 142: 658-665
        • Lingard L.
        • et al.
        Communication failures in the operating room: an observational classification of recurrent types and effects.
        Qual Saf Health Care. 2004; 13: 330-334
        • Bodor R.
        • Nguyen B.J.
        • Broder K.
        We are going to name names and call you out! Improving the team in the academic operating room environment.
        Ann Plas Surg. 2017; 78: S222-S224
        • Bobb M.R.
        • et al.
        Key high-efficiency practices of emergency department providers: a mixed-methods study.
        Acad Emerg Med. 2018; 25: 795-803
        • Grade M.M.
        • et al.
        Attending surgeons differ from other team members in their perceptions of operating room communication.
        J Surg Res. 2019; 235: 105-112
        • Burton Z.A.
        • et al.
        Mad as a hatter? Evaluationg doctors’ recall of names in theatres and attitudes towards adopting #theatrecapchallenge.
        Br J Anaesth. 2018; 121: 984-986
      1. American College of Surgeons. A Statement from the Meeting of ACS, AORN, ASA, APIC, AST, and TJC Concerning Recommendations for Operating Room Attire. Apr 26, 2018. Accessed Dec 8, 2020.

      2. Association of periOperative Registered Nurses. AORN Guideline for Surgical Attire. May 30, 2017. Accessed Dec 8, 2020.

      3. American Society of Anesthesiologists. Guidelines for Surgical Attire. Oct 23, 2019. Accessed Dec 8, 2020.

        • Moalem J.
        • et al.
        Proceedings and recommendations from the or attire summit: a collaborative model for guideline development.
        Bull Am Coll Surg. Epub. 2019 May 1; (Accessed Dec 8, 2020)
        • Markel T.A.
        • et al.
        Hats off: a study of different operating room headgear assessed by environmental quality indicators.
        J Am Coll Surg. 2017; 225: 573-581