Communication skills in high acuity situations: Team, Patient, Consultation
The bat phone rings at 10 o’clock on a chilly Tuesday morning in your ED. You huddle for warmth around the radio with your resuscitation team…
The paramedics are bringing a 58 year old lady with an episode of syncope this morning and increasing shortness of breath over 2 days. She has a background of metastatic lung cancer.
Vital signs: RR 28, Sats 97% r/a, HR 112, BP 88/56, T 36.7, GCS 15.
The patient arrives and is alert, ‘chipper’ and able to give a comprehensive history. You request an ECG, VBG and CXR and perform a bedside echo, which demonstrates a large pericardial effusion with signs of cardiac tamponade.
You smoothly coordinate your team to stabilise the patient, ascertain her treatment goals and request specialist interventional cardiology consultation with the end goal of transferring her to the interventional suite for pericardial drainage.
She recovers well and is discharged home a few days later to meet her new Granddaughter born the following week.
We discussed the following learning points in debrief:
Optimise your team’s performance through effective use of the pre-arrival time
- Brief your team as a whole involving medical and nursing team together
- Use a structured communication tool for preparing your team for a resuscitation for example the “Team Briefing Model”, see link below
- Consider asking all team members to verbalise their roles and priorities to one another prior to the patients’ arrival
- Use the opportunity to reinforce mutual respect amongst team members to encourage speaking up and making suggestions
Even though it’s a resuscitation, allow the patient opportunity to set their own agenda
- It is natural to want to use closed questions in a high acuity situation to establish facts, highlight red flags and rapidly rule in and out potential differentials. Evidence shows that open questions gather more information, more quickly than closed questions. And you will very quickly establish your patient’s main concerns, ideas and expectations
When consulting specialists over the phone use a structured approach, be polite and collaberative and most of all, be honest!
- Use a telephone consult structuring tool such as CONSULT or 5 Cs (see below)
- At night, allow at least a minute for the phone call recipient to wake up. Fill this time by politely introducing yourself (name, role, level of experience, location), checking who you are speaking to and giving details of the patient you are calling to discuss
- Quickly move on to the key question, which should be specific, focused and brief. Examples: “I need you to come in urgently to assist with xyz”; “I need your advice on whether to intubate the patient with hypercapnic respiratory failure and advanced, end stage COPD”; “I need you to come in to drain a pericardial effusion causing cardiac tamponade”
- Don’t panic if you can’t answer some of the more technical questions the specialist may ask. Be honest, don’t lie. Re-iterate your level of experience and your primary question