Communication in the heat of battle

Victoria Brazil

Communication is our most important clinical skill

There are some specific challenges in critical care

Training helps……a bit

Communication is our most important clinical skill

There are some specific challenges in critical care

Training helps……a bit

Communication is our most important clinical skill

• Most frequently performed• Greatest diagnostic utility• Saves lives• Best medicolegal defence• Most frequent problems if poorly

performed• Best skill to keep you happy at the end of

the day

Your day…….

36.5 communication events per hour

A third of communication events are interruptions

10% are concurrent conversations

Coiera etc al Med J Aust 2002; 176 (9): 415-418.

Your consultation

You saving lives

• Urgently

• Not so urgently

Your patients’ safety..

Your best medicolegal defence

Your happiness at the end of the day……..

Communication is our most important clinical skill

There are some specific challenges in critical care

Training helps……a bit…..

Teamwork and leadership

Crisis resource Management (CRM)

• Know your environment• Call for help early • Take a leadership role• Communicate effectively• Maintain situational awareness• Distribute the workload

Crisis resource Management (CRM)

• Know your environment• Call for help early • Take a leadership role• Communicate effectively• Maintain situational awareness• Distribute the workload

Training for CRM

Handovers

Interprofessional communication

Tribes are big in healthcare….

Cross cultural communication

Communication is our most important clinical skill

There are some specific challenges in critical care

Training helps……a bit

Simulation anyone..?

Communication skills for “early learners”

“Hello my name is……..”

“Training in communication skills

does not necessarily lead to skilled communication”

BEME Guide no 2: Teaching and Learning communication skills in medicine. Medical Teacher 1999

Gender matters

Getting more from our SPs…..?

( Vic sees the light after 8 years of mannequin

sim……!)

Patient care interaction with heightened arousal

More confederates…

SPs and ‘patient voice’

“There have been times if I am playing the role of a woman from the lower echelons of society, that I have actually felt the student’s disdain for me as a person. …

…..Perhaps the student did not realise he was showing disdain.”

“I have played the role of a pregnant mother who has been told her unborn baby has Down Syndrome. ..

In this situation I have been met with many varied responses… From nervous laughter, to distracted looks, to a complete lack of empathy……. I really feel the pain of that pregnant mother. ………I am physically crying and totally distraught.

……………. And if the responses to this situation are not right, I will tell the student exactly what is lacking, which is so often sensibility.”

SPs and Cultural issues

‘I just can’t do this [shaking head]’

—female medical student refuses to apply ECG electrodes to male SP Instructor

‘Crossing Boundaries’ “The Standardized Patient Instructor has an essential role in preparing and training medical students to break through that barrier. ………….the SP has a dual role of patient advocate and student educator, ……..requires deep sensitivity, psychological awareness, sociocultural knowledge and a commitment far beyond passive participation…….

……. Medical students need clinical scenarios that trigger conflict between the accepted notion of duty of care and personal socio-cultural values……….

………..Triggering the conflict opens the door to learning opportunities and bridge building;

……that is, the creation of acceptable compromises that will preserve the integrity of personal beliefs and values while upholding foundational bioethical and legal principles……...”

Lets think about some simulated patient educators for postgraduate training?

Handovers

• SBAR, isoBAR…….

• Training needs to be customised, and recognise context…..hierarchies, tribalism and more

Simulating patient journeys

Med student …..

“When the doctor isn’t there - who looks after the patients…?”

Simulating patient journeys -communication for advanced

practitioners

“STEMI-sim”

• Using sim to improve the care of real patients with STEMI at our institution

CL prep

Most valuable aspects?

• “The debrief as an entire group, was the most valuable part of this exercise. I felt it gave an opportunity to identify and discuss the entire process, (STEMI Patient), with other personnel that normally we would only interact with, in passing. “

• “Being able to 'stand back' and observe the process, allowing identification of potential areas of delay and ideas for improvement ‘

Results – STEMI patient data

• Baseline (july –Dec 2010)– Median ‘Door to lab’ 60 mins (n= 35)

• Post ‘stemi-sim’ ( July – Dec 2011)– Median ‘Door to lab’ 27 mins (n= 22)

• p = 0.003

Communication is our most important clinical skill

There are some specific challenges in critical care

Training helps……a bit