Effective Communication Techniques in Medical Emergency

Effective communication is a two-way process that involves sending the right message in the right way that is correctly received and understood. It sounds like an easy process. In fact, people communicate every day in many ways. But is this communication always effective?

Research suggests that much of our communication is not effective. In 2004, The Joint Health Care Commission found that in 70% of 2455 sentinel events the primary root cause was communication failure — and in 75% of these the patient died.

Because effective communication is so important to patient safety, many agencies have mandated that organizations implement improvement strategies. Tools such as SBAR (situation, background, assessment and recommendation), call out, check back, and handoff have all been suggested as ways to improve staff’s communication.

Techniques for effective communication

1.  SBAR: a technique for communicating critical information that requires immediate attention and action concerning a patient’s condition.

Situation – What is going on with the patient? “I am calling about Mrs. Joseph in room 251. Chief complaint is shortness of breath of new onset.” Background – What is the clinical background or context? “Patient is a 62-year-old female post- op day one from abdominal surgery. No prior history of cardiac or lung disease.” Assessment – What do I think the problem is? “Breath sounds are decreased on the right side with acknowledgment of pain. Would like to rule out pneumothorax?” Recommendation and Request – What would I do to correct it? “I feel strongly the patient should be assessed now. Can you come to room 251 now?"

2.      Call Out: Strategy used to communicate important or critical information

•  Informs all team members simultaneously during emergent situations

•  Helps team members anticipate next steps

•  Important to direct responsibility to a specific individual responsible for carrying out the task

Example during an incoming trauma: Leader:            “Airway status?” Resident:         “Airway clear” Leader:             “Breath sounds?” Resident:         “Breath sounds decreased on right” Leader:            “Blood pressure?” Nurse:              “BP is 96/62”

3.   Check Back: Using closed-loop communication to ensure that information conveyed by the sender is understood 

     by the receiver as intended

The steps include the following:

•     Sender initiates the message

•     Receiver accepts the message and provides feedback

•     Sender double-checks to ensure that the message was received

Example: Doctor:                “Give 25 mg Benadryl IV push” Nurse:                   “25 mg Benadryl IV push” Doctor:                “That’s correct”

  

4.   Handoff: The transfer of information (along with authority and responsibility) during transitions in care across the continuum. It includes an opportunity to ask questions, clarify, and confirm.

Examples of transitions in care include shift changes; transfer of responsibility between and among nursing assistants, nurses, nurse practitioners, physician assistants, and physicians; and patient transfers.

Strategy designed to enhance information exchange during transitions in care:

I PASS the BATON

I	Introduction	Introduce yourself and your role/job (include patient)
P	Patient	Name, identifiers, age, sex, location
A	Assessment	Present chief complaint, vital signs, symptoms, and diagnoses
S	Situation	Current status/circumstances, including code status, level of (un)certainty, recent changes, and response to treatment
S	Safety Concerns	Critical lab values/reports, socioeconomic factors, allergies, and alerts (falls, isolation, etc.)
THE
B	Background	Comorbidities, previous episodes, current medications, and family history
A	Actions	Explain what actions were taken or are required. Provide rationale.
T	Timing	Level of urgency and explicit timing and prioritization of actions
O	Ownership	Identify who is responsible (person/team), including patient/family members
N	Next	What will happen next? Anticipated changes? What is the plan? Are there contingency plans?

Reference:

TeamSTEPPS, Agency for Healthcare Research and Quality (2013). Retrieved from http://teamstepps.ahrq.gov/