Faith Kinnear CPNP-AC Brian Rissmiller MD The Great Big “C” COMMUNICATION Faith Kinnear CPNP-AC Brian Rissmiller MD

Objectives: Define 3 types of communication Explain importance of standardized communication Practice multiple handoffs

Good or Bad ? https://media.giphy.com/media/3o7TKAWRHYdIl4SjpS/giphy-downsized.gif https://www.youtube.com/watch?v=Z59AnkxekfI https://www.youtube.com/watch?v=Jt0MYij66jM

Communication: 1 a : a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior the function of pheromones in insect communication; also : exchange of information b : personal rapport a lack of communication between old and young persons 2 a : information communicated : information transmitted or conveyed b : a verbal or written message The captain received an important communication. 3 communications plural a : a system (as of telephones or computers) for transmitting or exchanging information wireless electronic communications b : a system of routes for moving troops, supplies, and vehicles c : personnel engaged in communicating : personnel engaged in transmitting or exchanging information 4 communications plural in form but singular or plural in construction a : a technique for expressing ideas effectively (as in speech) b : the technology of the transmission of information (as by print or telecommunication) 5 : an act or instance of transmitting the communication of disease 6 anatomy : a connection between bodily parts https://www.merriam-webster.com/dictionary/communication

Types of Communication: Verbal Non-Verbal Written/Visual

Let’s take a poll: Q1: Do you spend more time: texting, emailing or talking to people face to face Q2: How often do you experience frustration related to communication at work Never Sometimes Often Every shift Q3: Have you left a job because you felt like communication was poor Yes No Q4: What do you perceive to be the biggest barrier in daily communication Free Text

Why it matters We do it all day every day Negativity Bias verbal, text, email, waving, hugging, nodding Negativity Bias We are wired to respond stronger to negative input than positive ones- Dr Rick Hanson

Attrition & Communication Transparency Frustration Value Satisfaction

Statistics 1744 deaths in 5 years due to communication errors 1.7 billion dollar cost 80% serious medical errors happened when transferring patients due to miscommunication 27%-37% of malpractice cases due to miscommunication in 4 years Between providers, between providers and families and technology Standardized handoff reduced preventable errors by almost 50% 44% inpatient, 48% ambulatory, and 8% ER. Almost 50/50 in breakdown between providers and between providers and patients

Potential Barriers to Effective Communication I’m uncomfortable I don’t know you I have different beliefs, morals or ethical views from you What if I’m wrong If I say or do the wrong thing will I be punished

Overcoming Barriers Standardized process Get to know them Educational seminars Specialized training Badge cards Simulation Standardized process

Examples of Standardized Mnemonics SBAR +/- Q Daily communication SPIKES Helpful for breaking bad news CUS I have a Concern, I’m Uncomfortable, Safety NURSE Tool for responding to emotion IPASS Early studies on usefulness in critical patient care areas

+/- Q Questions

CUS CONCERN I am concerned that the respiratory rate has gone up by 10 UNCOMFORTABLE I am uncomfortable with the amount of urine the patient has had this shift SAFETY I am worried that the patient would be safer in the ICU due to his rapidly worsening respiratory distress

SPIKES Setting: Is it a private area? Sitting? Perception: How sick is the patient? Invitation: What do you want to know? How much? Knowledge: Share what you know, simply in a way they can understand Emotions: Let family show emotions, be present Strategy/Summary: Make a plan for next meeting, plan of action, etc

NURSE

Provider to provider handoff I-PASS Between teams Shift handoff PHM to ICU ICU/PHM to OR ER to ICU/PHM http://www.ponderingem.com/journal-club/pondering-em-journal-club-changes-in/