Case Scenario 4 Team Communication Case & Debrief

Case Scenario 4 75 year old patient with Chronic Kidney Disease was brought to hospital for breathlessness and suddenly collapses in the ward. The nurse calls a code. The code team arrives

Crisis Resource Management CRM – Adapted from aviation (Crew/Cockpit RM) – Goals To reduce disorganized communication and actions Improve patient care – Training critical to effective implementation Infrequent exposure to crisis situations Team composition frequently changes

Key principles: CRM There is one team-leader – Ultimately responsible for management Allocates roles and tasks Co-ordinates communication Checks that tasks are completed correctly Considers clinical information – History from patients records/other sources – Feedback and opinions from team members

Key principles: CRM There is one team-leader Implements therapeutic strategies Assessment and reassessment Debriefs team at end of resuscitation

Important Team leader – Should avoid too many, or complex technical procedures This may distract her/him from the responsibilities as a team leader

Communication Closed-loop communication: “Instruction” Acknowledge and “Repeat back” Person initiates instruction Listener repeats instruction and acknowledges Initiator verifies receipt of message

Communication: an example Adrenaline 1 mg IV 20 ml saline push Elevate arm Got it, 1 mg IV Adrenaline 20 ml saline push Elevate arm Yes 1 mg Adrenaline IV is correct With 20 ml saline push Elevate arm Initiator ListenerInitiator

Communication pitfalls Failure to communicate clearly – NOT LOUD ENOUGH! – Not detailed enough from leader PLEASE SHOCK PATIENT!, no defibrillation dose given Epinephrine, but no dose or route – Member acknowledgement but no “repeat back” E.g. drug names/doses Defibrillation settings

Communication pitfalls Failure to communicate clearly – Team members do not verbalise important clinical observations and relevant advice “call out” Leader too aggressive/intimidating Members not assertive enough – Failure of “report back” The team member should report back when task is completed

Conflict/disagreement Concerns about leader’s communication or decisions may be legitimate and important – BUT unnecessary challenges may disrupt team performance Graded assertiveness is a method that can be used in such circumstances

Graded Assertiveness Are you sure you wish to … I am Concerned that … I am Uncomfortable about… This…is a Safety issue, please pay attention to what I say to you The escalating comments/questions method (CUS)

“Short Cut” Assertiveness I am Concerned that … This…is a Safety issue, please pay attention to what I say to you The escalating comments/questions method (CUS)