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

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

3. Good or Bad ?

4. 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

5. Types of Communication:
Verbal
Non-Verbal
Written/Visual

6. Let’s take a poll:
Q1: Do you spend more time: texting, ing 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

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

9. Attrition & Communication
Transparency
Frustration
Value
Satisfaction

10. 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

11. 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

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

13. 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

14. +/- Q Questions

15. 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

16. 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

17. NURSE

18. Provider to provider handoff
I-PASS
Between teams
Shift handoff
PHM to ICU
ICU/PHM to OR
ER to ICU/PHM