In the Emergency Department and on the Field: Teamwork + Talking = Win!

Ever watch the coaches’ post-game interviews after a big game? You often hear the winning coaches give solid communication a big piece of the credit. They say things like, “They did a few things that we didn’t anticipate, so it was a good adjustment on the sideline with the staff and the players. We had good communication there.” -- Iowa University Coach Kirk Ferentz

In the Emergency Department and on the Field Teamwork Talking Win.jpg

And from coaches on the other end of the scoreboard, poor communication can get the blame.

“Yeah, you know I think there is a lot to figure out. I think a lot of that falls back on communication. Sometimes we are communicating well, sometimes we’re not. Different spots in the game and it is really not even week-to-week, it is really drive-to-drive, series-to-series. You know it is really good then it falls down and obviously some of it is holding us back.” -- Buffalo Bills’ Coach Rex Ryan

Both of these quotes are from last month. It’s interesting how team communication on the football field plays a role in success just as it does in the emergency department. Take out the references to sidelines and drives and I am struck by the similarities.

In the emergency room there are always unanticipated things that crop up -- it’s part of the job. Your healthcare providers need a plan for how to communicate those changes to adjust treatment plans.

And while you might have solid communication for the most part, slippage can cause you to fall down. It can cause medical errors putting patient safety at risk. It can also hold your organization back from earning the most it can in the growing pay-for-performance healthcare environment. 

This Thanksgiving here are three communication techniques I am thankful for that can help. I’ve seen them work in many emergency departments to help them maximize communication between doctors and nurses. Bonus, you don’t need an expensive new technology to implement them.

1. Try SBAR at the Get-Go -- This is an acronym that can help nurses remember crucial facts to pass along to doctors or physician's assistants after they do the initial workup of a patient. You’ll want to convey the Situation, the patient’s Background, an Assessment of what you saw and learned, and a Recommendation for action.

Wait? Nurses recommend an action to the doctor? Yes. This type of information can be crucial to a patient’s care. It’s all in how you do it. Let’s put the entire technique in perspective with an example.

A patient comes in after a fall and complaining of hip pain. He’s in his 60s and has diabetes. As his nurse, you help him change into a gown before the doctor comes into examine him, you come to learn his left toe hurts. You check it out and see that it is red and swollen. This isn’t the issue he came in complaining of but it is something that is causing him trouble. It could be from the fall or perhaps even gout. You make a mental note. “It’s probably worth the doctor checking out.” Then, when you give the doctor her briefing, mention it. Here’s how it breaks down: 
Situation -- The patient is complaining of hip pain.
Background – He came in after falling. He also has diabetes.
Assessment – In addition to hip pain he has a red inflamed big toe on his left foot.
Recommendation – You might want to check out his toe while examining him. 

This is a crucial information handoff point in the patient care continuum. But don’t let your in-person talks between doctors and nurses end there.

2. Communicate Face-to-Face Often -- Ah, remember the days of this? I’m only half joking but even in our nonprofessional lives it seems people are shying away from good old fashioned eye contact and human connection.  We have all gotten so busy and have benefited so much from technology tools that many of us now communicate mostly electronically. We’ve come to neglect tried-and-true means of human connection. Nearly a decade ago there was some pushback against this trend in the corporate world. In an effort cut its employees’ dependence on nonverbal communication over the phone or in-person exchanges, a few companies instituted e-mail-free Fridays.

"As a medium, [email]'s inherently ambiguous," said behavioral science professor Nicholas Epley of the University of Chicago Graduate School of Business in an ABC news article on instituting email-free Fridays. "There's not as much information conveyed. The pitch of your voice, the speed with which you say something, the emotional tone that's carried in your voice isn't there."

Sound familiar? The same can be said for relying too heavily on nonverbal communication tools in the emergency department. There are similar reasons to buck this trend of relying on only written communication.

Encouraging face-to-face communication can help build relationships between your staff. And it can be more efficient. Going to find the doctor or nurse you’re working with to tell them something may take time but it can save time as well. You can convey things in the moment and it presents an opportunity for a give and take, and the ability to ask questions and dive deeper to collect all the information in one communication session versus several electronic volleys. So the next time you have an important update on a patient, take five minutes to seek out the team member you’re collaborating with to give them a status update face-to-face.

3. Readback to Confirm the Message Is Received -- While you’re looking each other in the eye, try this one out as well. Most nurses do practice this but sometimes in my consulting work I find it is helpful to go back to some of these basics or foundation elements that are crucial to good communication. Reading back what a physician or physician's assistant says for confirmation can save your team from making mistakes and can even save lives. Was that 2 ccs or 25 ccs? In the nonmedical world, this technique can be called mimicking or rephrasing and is a key element of active listening. It helps signal that the nurse is listening and comprehending. It also provides an opportunity for the physician to reaffirm their order.

This is one little check and balance to add to your team’s arsenal whether it is about medications or discharge instructions. Doctors can try this as well to confirm that they have heard and understand the information nurses have relayed. It even works at shift change. It closes the loop. As the one on the receiving end of communication: Knowing the message you got is the one that the sender intended is a beautiful thing. And as the one doing the reporting of information: Knowing the message you sent was received is reassuring.

These are just three communication techniques you can try to improve communication among your emergency department team. It can be amazing how formulating a game plan for everyone to follow can really help team performance.

 If you’d like help with improving communication in your emergency department, contact me. I’d be honored to help by doing a personalized assessment of opportunities and formulate a customized action plan to put you all on the right path.