Brendan Flanagan

The teaching of a structured tool improves the clarity and content of interprofessional clinical communication

Introduction: Suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety. The use of a structured method of communication has been suggested to improve the quality of information exchange. The aim of this study was to determine if the teaching of a communication tool, ISBAR (Identify, Situation, Background, Assessment, Recommendation), a modification of SBAR (Situation, Background, Assessment, Recommendation), improved the content and clarity of a telephone referral in an immersive simulated clinical scenario conducted in real time. Method: Seventeen teams of final-year medical students were randomised into two groups. The intervention group participated in a 40 min education session about the ISBAR communication tool. A control group received no training. Each team of five students participated in a simulated clinical scenario using a patient simulator in a mocked-up clinical environment. During each scenario, one student made a telephone referral seeking assistance from a senior colleague. Audio data for the telephone referrals (n = 17 students) were captured during the scenario for both groups. During a blinded review of the data, communication was scored on both content and clarity. Results: Communication content was higher from a mean score of 10.2 to 17.4 items (p<0.001) with the intervention. Clarity of the delivery of information on a 5-point scale was also higher in the intervention group (ρ = 0.903, p<0.001). Conclusions: The teaching of a structured method of communication improved the communication during telephone referral in a simulated clinical setting. This research has implications for how healthcare professionals are taught to communicate with each other.

Learning surgical communication, leadership and teamwork through simulation.

BACKGROUND In Australia and New Zealand, surgical trainees are expected to develop competencies across 9 domains. Although structured training is provided in several domains, there is little or no formal program for professionalism, communication, collaboration, and management and leadership. The Australian federal Department of Health and Aging funded a pilot course in simulation-based education to address these competencies for surgical trainees. This article describes the course and evaluation. METHODS Course development: Content and methods drew on best-evidence for teaching and learning these competencies from other disciplines. Course evaluation: Participants completed surveys using rating scales and free text comments to identify aspects of the course that worked well and those that needed improvement. RESULTS Eleven of 12 participants completed evaluation forms immediately after the course. Participants reported largely meeting learning objectives and valuing the educational methods. High levels of realism in simulations contributed to the ease with which participants immersed themselves in scenarios. CONCLUSIONS This study demonstrates that a course designed to teach competencies in communication, teamwork, leadership, and the encompassing professionalism to surgical trainees is feasible. Although participants valued the content and methods, they identified areas for development. Limitations of the evaluation are highlighted, and further areas for research are identified.

ISBAR for Clear Communication: One Hospital's Experience Spreading the Message

All health services rely on efficient and accurate communication between health professionals to ensure safe and effective patient care. Our health service introduced a standardised technique, ISBAR (Identify, Situation, Background, Assessment, Request), for telephone communication. We describe and evaluate the implementation of this project; evaluation was undertaken using program logic mapping. Recommendations for other health services planning to introduce communication tools into routine clinical use are also provided.

Effective Management of Anaesthetic Crises: Development and Evaluation of a College-accredited Simulation-based Course for Anaesthesia Education in Australia and New Zealand

The Effective Management of Anesthetic Crises (EMAC) course is a joint initiative between the Australian and New Zealand College of Anesthetists (ANZCA) and simulation centers. This standardized 2.5-day course has become an integral component of training for Fellowship of ANZCA and as such is an innovative development on the global anesthesia scene. Since its inception in 2002, over 600 anesthetists, with equal numbers of specialists and trainees, have attended EMAC throughout Australia, New Zealand, and Hong Kong. Course evaluations from 499 anesthetists and a follow-up survey showed strong support for the course and its relevance to clinical practice. The course is perceived by participants as changing their practice and improving their management of anesthetic crises. Exposure to the concepts of effective crisis management is now widespread in the anesthetic community in the region and should contribute to improved patient safety.

Simulation-based education for building clinical teams.

Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented.

Telephone referral education, and evidence of retention and transfer after six-months

BackgroundEffective communication between clinicians is essential for safe, efficient healthcare. We undertook a study to determine the longer-term effectiveness of an education session employing a structured method to teach referral-making skills to medical students.MethodsAll final year medical students received a forty-five minute education intervention consisting: discussion of effective telephone referrals; video viewing and critique; explanation, demonstration and practice using ISBAR; provision of a memory aid for use in their clinical work. Audio recordings were taken during a subsequent standardised simulation scenario and blindly assessed using a validated scoring system. Recordings were taken immediately before (control), several hours after (intervention), and at approximately six months after the education. Retention of the acronym and self-reports of transfer to the clinical environment were measured with a questionnaire at eight months.ResultsReferral clarity at six months was significantly improved from pre-intervention, and referral content showed a trend towards improvement. Both measures were lower than the immediate post-education test. The ISBAR acronym was remembered by 59.4% (n = 95/160) and used by the vast majority of the respondents who had made a clinical telephone referral (n = 135/143; 94.4%).ConclusionsA brief education session improved telephone communication in a simulated environment above baseline for over six months, achieved functional retention of the acronym over a seven to eight month period and resulted in self reports of transfer of the learning into practice.

The Evaluation of Structured Communication Tools in Healthcare

Suboptimal communication between health professionals has been identified as a significant causative factor in incidents compromising patient safety. The use of a structured method of communication has been suggested to improve the quality of information exchange, particularly with inexperienced practitioners. One structure that has been suggested to improve communication is the situational briefing tool SBAR. This tool was developed by the US Navy for standardizing important and urgent communication in nuclear submarines. Despite its widespread uptake in some areas of healthcare, its effectiveness has until recently been unproven. This paper describes the benefits and pitfalls of methods we have used to prove the effectiveness of these communication tools.