Communication in the ED.

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In a resuscitation the Emergency Physician makes a decision which you strongly disagree with and think is dangerous. What should you do?

Make a note to bring it up later after the resuscitation.

Place a written complaint on the electronic complaint system.

Use graded assertiveness in the present resuscitation.

Accept that they are senior and probably know best.

Using graded assertiveness gives a framework to disagree constructively with an often more senior colleague.

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A patient intoxicated with alcohol becames verbally aggressive to staff. What communication approach is most appropriate initially?

Ignore the patient.

Tell the patient, in no uncertain terms, that we do not tolerate aggression in the ED.

Use calm, simple language and maintain a non threatening posture.

Call a "Code Black" and get IV sedation drawn up ASAP.

If this approach does not work then the safety of yourself, your colleagues, other patients and this patient is a priority so then call a "Code Black" to get security.

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When "breaking bad news" to the wife of a man who has just died following a cardiac arrest which of the following actions would show poor communication skills?

Taking a nurse with you when you speak to the wife in a quiet room.

Turning your mobile phone to silent.

Sitting down so both you and the wife are at the same level.

Asking the wife for two forms of identification to ensure you are speaking to the correct person.

Some of the principles here are 1/ Privacy 2/ Preparation 3/ Taking someone with you 4/ Empathy 5/ Quiet 6/ Not rushed 7/ Letting the bereaved speak 8/ Being available afterwards.

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A patient with limited English presents with abdominal pain. Her daughter offers to translate. What is best practice?

Use simple English and gestures with the patient.

Use a professional interpreter service.

Use the family member to translate.

Find a doctor or nurse in the ED that speaks the same language and use them.

There is a 24hr Health Care Interpreter Service (HCIS) that you can ring. Each LHD has a different number. EDs are prioritised. Interpreters may use the phone, attend face to face or via video conference. If it is a life threatening situation and an interpreter is not available----use staff or the patient's family.

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In "Graded Assertiveness" what does PACE stand for?

Point, Assess, Choice, Energise.

Position, Attitude, Challenge, Emerge.

Prevaricate, Attack, Cry, Entreat.

Probe, Alert, Challenge, Emergency.

Often you only require Probe and Alert to bring your concerns up and have them addressed.

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A patient becomes angry about long waiting times. What is the best communication strategy?

Tell them that they are free to leave and get them to sign the "discharge against medical advice" form.

Explain that other patients are more critical and it is important that they are seen first.

Listen actively and empathise with their situation.

Blame the NSW Health department and recommend they formally complain to their local member.

Always a difficult situation. Often patients just want to be heard and given some empathic feedback about when they are likely to be seen.

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You are explaining a treatment plan to a patient however they appear anxious and keep interrupting you. What do you do?

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Pause. Listen to what their concerns are and respond accordingly.

Pause. Ask them to stop interrupting.

Pause, then speak a little louder.

Pause, then remind them that you will call security if they continue.

Communication is a two way street. The patient needs acknowledgement of their concerns and an explanation to decrease their anxiety and increase their understanding.

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During a cardiac arrest multiple people are calling out instructions. Which of the following is NOT part of good communication in a team.

Closed loop communication.

Role delineation.

Rotating through multiple team leaders.

Using team members names when addressing them.

An effective team has multiple working parts and to suceed requires practise and regular debriefing (real life or via SIM) to be effective.

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Which of the following is the most significant contributor to adverse patient outcomes during shift to shift handovers in ED.

Using electronic based rather than paper based systems.

Failure to communicate clinical uncertainty and pending tasks.

Doing handover in a quiet area away from the clinical area.

Overview of handover by a senior clinician after night shift.

Using a framework like ISBAR (Identify, Situation, Background, Assessment, Recommendation) can assist especially with transfer of information between peers.

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Which of the following statements is TRUE concerning the use of the "Heidi Ai medical scribe" tool for documentation in Emergency Departments?

It stuggles to document in the noisy Emergency Department environment.

Using it has been shown to drop documentation time per patient from 25min to 18min.

All public Emergency Departments in New Zealand use it.

It is called "Heidi" because it was developed in Switzerland.

The name Heidi was taken because the character was warm and caring. It has been shown to drop documentation time for a patient from 17min to 4 min. It works in the noisy environment reasonable well and has been taken up all over NZ EDs after a successful pilot.