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Team communication


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Tools and techniques (Page 1 of 2)


  • We can all communicate better.
  • Structured approaches can improve the clarity of communication.
While the CMPA does not endorse any specific approach or structured communication tool, the following examples of techniques may be useful. Many others exist and researchers continue to explore ways to improve communication.

Group of physicians meeting around a table

Briefings

Teams in hospitals, clinics, or offices function better if everyone is on the "same page."

Briefings can set the tone for team interactions and help establish a shared mental model of what should happen during patient care.

Briefings can be used to identify safety risks, concerns about specific patients, medications, equipment issues, and backup plans.

Can you say "yes" to the following questions about your briefings?

  • Is the information detailed and specific?
  • Are the intended actions and possible problems understood?
  • Have questions been welcomed and answered?
  • Does everyone understand the plan?

Debriefings

  • Help enhance a culture of safety in an environment of respect, teamwork, and communication.
  • Can help you identify what went well and what happened when things didn't go as planned? What might be done better next time?  

An important component of a just culture of safety is continuous learning. Many teams find it valuable to have a respectful debriefing after an episode of patient care to determine how members feel about the events and processes of care, and to recognize opportunities for improvement and further education.

Closing the communication loop — Readbacks

  • Use a readback for verbal instructions and orders.

When you order take-out food by phone, the person taking the order normally confirms your request by reading it back. Similarly, readbacks in healthcare can also reduce miscommunication.

A readback is aimed at verifying that a message is correctly received and provides an opportunity to correct misinformation. Many find it especially useful in crisis situations.

Readbacks can be used to confirm such things as:
  • the patient's name
  • medication orders
  • critical test results
  • instructions and action items from supervisors

For similar-sounding medications, it may be worth spelling the name and stating what it is being used for.

Verbal orders must be entered in the medical record and be countersigned or approved.

Case: A newborn with tachypnea
Close up of newborn being examined by male physician

Background

A newborn, who was delivered at term 24 hours prior, develops tachypnea. The treating family physician consults a pediatrician by telephone.

The pediatrician recommends starting IV gentamicin and ampicillin while awaiting blood culture results. He recommends the gentamicin be given in divided doses 12 hours apart (q12h) for a total daily dosage of 5 mg/kg/day.

However, the family physician misunderstands the pediatrician's instructions and prescribes the total daily dose q12h.

Male physician on phone with laptop in front of him

Outcome

The newborn receives three doses before the dose is corrected. There are no gentamicin-related ototoxic or nephrotoxic complications.

Think about it

How could the family physician have avoided misinterpreting the gentamicin dosage?
Male physician with eyeglasses in his hand, talking on phone

Lessons learned

If the family physician had used a simple readback approach to verify the gentamicin instructions, the pediatrician would have noticed the mistake.
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