Communication and influencing for ED Professionals: A training programme developed in the emergency department for the emergency department

Julie C Humphries1, Mingshuang Ding1, Hansel Addae-Bosomprah1

1 Queen Elizabeth II Jubilee Hospital, Cnr Kessels Rd & Troughton Rd, Coopers Plains  QLD 4108 Australia

Background: An ED is a unique working environment characterised by time-stress, high patient turnover, unfamiliar patients, the management of high-risk patients, a high proportion of interruptions and a high level of multi-tasking, all of which contribute to making it a high-risk hospital area in regard to patient safety and medical errors.  ED health professionals have high communication loads quantified high communication loads quantified as 89% of a health professional’s time.

Breakdowns in communication are a significant contributor to adverse events in EDs.  It has been reported that miscommunication was associated with 12% of the clinical errors during an ED clinician’s shift.

Communication during triage, ambulance transfer, ED handover and admission are of vital importance.  Communication is a key cause of patient complaints in the ED.

Despite the identified need for effective communication, ED health professionals receive inadequate training in non-technical skills, including communicating, during their vocational medical education.  The key training areas in the ED reported in the literature, to date, include structured communication protocols to guide handover, structured communication tools to improve communication and teamwork training, comprised of team strategies and tools to enhance performance and patient safety (TeamSTEPPS) and crisis resource manage (CRM).

Of interest, the two most popular approaches reported within the literature for teamwork training have been translated from the defence (TeamSTEPPS) and aviation industries (CRAM).  In addition, there are limited reports of action learning or action research approaches taken to communication training within the ED, with the majority of approaches being didactic and teaching oriented.

Action learning is an iterative process of learning and reflection, with and by colleagues as they learn with and from each other in the context of their active working environment.  Action learning and action research approaches to training are suited to the ED for their unique ability to respond to complex organisational problems, the importance of effective high performing teams and the need for time efficient learning.

Objective: The objective of the present study is to develop and pilot a communication and influencing skills training programme that meets ED health professionals’ needs at an urban district hospital.

Methods: Qualitative methods within a participatory action research framework were utilised.  An interdisciplinary team guided the programme’s design and development.  A training needs analysis saw team meetings, interviews, focus groups and observations conducted across the ED.  Thematic analysis of the data identified health professions’ communication and influencing challenges.  The training needs analysis informed the training programme curriculum’s development.  The pilot programme involved an interdisciplinary group of seven health professionals across 5x2h sessions over 3 months, followed by a post-training survey.

Results: Five themes of communication and influencing challenges were identified: participating in effective handovers, involving patients in bedside handovers, effectively communicating with interdepartmental colleagues, asking ED colleagues to do tasks and understanding ED colleagues’ roles, expectations and assumptions.  Based on these challenges, the formulated RESPECT model (which stands for Relationships, Expectations, Styles, Partnerships, Enquiry, Coaching and Teamwork) informed the training curriculum.  The peer coaching model used in the training programme was highly regarded by participants.

Conclusions: Communication and influencing for ED professionals addresses a gap for communication programme developed in the ED for the ED.  Future research will evaluate the programme’s impact in this ED.

References

1. Rixon A, Rixon S, Addae-Bosomprah H, Ding M, Bell A. Communication and Influencing for ED Professionals: A training programme developed in the emergency department for the emergency department: Communication and Influencing for ED Professionals. Emergency Medicine Australasia. 2016;28(4):404-11.

Biography

Mingshuang (Monica) Ding BMid;  MMidRes;  RM ;PhD Scholar Research Nurse/Midwife at the Emergency Department | QE II Jubilee Hospital AIA (Aeromedical Innovation Australasia) as a research Consultant  Awarded academic title with Griffith University as a  Lecturer with in the School of Nursing and Midwifery

Julie Humphries BNur; M(advance practice-emergency nursing); RNNurse Educator at the Emergency Department | QE II Jubilee Hospital

Hansel Addae-Bosomprah Senior Medical Officer at the Emergency Department | QE II Jubilee Hospital