Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September

Communication Tips in the Trauma Setting

Paul Acedera, MHSA, LHRM, CPHRM
Jan Rebstock, RHIT, LHRM, CPHRM
J. Bracken Burns, Jr., DO, FACOS
11-4-3 Even under ideal conditions, communication in the health care setting, whether among providers or between providers and their patients, continues to be a challenge from a patient safety and customer service standpoint.  Data from The Joint Commission indicates that poor communication has contributed to approximately 70% of the sentinel events reported and has consistently been listed as one of the top three root causes since 2005. Communication failures between providers and patients during an encounter in any setting increases the opportunity for a complaint or malpractice claim.  Trauma teams are faced with a combination of medically complex patients who in many instances have no prior medical history with the facility and operating under extreme time pressures with very narrow intervention windows. Trauma and emergency medicine teams are expected to rapidly perform the substantial tasks of assessing, getting ancillary tests, diagnosing and determining the best resuscitative and interventional course to take. There are three general aspects of communication in the trauma setting discussed in this article.   Communication with the Patient A primary area of concern with respect to communication is obtaining informed consent from a patient who may or may not be able to participate in the consent process at the time of initial evaluation or before a procedural intervention is required.   In circumstances where obtaining informed consent is impossible because the patient is incapacitated, consent is implied, however, documentation should reflect the emergent nature of the patient’s condition and procedure. It’s always a plus if the patient comes in with outside medical records or has been a patient in the facility enabling review of records for significant historical clinical information, presence of an advanced directive and identify next-of-kin or other listed emergency contact who can be notified and participate in the consent process. Communication with the patient and family members by the trauma team while perhaps succinct and to-the-point out of necessity, should always be respectful.  Presenting a caring demeanor and addressing the patient by name promotes trust, respect and rapport with the physician and team members. Active listening, providing clinical information in terms consistent with the patient’s level of understanding and encouraging patient feedback goes a long way to help patients cope with what may be a dramatic, overwhelming, and life-changing event.   Communicating Bad News Delivering bad news is a reluctantly-performed task, fraught with stress that takes a heavy toll on care providers as well as the patient and family. Before meeting with the patient or family, team members should take a little time to come to terms with their own emotions to ensure information is relayed in a compassionate and empathetic and, to the extent possible, non-hurried manner. Setting a fast pace just to get a painful task over with is not the best approach. Patients and family need time to absorb and process what they are being told and made to feel comfortable about asking questions.   When the prognosis or outcome is grim, speaking with all present family members during the exchange of information is a good idea so that everyone hears the same message at the same time from the same person.  Stress-provoking medical statistics or “survival odds” or other medical jargon may be saved for a future conversation.  Keep it simple, understandable and human. As patient conditions can rapidly change in the trauma setting, it is important that trauma staff be prepared to compassionately deal with the patient’s or family’s expressions of grief that can manifest in shock and denial, anger, fear, guilt, despair and tears. Through it all, maintaining a calm, caring, non-judgmental, and non-defensive demeanor as difficult as it may be, will go a long way.  Allowing the patient or family to  express their emotions helps them cope and begin the acceptance process.  Having specialized staff resources or the skills to deal with the range of emotions that can be encountered is very helpful as is the availability and support of clergy to provide spiritual support.   Communication Among providers Resuscitation in a trauma setting involves multiple disciplines usually led by surgical teams. However, many trauma centers incorporate emergency department physicians and staff resulting in shared, cross-disciplinary decision-making. In a setting where time is of the essence, multiple staff with varying roles, responsibilities, and experience levels can create logistical issues and confusion with regard to chain of command and handoff communications. Consequently, effective leadership and training of the team is crucial to the smooth coordination of operations to ensure the most timely and optimal patient outcome.   Bibliography: Caprice C. Greenberg, MD, MPH; Scott E. Regenbogen, MD; David M. Studdert, LLB, SCD, MPH; Stuart R. Lipsitz, SCD; Selwyn O. Rogers, MD, MPH, FACS; Michael J. Zinner, MD, FACS and Atul A. Gawande, MD, MPH, FACS: Patterns of Communication Breakdowns Resulting in Injury to Surgical Patients, 2007   The American College of Surgeons.   Charles J> Schubert, MD and Patricia Chambers, MD: Building the Skill of Delivering Bad News, Clinical Pediatric Emergency Medicine 2005. Englebert A.G. Bergs; Frans L.P.A. Rutten; Tamer Tadros; Pietra Krijnen and Inger B. Schipper: Communication during trauma resuscitation: do we know what is happening?  Injury International Journal of the Care of the Injured, 2005. Nicole K. Roberts, Ph.D.; Reed G. Williams, Ph.D.; Cathy J. Schwind, R.N., M.S.; John Sutyak, M.D.; Christopher McDowell, M.D.; David Griffen, M.D.; Jarrod Wall, M.D.; Hilary Sanfey, M.B., B.Ch.; Audra Chestnut, M.S.; Andreas H. Meir, M.D.; Christopher Wohltmann, M.D.; Ted R. Clark, M.D. and                                    Nathan Wetter, B.S.: The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings.  The American Journal of Surgery, (2014) 207, 170-178. Aleksandra Sarcevic, Ivan Marsic, Lauren J. Waterhouse and David C. Stockwell: Leadership structures in emergency care settings: A study of trauma centers.  International Journal of Medical Information 80 (2011) 227-238.