Dr. Akshay Department of Emergency Medicine, AIIMS, Delhi

1. Communication Skills in
High-Stake Environment
Department of Emergency
Medicine, AIIMS, Delhi

2. Building a World-Class Emergency
Department through Communication
Department of Emergency
Medicine, AIIMS, Delhi

3. A patient is a person seeking
help, relief and reassurance
Harrison Principles of Internal Medicine

4. Communication – a process
• At birth child communicates by crying
• A cognitive behavior
• Can be good and skilled / poor and unskilled
• Gesticulations / Histrionics / Verbal / Written /
Body language / Electronic
• Individual strengths and weaknesses to
gesticulate, dramatize, verbalize, write or
messaging

5. Communication – a process
Encoder
Information
Transmitter Receiver
Decoder
Destination
Noise
Medium
NoiseNoise
Feedback

6. Effective Communication – 7 Cs
1. Clarity
2. Completeness
3. Coherence
4. Consciousness
5. Credibility
6. Correctness
7. Continuity

7. Ultimate Goal in Emergency Care
Patient Safety
Quality
Emergency
Care
Patient
satisfaction
Communication

8. Patient Safety FIRST

9. In the words of Edward Livingston Trudeau
Cure sometimes
Relieve often
Comfort always

10. Emergency Room

11. Emergency Room
• Uncontrolled environment
• Congested, Large number of sick patients
• Anxiety, Emotions are high
• Police, Medico-legal cases
• Long waiting lines for patients and relatives
causing frustration
• No privacy
• Noise
• Frequent interruptions
• Rapid turnover of patients

12. Why Communicate?
• For all the above reasons
• Good communication influences patients’
health, symptoms, function and physiology
• Time efficient & decreases inappropriate
work-up
• Inter-personal conflicts
• Litigation
• Enhances compliance and follow-up

15. Why Communicate
• Collaboration to improve cooperation
• Team Work = Quality Emergency Care
• Non-technical skills as important as
technical skills
• Bad communication leads to stress, lack
of job satisfaction

16. Highlighting Studies
• Patient satisfaction not related to interview
length
Korsch etal
• Patients presented all their concerns in average of
75 secs Langewitz etal
• Discharge interview (5 min) increased compliance
and follow up by more than 50% Waggoner etal
• Patient satisfaction and willingness to return poor
with poor explanation of problems Sun etal
Korsch BM etal . Gaps in doctor–patient communication. Pediatrics 1968
Langewitz W etal. Spontaneous talking time at start of consultation in outpatient clinic. BMJ 2002
Waggoner DM etal. Physician influence on patient compliance: a clinical trial. Ann Emerg Med 1981
Sun BC etal. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med 2000

17. Other Studies
• Consistently show poor communication leads
to poor satisfaction among patients
• Patients were frequently interrupted
• Patients consistently not given diagnosis and
follow-up information in over 40% instances
Rhodes KV etal. Resuscitating the Physician-Patient Relationship Emergency Department Communication
in an Academic Medical Center. Ann Emerg Med. 2004.

18. Care provider-to-patient
• Understand the agendas of our patients
• Do we really know what the patient wants
• Stand in our patient’s shoes
• Strive for an authentic human encounter
• Assess emotional distress
• Communicate honestly and compassionately
• Treat with kindness and respect

19. Care provider-to-patient
Society for Academic Emergency Medicine
• Early
• Establish Rapport
• Gather information
• Give information
• Provide comfort – Listening to distressed
• Collaborate
• Feedback to the communication

20. Care provider-to-patient
• Transfer of cognitive data and emotional
data
• Balance the dialogue with a mix of cognition
and emotion
• Handle emotion by non-verbal expressions
• Serious illnesses may lead to psychological
morbidity
• Address concerns to facilitate effective coping
and reduce complaints

21. A sincere emergency care
provider
Best Non-Verbal Communication

22. High Yield Communication
Early
Communication
Discharge
Interview
Address specific
concerns. Why
are you here
today?

23. Breaking Bad News
S P I K E S endorsed by American Society of Clinical Oncology
and several other societies
• Setting up the Scene
• Assessing patients Perception
• Patients Invitation to share the information
• Giving Knowledge and information to the
patient
• Address patients Emotions & Empathize
• Strategy and Summary

24. Care provider-to-Care provider
ISBAR – Widely used for relaying clinical information. First used by US Navy
I - Introduction of self
S - Situation
B - Background
A - Assessment
R - Recommendation
Feedback to the conversation
Acknowledgment
Repeat History
Plan of Action

25. Leadership
• Leader needs NO TITLE
• Everyone is a leader

26. Leading the Code Blue
• Most senior/experienced person usually leads the
code
• Designating job to team members
• Call people by name
• Involving para-medical staff in active
resuscitation
• Closed loop communication
• Team work should not require anyone to shout,
everyone should be playing their part

27. Documentation
• If not documented it never happened
• ED notes - short, clear, crisp, dated and timed
• Assessing the patient – Write notes A B C
approach
• Highlighting current issues and
management and plan
• Summarizing the events in few lines

28. Hand-Over
• The summary in the medical notes
• Physical handover over the patients’ bed
• Print a list of patients
• Highlight the priority patients
• Be specific

29. All Talk and no Work!
There has to be hard and sincere skillful
delivery of the health care product
Empathetic human resource
Judicious use of technology to achieve the 3
goals of safety, satisfaction and quality care.

30. A bit of Empathy and a little
bit of humor go a long way

31. I hear & I forget
I see & I remember
I do & I understand
Chinese Proverb

32. Get to Work!
Our Emergency patients do not need
condolences
Further problem identification is not
required
We need to Get interested and Get to
WORK!