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ERcast Lite

Welcome to ERCast, a focused discussion on the questions, quagmires and known unknowns we face everyday in the emergency department.

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Oct 23, 2017

Have you ever watched a volleyball game and seen the ball fall between two players? What happened there? It was probably inadequate or insufficient communication as to who was going to make the play. The same thing happens in almost every professional arena: mistakes are made because of poor communication. In this episode we discuss three tools to improve how we relay information to each other, eliminate ambiguity, and the biggest goal of all - improve patient safety.

Tools discussed in this show

  • Three way repeat backs
  • Phonetic clarification
  • Clarifying language with numbers
  • Using a dry erase board in the resus bay
  • Posters in the resus bay with simple but important checklists

Links mentioned in this show

Three way repeat backs

Sender: Gives the initial information

Receiver: Repeats information back

Sender: if the repeated information is correct, responds with, "That's correct."

Using the phrase "that's correct" takes away the vagueness that can happen with words such as right, OK, yup, got it, etc.

Phonetic clarification

Use the phonetic alphabet to spell out easily misspelled or misunderstood words. For example, my name is often misspelled, so I will say, "It's Orman, O-R-Mike-Apple-Nickel." There are many phonetic alphabets out there, and you don't have to use one in particular. Just use what makes sense to you and is clear to the listener.

Clarifying language with numbers

When there are numbers that sound alike such as 15 and 50, say the number and then say the digit. "Please give fifteen milligrams of drug X, that's one five milligrams"

Using a dry erase board in the resus bay

I use the board to write my induction, paralytic, and post intubation medication plan. This is discussed out loud with the team while I'm writing it out. I use Reuben Strayer's intubation checklist as my reference. Here is an example (written on my board at home, not an actual patient).

Posters in the resus bay with simple but important checklists

It's amazing how much can be missed in a trauma resuscitation. Going back through the primary and secondary survey, step by step, can help organize your management and keep you from missing critical issues. Here are two posters in my favorite resus bay: