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This is the 178th #WILTW

One of the joys of being involved in our simulation programme is the constant stimulus to improve your own practice, especially in the grey area of leadership and communication

The critically ill child poses a logistical dilemma. There are various body systems that simultaneously need attention: the airway, the circulation, the neurological system etc. Life threatening illness is unstable and this means those systems may respond to treatment, or they might not. Either way it is possible they may require further intervention at a future point. The systems also interact with each other; sometimes in series (only by tacking one problem can you solve another) and sometimes in parallel (simultaneous collapse requiring completely different management approaches).

Imagine different members of staff, both medical and nursing, needing to interact with each other in a co-ordinated fashion, delivering medications which are dose dependant (you need to make sure you give the right amount or the patient will come to harm) but also time critical (take too long drawing them up and the patient will come to harm).

The ability to orchestrate a team around a child is an art. There are some skills you can be introduced to, and some common approaches to take, but when the manure hits the proverbial fan, especially if you are working with people you may have never met before, there is not a textbook to rely on.

Ensuring the patient is receiving enough oxygen,

and that they are breathing effectively,

and that someone is drawing up some fluids while someone else is drawing up some antibiotics,

and that you’ve not missed the fact they are low on glucose,

and that you can’t hear yourself think because a monitor is alerting you to the fact that the heart rate is dangerously low

and that two phones are ringing to let you know that the CT scan is ready but that theatre won’t be ready just yet,

and someone curses because they’ve not been able to get a cannula into the child for the third time,

And then you realise you’ve not even updated a terrified parent let alone your team.

Experience brings with it the ability to determine courses of action swiftly, delegate tasks effectively and decisively communicate multiple instructions without needing to raise your voice. But there are still times when you wish time would just stop and you could Matrix style weave yourself through the scene checking each system in sequence and collating information in a non hurried fashion.

There is no one best way to manage the communication cascades that develop but there definitely patterns that emerge and as a thought experiment the digital era has offered us some comparisons..

For real control you could adopt a text messaging approach with each individual submitting questions and receiving answers only from you. This  means no mixed messages and would make sure people don’t get overloaded with tasks i.e. deliver blood transfusion before sending/receiving next message. The problem is that the team leader is left with a list of messages to answer and the rest of the team don’t know what has and hasn’t been actioned.

It might be that e-mail would facilitate more than one individual knowing what was happening at any given time. A reply to all function would allow everyone to see the questions and the answer. Email makes it difficult to scroll through though conversations quickly though..

Conversely a WhatsApp communication channel would keep everyone up to speed in a visually accessible way and allow team members to delegate tasks amongst themselves. However leadership of a this group would be challenging especially with messages flying in every direction…

You could try a Twitter approach with the team members only allowed to follow the team leader and not each other, using #patient to allow for global updates. This would enable short pithy communications but runs the risk of errors when complex decisions are required.

While clearly we are not about to see teams, face down, looking at their phones during resuscitations, the analogy demonstrates the complexity of communication management required.

What have you learnt this week? #WILTW

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