Communicating Neurocritical Illness: The Anatomy of Misunderstanding
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Communicating Neurocritical Illness: The Anatomy of Misunderstanding Eelco F. M. Wijdicks* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract We talk, text, email all day. Do we perceive things correctly? Do we need to improve the way we communicate? It is a truism that providing insufficient information about a patient results in delays and errors in management. How can we best communicate urgent triage or urgent changes in the patient condition? There is no substitute for a face-toface conversation but what would the receiving end want to know? One starting point for those practicing acute neurology and neurocritical care is a new mnemonic TELL ME (Time course, Essence, Laboratory, Life-sustaining interventions, Management, Expectation), which will assist physicians in standardizing their communication skills before they start a conversation or pick up a phone. These include knowing the time course (new and "out of the blue" or ongoing for some time); extracting the essentials (eliminating all irrelevancies); communicating what tests are known and pending (computerized tomography and laboratory); relaying how much critical support will be needed (secretion burden, intubation, vasopressors); knowing fully which emergency drugs have been administered (e.g., mannitol, antiepileptics, tranexamic acid), when transport is anticipated, and what can be expected in the following hours. Perfect orchestration in communication may be too much to ask, but we neurointensivists strive to convey information accurately and completely. Communication must be taught, learned, and practiced. This article provides guiding principles for a number of scenarios involving communication inside and outside the hospital. Keywords: Communication, Neurocritical illness, Handoff, TELL ME Introduction We write and read notes; then we talk, call, text and email about our patients [1–4]. We can be reached instantaneously, but, in all sincerity, why are some messages unheeded? We all like to believe that we are getting the relevant information in a timely manner—but not necessarily. Bear in mind that providers are interrupted constantly [5]; plans change and decisions multiply rapidly throughout the day. Communication between healthcare workers involves communication of an incoming patient or outgoing patient with transfer in the hospital or out the hospital. Handoffs (sign-outs) have been best studied and the importance of the handoff is bolstered by the observation that night interns reference the written *Correspondence: [email protected] Division of Neurocritical Care and Hospital Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
or verbal sign-out in order to answer questions that arise during the night [6]. At least one survey suggests that a "better" signout would lead to a reduction in adverse events [7]. Another survey study asked clinicians to identify for each patient whether they anticipated any nighttime events and what type of events they would
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