Situational Awareness

Describe how the chosen factor was utilised or failed, in the video.

In the video, communication as the chose factor failed multiple times, when the nurse states that a tracheostomy needs to be performed with the set already brought in by her and is ignored by the team of surgeons and anaesthetists. Following that, when another nurse confirmed of availability of ICU bed but was ignored. 

Describe how a different response / performance may have changed outcome.

Communication between the team is an essential human factor directly affecting the patient’s safety and health outcome (Suzie, Groom, & Mercer, 2015). Following a good communication within the team members would have led to a quicker way of the patient’s airway being secured (Suzie et al., 2015). For the communication to flow smoothly while handling in an high acuity situation like emergency airway management, the role of a leader is also paramount as in this case, no one was there taking the charge and providing instructions (Suzie et al., 2015). The team was also guilty of not developing a brief for the smooth flow of communication as there was no meeting between the multidisciplinary team meeting of the operation being performed and neither any discussion of potential arising problems (Suzie et al., 2015).

The negative health outcome in this scenario was a result of breakdown in verbal communication between the team (Rozenfeld et al., 2020). In a situation where performing emergency airway management following verbal orders, confirming with the physician and respecting the chain of communication command is essential (Rozenfeld et al., 2020). There should have been a declaring by the team leader that this is an emergency and each team member would be aware of their parts (Rozenfeld et al., 2020). A checklist should have been made for these emergency situation based on standardized protocols. The checklist would have mentioned that after failed intubation attempts to go for the tracheostomy set to be used when the airway was inaccessible and following on from then, if an ICU bed was available (Rozenfeld et al., 2020).

There was a clear lack of communication with the team during the emergency situation, there should have been a checklist to go through, the video doesn’t mention about the drugs and medication used before beginning of the procedure by the anaesthesiologist, which would have benefitted the team leader in relaying rest of the instructions to the team. There should be a standardization of clear and defined roles to be performed respectively by each member of the team (Rozenfeld et al., 2020).There is a need of concise and clear communication throughout any hospital procedure, particularly in a high acuity situation where there should be a leader who can co-ordinate what to do and smooth in the decisions (Suzie, Groom, & Mercer, 2015). A line of command, work flow chart and a checklist would have been more helpful than the randomness seen in this case and would have given the patient positive health outcome (Rozenfeld et al., 2020; Suzie, Groom, & Mercer, 2015).

Describe the chosen factor and its importance in maintaining patient safety in high acuity settings. How can this factor affect healthcare delivery in an emergent situation?

Communication in the health is described as transfer of knowledge and commands in an orderly fashion, with each team member’s relaying from their respective position and a team leader handling the overall situation (Suzie et al., 2015). Deterioration in the communication chain leads to harmful effects on the patient and avoidable medical errors and the negative result in magnified in acute settings because the consequences are that much severe (Henriksen, 2008). Poor communication between the health care team in high acuity settings leads to the patient spending more time in hospital recovering and the risk of mortality is increase as well along with dissatisfaction from the patient’s family carers (Henriksen, 2008). The burden for maintaining a good communication flow of chain falls on the entire team, as everyone should be aware of their duties and roles, each order given/taken should be completely accurate (Henriksen, 2008).

Maintaining communication on a successful level from the health team in high acuity settings is quite demanding as in those cases, the care being provided is multifaceted fur to multiple affecting factors leading to high unpredictability (Henriksen, 2008). Maintaining the cohesion between the multidisciplinary team in high acuity setting teams is demand of the hour should always be aimed at reducing the mortality rates as much as they can (Henriksen, 2008). Lack of open communication also happens due to intimidation from the doctors towards the nurses or when the nurses who have just joined the team and are afraid of saying about the intervention (Henriksen, 2008). There is also the factor of where the nurse got her education and training to where she is working as different health care organisations have different set of rules and protocols (Henriksen, 2008). Multiple researches have been conducted on “The Situation, Background, Assessment and Recommendation (SBAR) model” for proper communication between the healthcare team members (Blom, 2015). Through this model, the situation should be analysed that presents before them or run drills for similar situations, knowing the background of the team and the patient history helps in this aspect; assessing the patient condition and whether emergency or other such intervention are required or not and finally with recommending what treatment pan and protocols to follow which will allow for the lowest possible mortality and highest positive health outcome scenario (Blom, 2015).

In emergency settings, communication is a non-technical skill which a multidisciplinary team has to learn and master to improve the patient outcome and perform interventions that in crunch situations and save their lives (Murphy, Curtis & McCloughen, 2016). The problem with communication problem can arise due to cultural differences, when working in countries like Australia, the medium of communication should be kept to English to avoid any miscommunication (Murphy, Curtis & McCloughen, 2016). Mastering communication is one of the essential “crisis resource management” skills by the health care team and its needs increase in an emergency settings along with decision making by the team (Murphy, Curtis & McCloughen, 2016). Maintaining a clean communication line in an emergency setting is effective as it allows the team to handle the situation as it grows and can tackle any adversity (Murphy, Curtis & McCloughen, 2016). Failure to communicate is one of the leading cases of medical errors and needs the health care team to run simulations or drills to prepare for such an event (Murphy, Curtis & McCloughen, 2016). Training for such scenarios will make the more proficient and will lead to better decision making in such scenarios with timely interventions (Murphy, Curtis & McCloughen, 2016).

References for Human Factors in Complex Airway Management

Henriksen, K. (2008). Advances in Patient Safety: New Directions and Alternative Approaches. Agency for Healthcare Research and Quality US. https://www.ncbi.nlm.nih.gov/books/NBK43624/

Lisbeth Blom, R. (2015). The situation, background, assessment and recommendation (SBAR) model for communication between health care professionals: A clinical intervention pilot study. International Journal of Caring Sciences8(3), 530. https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A871551&dswid=473

Murphy, M., Curtis, K., & McCloughen, A. (2016). What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review. Australasian emergency nursing journal19(1), 44-53.

Rozenfeld, R. A., Nannicelli, A. P., Brown, A. R., Eppich, W. J., Woods, D. M., Lestrud, S. O., Noah, Z. L., & Holl, J. L. (2020). Verbal Communication During Airway Management and Emergent Endotracheal Intubation: Observations of Team Behavior Among Multi-institutional
Pediatric Intensive Care Unit In Situ Simulations. Journal of Patient safety16(3), e114–e119. https://doi.org/10.1097/PTS.0000000000000272

Suzie, G., Groom, P., & Mercer, S. (2015). Human factors in complex airway management. BJA Education, 16, mkv045. doi:10.1093/bjaed/mkv045

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