Time-Critical Telephone Communications with Relatives in the ED: Role-play Sim
One of the biggest challenges that we face in Emergency Medicine is that of breaking bad news to a patient’s next of kin (NOK) over the telephone rather than in person. The circumstance associated with the current COVID-19 pandemic has made this situation more frequent. As a result, the EM3 education team has taken the opportunity to coach our staff in preparing for this emotionally challenging situation.
For patients brought to an Emergency Department (ED) these scenarios can arise with little warning for either the family or the staff. Senior staff members will have experience of this and may have received some training for rapid fact-finding and giving sad news in stressful scenarios. Putting a telephone between you and the recipient of this information makes it much harder as we cannot depend on body language, facial expressions and interpersonal dynamics to express empathy, or gauge the situation.
This bespoke training package enables staff to practice phrases and approaches when communicating with relatives over the telephone during time-critical situations.
Our Approach
We chose to use simulated role-play (using a trained actor representing the NOK/relative) as a modality for providing learners with a close-to-real-life experience. The actor was trained in both acting skills and providing balanced feedback for learners. This was the unique feature of our training package as in reality, we wouldn’t usually receive direct feedback from recently-bereaved relatives.
Secondarily, our scenarios were delivered in a “safe space” away from the busy clinical environment allowing learners to practice, share thoughts or experiences and gain additional feedback from facilitators and observers.
Before the session
We consulted existing resources focusing on the following areas: end-of-life conversations; ceiling of care communication aids; experiences of police call handlers and senior staff. We used this information to create a short eLearning package to help learners prepare for the session beforehand.
During the session (45-60 mins)
Each inter-professional group (5-10 staff members) consisted of individuals of varied seniority with a combination of active participants and observers split across two adjacent rooms. Two telephone calls were made to the actor where learners in both rooms could hear the conversation, linked by a telephone line. This approach was used to reduce anxiety for the callers (active participants).
Call 1 / Learner 1
Rapid fact-finding and explaining that the patient is critically ill (approx. 5 mins)
Followed by feedback from the actor (approx. 10 mins), e.g. how it felt to receive the news; areas of strengths and tips for improvement
Observers share thoughts, e.g. preparatory eLearning package, prior experiences, current scenario
Call 2 / Learner 2
Relaying news that patient had sadly died despite cardio-pulmonary resuscitation (CPR)
Call 2 takes place 15 minutes after Call 1 but assumes that one hour has passed in the scenario
Same actor-delivered feedback is given along with further group discussion
After the session
Written feedback forms completed by all participants are collected at the end of the session. The evaluative phase will take place in one month’s time (electronic evaluation form to be sent to learners) to allow sufficient time for reflection.
What you will gain from running this simulation
An opportunity to provide an educational experience within an inter-professional team
An enjoyable experience where you can see immediate improvements in staff confidence
Testimonials
“I learned some useful stock phrases, and words to avoid.”
“This session made me think about how to prepare for the call, even when time is short.”
“The actor was so realistic and gave such useful feedback, thank you for the session.”
You can download everything you will need to run these sessions for your own department by clicking on the buttons below. Our content is provided under a Creative Commons (CC BY-NC-SA 4.0) International License, so feel free to adapt for your own uses as needed. The Facilitators’ Pack will help prepare you for practical, technical and emotional issues that you may face.
We wish to thank Role Plays for Training for providing highly-skilled actors who have made this unique training opportunity both realistic and invaluable for our staff.
Additionally, we'd like to acknowledge the following as sources of information, advice and assistance in producing and promoting this training module: Ms Simone Tate, Leicestershire Police, Barts Simulation Centre, Dr Helen Parker, NHS Education for Scotland, Claire Henry, Dr Kathryn Mannix, West Middlesex Palliative Care, eLearning for Health, the Royal College of Emergency Medicine, and the UHL Palliative Care nursing team. (Photo credit for blog/booklet).
Finally, a big thanks to Dr Ffion Davies and Dr Sunny Jutla for helping write this blog 🌟
