A little communication goes a long way

I tried something new on my last 2 ER calls.  I don't know if it is going to change anything, but it passed the "good idea" test with most of the nursing staff that I worked with on these last 2 ER calls.  So what did I do - nothing spectacular and no new concept - I created an opportunity for communication amongst the team in the ER.  To understand it, I will give a little bit of background first.

I am a family physician that works shifts in our local ER.  We don't have full time ER docs and there are 10 of us family physicians that do 12h shifts in the ER - divided equally over the year.  Our ER sees about 50 - 100 visits per day and averages about 1900 visits per month.  We have 1 family physician per 12h (8am to 8pm, 8pm-8am), 3 registered nurses during day (7am - 7pm), 1 registered nurse (9am-9pm), 2 registered nurses during night (7pm-7am), 1 ward clerk and a (new) nurse practitioner who does about 14x12h shifts (normally day time) in a month.

In the past 12 years that I have worked in the ER here, all of us just came to work to do our shifts and for the most part got along quite well together, but we have never had a meeting.  The nurses have handover rounds at 7am and 7pm and the physicians hand over to each other at 8am and 8pm.

On Thursday and Saturday on my last 2 calls I called a meeting at 9am and 7pm and invited everyone - the wardclerk, nurses and even house cleaning.  I explained that I wanted to create opportunity for a huddle before we start the shift and a debrief at the end of the shift.  These meetings only lasted 3-5 minutes.  We discussed the safe environment where anything can be brought up on how to do things better in a no blame atmosphere.  We all want to learn what we can do better.  We discussed our poor "door to needle times" for ST elevation myocardial infarctions (heart attacks) and that we want to get them better.  I was busy with a longer case at 7pm on thursday, so we did not have a debrief, but on Saturday we had both the pre-shift huddle and post-shift debrief.   Some of the nursing staff were so excited that I almost got a hug. 

So what did we learn - the team values communication opportunities and sometimes we don't know when others are scared or uncertain too.  One of the nurses was glad to hear that she was not alone when she felt scared when a little girl of 4 years came in with a severe nut allergy needing epinephrin.  During the debrief I could share that I was scared too when she turned white with blue lips and telling us her tongue feels thick and I can hear wheezing in her chest.  Luckily for all involved the epinephrin worked it's magic and after 4h observation in ER she was playing and being her old self again...

These brief meetings seem so obvious and minor in the scheme of things going on in ER, but on these last 2 calls things felt different and the calls had more a feeling of a "team approach".  Will I keep doing it ?  Well, I will try it for 3 months and reassess - so far it has been a positive experience.

Like the Japanese proverb says: "None  of us is as smart as all of us" .....