Descriptive feedback with targeted education to improve telephonic escalation of care: a simulation-based study

Aster Kuriakose; Subodhini Puhambugoda Arachchige; Theophilus I Emeto; Matthew I Hiskens; Gopakumar Hariharan

doi:10.1186/s12909-024-05260-1

Descriptive feedback with targeted education to improve telephonic escalation of care: a simulation-based study

BMC Med Educ. 2024 Mar 13;24(1):281. doi: 10.1186/s12909-024-05260-1.

Authors

Aster Kuriakose¹, Subodhini Puhambugoda Arachchige¹, Theophilus I Emeto², Matthew I Hiskens³, Gopakumar Hariharan¹

Affiliations

¹ Department of General Paediatrics, Mackay Base Hospital, 4740, Mackay, QLD, Australia.
² Public Health & Tropical Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, 4811, Townsville, QLD, Australia.
³ Mackay Institute of Research and Innovation, Mackay Base Hospital, 475 Bridge Road, 4740, Mackay, QLD, Australia. matthew.hiskens@health.qld.gov.au.

Abstract

Background: Awareness of communication failures in healthcare has necessitated the implementation of standardized, validated handover tools such as Identification, Situation, Background, Assessment, Recommendation (ISBAR). Although educational sessions improve communication, the effectiveness of individualized care escalation communication training is unknown. The primary aim was to conduct a simulation-based study to assess individualized one-on-one communication training for junior medical doctors for improving care escalation in pediatric emergencies. The secondary aim was to assess the evaluation of the training.

Methods: The prospective observational study assessed participants pre- and post-intervention. In Session One, participants presented a written case scenario telephonically to two senior pediatricians. Fifty participants were scored using an 18-item checklist based on the ISBAR tool and "free text" responses. Immediately following case presentations, participants completed individualized one-on-one 30-minute educational sessions regarding self-reflection, didactic teaching, and constructive feedback based on the ISBAR. Session Two included a second case presentation and reassessment. We conducted qualitative analysis of supervisor's feedback on performance and trainee doctor's evaluation of the training.

Results: There was significant improvement in 8 of the 18 components of the ISBAR checklist. All elements of care escalation were significantly improved, and overall communication was higher post-intervention (P < 0.001); however, no improvement was noted in participants' explorations of differential diagnoses (P = 0.263). The qualitative analysis identified themes of improved urgency in seeking senior support and conversational clarity from supervisors, and improved intervention quality and self-confidence from participants.

Conclusions: Individualized communication training may improve pediatric emergency care escalation and communication among junior doctors.

Keywords: Communication; Education; Simulation; Training.

Publication types

Observational Study

MeSH terms

Child
Clinical Competence
Communication*
Delivery of Health Care*
Feedback
Humans
Pediatricians