A description of communication patterns during CPR in ICU

Area of Science:

• Medical communication research
• Healthcare quality improvement
• Pediatric critical care

Background:

• Communication deficiencies in healthcare are a significant cause of medical errors.
• Effective communication is crucial for successful resuscitation efforts, particularly in pediatric intensive care units (ICUs).
• Understanding communication patterns during resuscitation can inform teaching and improve team performance.

Purpose of the Study:

• To describe communication patterns during pediatric medical and surgical intensive care unit (ICU) resuscitations.
• To analyze the content, initiator, and audience of communication epochs during resuscitation events.
• To evaluate the utility of audio recordings for assessing teamwork behaviors using the Anesthesia Nontechnical Skills (ANTS) framework.

Main Methods:

• Prospective audio-recording of resuscitation events in a mixed pediatric ICU by trained observers.
• Transcription and anonymization of recordings within 24 hours.
• Grouping of utterances into communication epochs and analysis of initiator, audience, and message content; assessment of teamwork using the ANTS framework.

Main Results:

• Analysis of 36 minutes of audio from 4 cardiac arrest events revealed 180 communication epochs (average 1 every 12 seconds).
• Team leaders initiated 56% of epochs, primarily for orders or authority assertion (61%).
• Non-team leaders initiated 44% of epochs, often directed to the team (65%) rather than the leader, forming an 'outer loop' of communication.

Conclusions:

• Communication during pediatric resuscitation is frequent and largely leader-driven, but a significant 'outer loop' of communication exists among non-leaders.
• Audio recordings effectively captured data for teamwork behavior assessment (80% of ANTS elements).
• Further research is needed to optimize the balance between leader-led and team communication and improve resuscitation strategies.