title: A description of communication patterns during CPR in ICU.
abstract: BACKGROUND
  Deficiencies in communication in health care are a common source of medical error. Preferred communication patterns are a component of resuscitation teaching. We audio-recorded resuscitations in a mixed paediatric medical and surgical ICU to describe communication.
  
  
  METHODS
  In the intensive care unit, resuscitation events were prospectively audio-recorded by two trained observers (using handheld recorders). Recordings were transcribed and anonymised within 24h. We grouped utterances regarding the same subject matter from beginning (irrespective of response) as a communication epoch. For each epoch, we describe the initiator, audience and content of message. Teamwork behaviours were described using Anesthesia Nontechnical Skills framework (ANTS), a behavioural marker system for crisis-resource management.
  
  
  RESULTS
  Consent rates from staff were 139/140 (99%) and parents were 67/92 (73%). We analysed 36min 57s of audio dialogue from 4 cardiac arrest events in 363h of prospective screening. There were 180 communication epochs (1 every 12s): 100 (56%) from the team-leader and 80 (44%) from non-team-leader(s). Team-leader epochs were to give or confirm orders or assert authority (61%), clarify patient history (14%) and provide clinical updates (25%). Non-team-leader epochs were more often directed to the team (65%) than the team-leader (35%). Audio-recordings provided information for 80% of the ANTS component elements with scores of 2-4.
  
  
  CONCLUSIONS
  Communication epochs were frequent, most from the team-leader. We identified an 'outer loop' of communication between team members not including the team-leader, responsible for 44% of all communication events. We discuss difficulties in this research methodology. Future work includes exploring the process of the 'outer loop' by resuscitation team members to evaluate the optimal balance between single leader and team suggestions, the content of the outer loop discussions and in-event communication strategies to improve outcomes.
authors.affiliation: Department of Anaesthesia, Hospital for Sick Children, Canada; Research Institute, Hospital for Sick Children, Canada; University of Toronto, Canada. Electronic address: Katherine.taylor@sickkids.ca.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Taylor
authors.affiliation: Department of Critical Care Medicine, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Ferri
authors.affiliation: Department of Critical Care Medicine, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Yavorska
authors.affiliation: Department of Anaesthesia, Hospital for Sick Children, Canada; University of Toronto, Canada.
authors.forename: Tobias
authors.initials: T
authors.lastname: Everett
authors.affiliation: Research Institute, Hospital for Sick Children, Canada; University of Toronto, Canada; Department of Critical Care Medicine, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Parshuram
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003142:Communication; D006801:Humans; D007362:Intensive Care Units; D011446:Prospective Studies
keywords: Communication; Crisis resource management; Resuscitation; Team performance.