Watch the Podcast
This podcast provides a practical guide to effective leadership during a Paediatric Emergency. It covers key pearls on what to do and importantly provides advice on how to avoid the common pitfalls.
Videos of the Elaine Bromiley case
The two videos referred to in the podcast are below. The first video is a reconstruction of what actually happened during the case and the second video shows how a different outcome may have been possible had the team paid more attention to leadership and human factors.
Video 1
The Elaine Bromiley Case Video. Simpact Pty Ltd, 2014. Reproduced under Creative Commons Attribution Non-Commercial No Derivatives License. © Copyright Simpact Pty Ltd 2014.
Video 2
What If? Teamwork in Emergency Airway Management Video. Simpact Pty Ltd, 2014. Reproduced under Creative Commons Attribution Non-Commercial No Derivatives License. © Copyright Simpact Pty Ltd 2014.
Thanks for this podcast! This is an area I’ve been giving a lot of thought to. One thing I’ve struggled with is noise – particularly when there are multiple conversations going on, where apparently people are working in parallel to help the patient. Apart from a big “shush”, how do you manage this aspect?
Hi Dilshad, I think it is definitely easier to keep control of the room, rather than get it back once you have lost it (and the longer you leave it the harder it is to regain control). I think the best way to do this is to keep talking in a slow controlled way, sharing your thinking and plans for what to do next. I think you risk loosing control when you get sucked into a specific aspect of the patient management, so best to say back and keep that overview (otherwise when you step back to reassess the room can have descended into chaos).
Obviously there will be times when there are a number of teams carrying out specific tasks and this can generate noise. Again when this starts to get distracting I think you are better to try and intervene earlier and I normally deal with a statement like “OK there’s too much noise” followed by taking control of the room by talking for the next 30 seconds e.g. recap on where we are, what we need to do next is ….
I think simulation training in your department will help and raising awareness of human factors and the importance of effective leadership, as a well trained team will be more likely to behave as you want them to and will recognise the “OK there’s too much noise” prompt and realise why you are saying it and not just think you are being rude.
However even if your team is the best trained team you will always have someone from another other speciality coming in and disrupting things – the key is finding ways to deal with this and I find simulation very useful for this (where the leadership strategies for dealing with the difficult team member is what you are testing and developing rather than the actual medicine of the scenario).
Again this isn’t something I claim to be an expert in and the podcast only covers some basic but very effective techniques. Might be best to check with an expert and I’m sure there is lots written on this. If you do find other tips for dealing with this can you come back and share them here so others can benefit from them.
Good to hear from you again.
Chris
Another very useful podcast, thanks once again for this excellent series Chris.
I’m in my ST8 year and through experience and reflection I’ve come to the same conclusions you talk about in your podcast. I only came to these conclusions after making some of the mistakes you discuss though.
In particular I wanted to share an experience from my ST5 year. I was called to a septic 1 year old in ED. When I arrived there was no clear leader. I took over the leader role but was probably not very clear that this was what I was doing. The whole team then became task fixated on getting IV access. This was initially via the intravenous route (not sure how long but must have been at least 15 minutes) followed by IO access (but this also took some time to achieve). On reflection, we all neglected to monitor the child’s condition and lost the ‘big picture’. My consultant arrived and immediately recognised that this child needed intubating as the priority. Fortunately the child did well and I was able to meet her, looking well, in clinic a few months later. Some important learning points for me though and I’ll be trying to ensure trainees working for me in the future don’t make the same mistakes.
Hi Richard, your story will be very familiar to most and again it illustrates the importance of keeping the whole picture in view (this is what your consultant saw from the end of the bed on arrival).
I had a similar experience where I arrived to a retrieve a deteriorating patient shortly after CPR had started. Rather than get the whole picture I had to get stuck straight in with intubation which achieved ROSC, but following this the BP was awful and I focused on fixing this with peripheral vasoactive drugs before inserting a CVL to allow administration of other essential medications. It was only following this when I took a step back and looked at the whole picture that the diagnosis became obvious.
Thanks for sharing your case and hopefully others will learn from it.
Regards
Chris