Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Crit Care. 2011 Apr;26(2):155-9. doi: 10.1016/j.jcrc.2011.03.004.
Human errors are the most common reason for planes to crash, and of all human errors, suboptimal communication is the number 1 issue. Mounting evidence suggests the same for errors during short-term medical care. Strong verbal communication skills are key whether for establishing a shared mental model, coordinating tasks, centralizing the flow of information, or stabilizing emotions. However, in contrast to aerospace, most medical curricula rarely address communication norms during impending crises. Therefore, this article offers practical strategies borrowed from aviation and applied to critical care medicine. These crisis communication strategies include "flying by voice," the need to combat "mitigating language," the uses of "graded assertiveness" and "5-step advocacy," and the potential role of Situation, Background, Assessment, and Recommendation communication. We also outline the "step-back method," the concept of communication "below ten thousand feet," the impetus behind "closed-loop communication," and the closely related "repeat-back method." The goal is for critical care practitioners to develop a "verbal dexterity" to match their procedural dexterity and factual expertise.
人为失误是导致飞机失事的最常见原因，而在所有人为失误中，沟通不当是头号问题。越来越多的证据表明，短期医疗护理过程中的失误也是如此。无论是建立共享心理模型、协调任务、集中信息流动还是稳定情绪，强有力的口头沟通技巧都是关键。然而，与航空业不同的是，大多数医学课程很少涉及即将发生的危机期间的沟通规范。因此，本文借鉴航空业并将其应用于重症监护医学，提供了一些实用的策略。这些危机沟通策略包括“通过语音飞行”、需要对抗“缓解性语言”、使用“渐进自信”和“五步倡导”，以及情境、背景、评估和建议沟通的潜在作用。我们还概述了“后退法”、沟通的“一万英尺以下”概念、“闭环沟通”背后的动力，以及密切相关的“重复回读法”。目标是让重症监护医生发展出一种“言语的灵活性”，以匹配他们的程序灵活性和事实专业知识。
