PG32 MAPstop: making difficult conversations easier

Abstract

Background Communication in a healthcare setting not only occurs between a patient and their parent team, but also between different healthcare teams. Given that patients admitted to hospital have ever more complex medical and social needs,1 collaboration between teams is essential. Communication is a key factor in effective interprofessional working and errors in communication are a key factor in incidences of unintentional patient harm, and a common reason for patient complaints.2 To attempt to improve multi-disciplinary communication amongst senior decision makers in our Trust, the MAPstop (Management Action Plan) simulation session was designed. Summary of Work The aim of the session was for senior paediatricians, anaesthetists and emergency medicine consultants to practise using the MAPstop communication intervention in a simulation scenario involving an acutely unwell child. MAPstop is used as follows: Clinician has a concern about patient care, the management plan or communication. Clinician states ‘I want a MAPstop between myself and person X, person Y and person Z – everyone else continue with the resuscitation.’ SBAR (situation, background, assessment, recommendation) discussion focussing on the concerns. Unanimous decision regarding action plan. The MAPstop intervention was trialled with consultants and senior trainees in paediatrics, anaesthetics and emergency medicine in our simulation centre. Participant feedback on the utility of the intervention and effectiveness of simulation teaching was obtained via a post-session questionnaire. Summary of Results The feedback response rate was 75% (3/4 participants). MAPstop was extremely well-received by all who participated, with one participant describing it as an ‘empowering tool to ensure discussion could occur’ and another felt the tool could be used by more junior staff to communicate what they want from consultants. The simulation session was felt to be ‘very realistic’ with ‘challenging situations’ better learnt about in a simulation setting as opposed to real life. Discussion and Conclusions We view MAPstop as a new paradigm for communication between senior decision makers during difficult clinical situations. Using simulation to teach the MAPstop approach moves us beyond the historical use of simulation mainly for perfecting the A to E assessment, towards optimising communication skills for all levels of decision makers, right up to consultants. Recommendations MAPstop needs to be trialled by other medical disciplines, and could also potentially be used to facilitate communication between clinicians and the hospital management team. References Greenaway D. Shape of training: securing the future of excellent patient care: final report of the independent review. 2013. https://www.gmc-uk.org/-/media/documents/shape-of-training-final-report_pdf-53977887.pdf Murphy JG, Dunn WF. Medical errors and poor communication. Chest 2010;138:1475–79. https://doi.org/10.1378/chest.10-2263.