Time-critical telephone conversations in the emergency department: lessons learnt from a pilot educational project to improve communication skills over the telephone in response to the COVID-19 global pandemic

Correspondence to Dr Sarah Edwards, Emergency Department, Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK; [email protected]

Introduction and background

The global COVID-19 pandemic has brought about many challenges to the emergency medicine (EM) community around the world. To reduce the spread of COVID-19, many hospitals restricted visiting.^1–3 Having difficult conversations over the telephone in time-critical situations has been an unexpected consequence and a challenge of the pandemic.⁴ Staff in emergency departments (EDs) may have to gather information from relatives, if the patient is unable to give the full information, while breaking difficult news of their current (critically ill) condition. Breaking bad news (BBN) is traditionally encouraged as an in-person conversation to optimise communication (such as body language, eye contact and touch).^1–3 However, during COVID-19, this has had to be modified. BBN in person, let alone via telephone, is a challenging task. Within the ED, there is the added pressure of doing this with patients and their relatives when the physician has only known the patient for a short period of time or not at all. The Royal College of Emergency Medicine in the UK acknowledges and states that BBN is an important skill for healthcare professionals who work in the ED.⁵

There is limited research in delivering bad news from the ED over the telephone. Models such as SPIKES,⁶ BREAKS⁷ and Kayes⁸ (figure 1) are rooted in the oncology or palliative care setting.⁶ Here there is often time to build rapport (through regular clinic visits) and deliver bad news in a quiet, unhurried setting. SPIKES is a six-step approach first described in 2000, having been created to assist oncologists with a structure for BBN.⁶ In 2010, the BREAKS protocol for generic BBN was developed⁷ with the Kayes 10-step model being developed in palliative care in 1996.⁸ These models offer a reminder of important concepts that need to be considered for BBN, but these are focused on the face-to-face setting. Undoubtedly, these core concepts apply to everyday EM practice in relation to BBN. However, these models were not set up for the acute setting. Evidence does suggest that BBN is challenging in the ED, with physicians and those they speak...