Improving verbal communication in critical care medicine

Human errors are the most common reason for planes to crash, and of all human errors, suboptimal communication is the number one issue. Mounting evidence suggests the same for errors during immediate medical care. Strong verbal communication skills are key whether for establishing a shared mental model, coordinating tasks, centralizing the flow of information, or for 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 “five step advocacy”; and the potential role of SBAR communication. We also outline the rationale for dividing verbal communication into 1 of 4 categories: “aggressive,” “assertive,” “submissive,” or “collaborative.” We outline the “step back method,” the concept of “below-ten” communication, 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.