Chinese whispers is a clustering method used in network science named after the famous whispering game. Clustering methods are basically used to identify communities of nodes or links in a given network. This algorithm was designed by Chris Biemann and Sven Teresniak in 2005. The name comes from the fact that the process can be modeled as a separation of communities where the nodes send the.
Misinformation is easy to pass on and near impossible to correct.The difference, of course, between Chinese Whispers and clinical handovers is that we take every opportunity to hear the information being shared and we are all trained in communication so we do a great job of paying attention when our colleagues try to share clinical information and we always check what we have understood is the right information.Except we don’t. The name of the game is archaic and may be considered offensive but the concept resonates deeply enough for the phrase “Chinese whispers” to have been adopted into common parlance in the UK.The game is essentially about the quality of communication.OK, it isn’t packaged as such and I imagine the opportunities to break down, feedback and reflect on the task afterwards are not often seized at birthday parties, but there is a message we can take from it into our clinical practice. Usually the message becomes more and more corrupted until by the end of the line or circle it is unrecognisable from its original form. The receiver has a single opportunity to hear the message and then has to pass it on. But something similar happened recently, and not for the first time, and it made me wonder why, when I’ve spent five minutes writing a legible, succinct history in the notes, is misinformation being passed on?Image courtesy of David Castillo Dominici / FreeDigitalPhotos.netChinese Whispers is a children’s game (called Telephone in the US) in which children pass on what they think they’ve heard in a message whispered by another child.
But I’m not as thorough or structured as I ought to be. But until now I’ve been lazy with my handovers, I’ll admit.Yes, I always seek out the nurse looking after the patient I’ve seen and explain my assessment and plan to them. I like to know what is going on and I think that’s a skill which becomes more important the more senior I become. I think it makes me good at my job – I am quite good at overhearing conversations which have led to me getting involved in the care of patients in the ED who actually really needed it (without my being invited to do so).
We often have multiple single-patient handover events from a paramedic crew on arrival, between doctors going off shift, from the nurse looking after the patient when we go to start a clinical assessment and then back to the nurse once we have formulated a plan, to our seniors or colleagues when cases aren’t straightforward, to our specialty colleagues when we make a referral. And we forget that communication is a two-way process, which means there is responsibility for both parties.There is additional risk in the ED. As doctors we rarely have co-ordinated team handovers (due to shift work and unpredictability of our workload). We have lots of patients waiting and a million things to do. We think we’re good at it.
This recently published (and open access!) JAMA study describes how introducing a standardised handover reduced errors among paediatric inpatients.Cut out unnecessary information. This might be SBAR (situation, background, assessment, recommendations) or ABC (airway, breathing, circulation) according to the nature of the handover you are giving. Put aside the time pressures of the ED and remember that this is one of the most important things you will do.Using a recognised structure (and signposting to it) helps aid the retention of information. Pause frequently and listen out for active listening noises to signal that the receiver is ready for more information. Make sure the receiver is ready before you start and consciously speak slowly and clearly.
Stick to the important positives and negatives.When you have finished, repeat your initial summary sentence. Either one of these things will cause me to switch off entirely and disengage from you as you try to overload me with unnecessary information. Neither should you read verbatim the history you have just written in the patient’s notes. If you are talking to me as your senior for advice on a patient, you do not need to regurgitate the entire consultation.
Interruptions are rife in the ED and impede our ability to process information, potentially contributing to medical error. This might mean you need to ask other people to stop talking (for an ambulance handover in resus), put away your phone, move to a different area of the department or ask the other person to wait while you finish assessing an ECG or requesting a chest x-ray so you can give them your full attention. There are also several things we can do to improve our performance here.By this I mean we need to focus on the incoming information and become active listeners.
Be polite though 🙂When the conversation is finished, you can check you have an accurate shared understanding by using SBAR to make your own summary of the clinical scenario and next steps. This will also prevent you asking clarification questions the information giver has already answered if someone has ever done that to you, you know how frustrating and demoralising that feels.When the information giver has finished talking, now is the time to ask questions to clarify anything you didn’t quite understand or to obtain information not originally shared. It’s incredibly tempting to interrupt someone who is committing the crimes mentioned in “Simplicity” above – especially in a busy ED with 3hr wait to be seen and a queue of other people waiting for a piece of your time – but try to resist! Focus on what is being shared. In doctor/patient consultations we are notoriously bad at this with one study finding that only 23% of patients completed their opening statement (there’s more info on this here).
Handover is an area we are making mistakes we can avoid – ones which can have potentially serious consequences. Read the ED notes or medical clerking to consolidate the information you have received.This is simple stuff, right? At the end of the day we are fallible, busy human beings who try our best to do the right thing by our patients and to keep them safe.
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