The care of the older adult patient requires effective communication across many disciplines. In order for all the members of the geriatric team to deliver quality patient care, this demands that efforts of all members be well coordinated and performed in the most efficient manner. Effective communication within a team is a crucial element of being successful. Ineffective team communication has been linked to increased patient mortality, increased cost and longer lengths of stay as well as rising medical error rates. Despite data to support that effective interdisciplinary team communication has a positive impact on geriatric patient care outcomes, communication skills training amongst teams is lacking in most curricula.

You're Being Paged! A Nursing Home On-Call Role-Playing Exercise by Drs. Christina Bell and Misty Yee from the Department of Geriatric Medicine of the University of Hawaii John A. Burns School of Medicine introduces geriatric fellows to the issues they will face when on call for a nursing home. Learning how to effectively cover phone calls from nursing home staff is an important skill for fellows to master. Gaining competence in nursing home phone medicine addresses the ACGME competencies of patient care, interpersonal and communication skills, professionalism and system-based learning. It also has an equally important objective of seeking to improve one’s awareness about nursing home staffing and procedures before one goes on a nursing home call.

This product provides a PowerPoint presentation to be used as an introduction. During the presentation, fellows are asked to participate in role-play exercises to illustrate the various issues they will face. The product includes a brief facilitator’s guide along with 10 phone call exercises. Two fellows are asked to act out each scenario, one as the fellow on call and the other a nurse calling with a problem. The “nurse” is given a summary of relevant information about the patient including onset of the problem and vital statistics, and is asked not to give out the information until the fellow asks for it. Once the fellow decides that he/she has completed the call, the facilitator reviews the scenario and provides feedback on the fellow’s communication skills and resolution of the problem.

The exercise focuses on everyday calls one may get while working in a nursing home including new patient symptoms, medication compliance, order entry problems and communications with family members. The product includes detailed patient scenarios with a list of suggested teaching points for each including nursing home staffing situations, realistic expectations of vital sign frequency, communication with the nurse and attending physician on call, and the challenges and limitations of practicing medicine over the phone and in a nursing home. As with any exercise that involves role-play, participants must feel relatively safe to make mistakes and try out things during the exercise. Therefore this skills exercise requires an effective and active facilitator. A more extensive facilitator guide on how to effect a safe learning environment specifically during role-plays would be extremely helpful. In addition, how the facilitator manages the time will dictate how many scenarios will be completed in the time allotted. Although the exercise scenarios focus on communication between physicians and nurses, they could be modified to focus on improving communication skills among any who participate in the care of older adult patients.

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