The practice of breaking bad news

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

In many countries, the COVID-19 pandemic resulted in restricted hospital visiting by relatives.Staff have been forced to deliver unwelcome and bad news over the telephone. There are few training resources around how to do this. We created a bespoke training package consisting of a 15 min eLearning session and a 1-hour facilitated role-play session. Two simulated telephone calls to a professional actor posing as the relative were undertaken on a speakerphone. Following each simulated call, the actor gave feedback to the caller, focusing on the likely experience of a relative during these conversations. Elements specific to telephone conversations included ensuring the safety of the recipient to take the call (eg, not driving a car), ensuring they had adequate local support, and allowing a deliberate silence after delivering the bad news. Silence has a powerful impact, despite being uncomfortable. The opportunity to have written notes before calling and to offer a return call was seen as an opportunity for improving communication. We collated these experiences into a series of phrases found most useful and empathic by the actor and participants. A practical aide- mémoir was created from this learning that could be used to help deliver bad news quickly in the emergency department.