Chaisson, Neal F.

Abstract Problem Statement Communication failures in critical care contribute to preventable medical errors, impaired team performance, and unsafe care environments. Despite recognition of its importance, communication training for fellows remains inconsistent across hierarchical (ICU) and non-hierarchical (research/QI) environments. This variability limits fellows’ ability to adapt communication strategies, affecting clinical decision making and collaboration. Existing curricula often lack experiential rehearsal and cross-context transfer, leaving trainees underprepared to communicate across settings. Targeted Needs Assessment A pre-course focused assessment of critical care fellows at a single center revealed heterogeneity in formal communication training and confidence in applying communication strategies across team structures. Peer feedback identified gaps in negotiation, nonverbal cue recognition, and role clarity. Primary Goal Equip critical care fellows to communicate with intentional presence and professionalism across hierarchical and non-hierarchical clinical settings. Objectives Implement a one-day curriculum aligned with ACGME Critical Care Medicine milestones and CCF HRO (High Reliability Organization) principles. - Demonstrate effective active listening and closed-loop communication - Identify and respond to verbal and nonverbal cues - Exhibit leadership behaviors promoting psychological safety - Adapt communication strategies across team structures Educational Strategies and Curriculum Design Curriculum planning involved interdisciplinary meetings between critical care faculty, simulation education specialists, curriculum leads, and improvisation specialist. Design aligned with adult learning and simulation best practices. The curriculum integrated three educational approaches 1) Improvisational communication training emphasizing inclusive language and nonverbal cue awareness 2) Narrative reflection and professional identity formation 3) High fidelity simulation using communication-intensive ICU and non-ICU scenarios. Simulation scenarios included a) Dual patient respiratory failure and cardiac arrest requiring role assignment and closed-loop communication b) Plane crash survival lab requiring group consensus without assigned leadership Implementation and Learner Evaluation Eleven of twelve critical care medicine fellows participated. Pre and post-course surveys assessing communication confidence across settings were completed by all participants. Faculty observation rubrics assessed communication behaviors. Key Outcomes/Results (see graphs) Substantial increases in communication confidence were observed across hierarchical ICU and non-hierarchical environments. Fellows agreed that communication competency should be a required component of training. High impact elements included a) Improvisational communication techniques integrated with simulation b) Nonverbal communication awareness c) Adoption of inclusive language d) Psychological safety e) Improved professionalism and interdisciplinary communication consistency Conclusion and Next Steps This improvisation-enhanced simulation curriculum improved fellows’ confidence communicating across hierarchical and non-hierarchical settings. Next steps include incorporating cognitive load management training; the curriculum is adaptable to external audiences and supports organizational HRO principles. This abstract is funded by: N/A

Abstract Rationale Current guidelines recognize the utility of provocative maneuvers during right heart catheterization to aid the diagnosis of pulmonary hypertension. Few studies have compared the performance of different provocation maneuvers. Objectives To assess the hemodynamic correlation among three provocative maneuvers, including their effect on pulmonary hypertension classification. Methods This prospective trial was conducted between October 2016 and May 2018. Adult patients underwent three provocative maneuvers during right heart catheterization: passive leg raise (PLR), load-targeted supine bicycle exercise, and rapid crystalloid fluid infusion. Patients were classified as follows: no pulmonary hypertension, precapillary pulmonary hypertension, isolated postcapillary pulmonary hypertension, combined pre- and postcapillary pulmonary hypertension, and uncategorized pulmonary hypertension. We assessed the hemodynamic changes associated with each maneuver. We also assessed whether provocative maneuvers led to hemodynamic reclassification of the patient to either postcapillary pulmonary hypertension with provocation or exercise pulmonary hypertension. Results Eighty-five patients (mean age 62 ± 12 years, 53% women) were included. Correlation between exercise and fluid challenge was moderate to strong (0.49–0.82; P < 0.001) for changes in right atrial pressure, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, and cardiac index from baseline. Correlation between PLR and exercise (0.4–0.65; P < 0.001) and between PLR and fluid challenge (0.45–0.6; P < 0.001) was moderate for changes in right atrial pressure, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, pulmonary vascular resistance, and cardiac index. Hemodynamic correlation between other provocative maneuvers was poor. Depending on provocative maneuver and classification criteria, there was significant variation in the number of patients reclassified as having exercise pulmonary hypertension (3–50%) or postcapillary pulmonary hypertension with provocation (11–48%). Conclusions Hemodynamic determinations during exercise and fluid challenge showed moderate to strong hemodynamic correlation. Moderate hemodynamic correlation was seen between PLR and exercise or fluid challenge. Although some provocative maneuvers demonstrate good hemodynamic correlation, there is inconsistency when using these maneuvers to identify patients with postcapillary or exercise pulmonary hypertension.