Bandwidth

Have you heard of the term ‘bandwidth’?

In simple terms,  our ‘bandwidth’ can be thought of as how much capacity we have to deal with X.

In anaesthetics, X is the RSI/nerve block/resuscitation/enter-other-that-you’re-about-to-perform – the task that has its complexities that need mastering to get right, escape plans if it goes wrong, and consequences if it goes really wrong.

For an expert in the field it might not take much bandwidth to deal with a routine case, instead turning on auto-pilot to tackle other problems or tasks. An established consultant that I know comes to mind – breezily keeping one eye on the monitor while delivering engaging teaching to his trainee while simultaneously making jokes with the nurses about the surgeon.

However, when tricky situations start to approach an individual’s level of confidence, they may find that their bandwidth becomes quickly consumed, almost filling at an exponential rate with increasing stress.

Bandwidth can also be taken up by problems that aren’t being dealt with in the immediate present – tiredness, hunger, stress, a long commute, or worries and difficulties in life such as finances and relationships.

The problem that will occur when bandwidth is exceeded is failure – which, depending on the circumstances, may mean different things.

Often, bandwidth failure presents as short, sharp, or snappy communication – demanding, not asking. Stating, not suggesting. Arrogance versus humility. Words, not sentences. We’ve all been in situations when, in the heat of the moment, we have said something unpleasant or less-than-gracious that we look back on with regret.

Knowing the capacity and status of your bandwidth is one way of predicting and avoiding errors of misjudged communication. We also know that, in a situation that is complex and overwhelming, progress can be made by asking for help and establishing teamwork; something that, ironically, a stressed-out bandwidth and choppy communication may seek to undermine. Treating team members with incivility or impatience when under pressure probably won’t kick start your colleagues into action but will subdue them with a reluctance to act to avoid further harm – a very real example of how stress and incivility may progressively dismantle teamwork to act as a contributor to disaster.

Obviously, this is a disasterpants scenario that we hope to avoid. What about smaller errors, such as failing a cannula because of hunger, needing a wee, but also needing to see that really sick patient at the other side of the hospital?

You already know what the solutions are to avoid bandwidth errors. While communication errors can derive from a saturated bandwidth, good and transparent communication frees them up. We can check in on our own bandwidths and those of our colleagues – a simple check that spreads the load of complex situations, and makes non-complex situations much more enjoyable for everyone involved.

Addressing the easy stuff – are you and your team fed, watered, caffeinated, and happy in their jobs – will keep the complex stuff easy, too.

Finally, if you feel stressed or that your bandwidth is being squeezed or stretched, take the opportunity to call for help or advice early. Asking for help won’t look bad, but will potentially avoid a tricky situation, and will certainly free up your own capacity to focus on what you can do to help, or what you can learn, or what next step in management you could do independently next time.

Dr Rory Heath

Clinical Fellow in Emergency Medicine