Emergency Department Communication Links and Patterns
Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2006, San Francisco, CA; and the Industrial Engineering Research Conference, May 2006, Orlando, FL; and presented as a conference proceeding at the Systems and Information Engineering Design Symposium, April 2005, Charlottesville, VA; and the International Ergonomics Association annual meeting, July 2006, Maastricht, The Netherlands.
Received 7 June 2006; received in revised form 20 January 2007; accepted 16 March 2007. published online 13 June 2007.
Refers to article:
Studying the Technical Work of Emergency Care
Christopher P. Nemeth, Richard I. Cook, Robert L. Wears
Annals of Emergency Medicine
October 2007 (Vol. 50, Issue 4, Pages 384-386) Full Text |
Full-Text PDF (68 KB)
Study objective
We characterize and describe the communication links and patterns between and within emergency department (ED) practitioner types.
Methods
This is a prospective, observational study of emergency physician and nursing staff communication patterns in an academic ED using link analysis techniques. Twenty ED staff members were observed in the pediatric and adult acute areas of the ED, including attending physicians, residents, nurses, and charge nurses. Data were recorded for each communication event, including duration, mode, partner, location, and interruptions. Because this study was intended to focus on professionally related communication between staff, social interactions and direct patient interactions were excluded. Frequency percentage and duration were calculated for each measure, and link analysis graphs were prepared to assist in interpretation of the data.
Results
One thousand six hundred sixty-five total communication events were recorded during a total of 39 hours 12 minutes of observation. Face-to-face communication was the most common mode. Communication links and patterns were described and graphically represented using a link analysis technique. Communication gaps were found between ambulance providers and the providers who would ultimately take care of the patient during their ED stay. Attending physicians communicated often despite caring for separate patients, and the charge nurse seemed to be the hub for communication, linking ED personnel with non-ED staff. In the adult area, interruption rates ranged from 6.9 per hour (attending physician) to 0.5 per hour (bedside nurse), and in the pediatric area they ranged from 3.6 per hour (attending physician) to 0.3 (bedside nurse).
Conclusion
Distinct patterns are identified. These results will be helpful in designing future communication adjuncts in the ED.
aDepartment of Emergency Medicine, University of Rochester School of Medicine, Rochester, NY
bDepartment of Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, NY.
Address for correspondence: Rollin J. (Terry) Fairbanks, MD, MS, Department of Emergency Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 655, Rochester, NY 14642; 585-273-3849, fax 585-275-2092
Supervising editor: Robert L. Wears, MD, MS
Author contributions: RJF and AMB conceived the study, designed the study, obtained research funding, and supervised the conduct of the study and data collection. RJF and MS undertook recruitment of ED staff member participants. MS performed all observations and entered the data. AMB and MS managed the data. All investigators participated in the analysis, and AMB provided statistical oversight. RJF drafted the article, and all authors contributed substantially to its revision. MS designed the figures and tables under the supervision of RJF and AMB. RJF takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that may create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Support was provided for this study by the Ronald McDonald House Children’s Charities Research Fund. At the time of the study, Dr. Bisantz and Ms. Sunm were partially supported by the National Science Foundation (grant no. IIE9984079); and Dr. Fairbanks, by the NIH (1R41NR009592) and AHRQ (1U18HS015818).
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