Understanding team, interpersonal and situational factors is essential for routine communication with patients in the emergency department (ED): A scoping literature review and formation of the ‘T.IP.S’ conceptual framework

Abstract

Introduction Most patient–provider communication skills frameworks focus on interpersonal behaviours within the context of a single consultation. In contrast, Emergency Department (ED) patient encounters consist of many new interactions with different professionals over a short time period. Additionally, ED care often occurs in a chaotic, unpredictable, and overcrowded environment. While these factors are recognised to present a major challenge to effective patient–provider communication in the ED, there is no accepted framework to guide how professionals or teams should approach and optimise communication with patients in the ED.

Objectives This review aims to identify the current literature relating to routine patient provider communication processes in the ED and synthesise a new framework to enhance understanding of routine patient-provider communication processes in the ED.

Methods Searches of Scopus, Medline, EMBASE and CINAHL were conducted to identify literature written between 2000 and 2016 using the terms ((communication OR consultation OR health literacy) AND (patient) AND (emergency medicine OR emergency department)).

Results Fifty-five relevant articles were selected for final inclusion. A qualitative synthesis was conducted and content interpreted as either facilitating factors or obstacles to routine ED communication were coded and grouped into three overarching themes. These were Team, Interpersonal and Situational factors, which together form the basis of the proposed T.IP.S framework.

Conclusion T.IP.S is the first framework for patient-provider communication specific to the ED setting. The T.IP.S framework may be utilised to evaluate communication strengths and vulnerabilities, identify training requirements professionals, and ultimately improve patient experience and outcomes in the ED.

Keywords:

• Provider–patient communication
• Emergency department
• ED
• Emergency medicine

Disclaimer statement

Contributors B Graham (BG) conducted the review, thematic analysis, coding and write up. J Smith (JS) reviewed the paper, and supervised conduct of the review. BG and JS conceived the idea for the review and edited the discussion and analysis. Additionally, BG undertook the literature review, coding and synthesis, and devised the T.IP.S framework.

Funding No external funding.

Conflict of interest No conflicts of interest to declare.

Ethics approval This study does not involve human participants and was exempt from IRB review.

Additional information

Notes on contributors

Blair Graham

Dr Blair Graham is an Academic Clinical Fellow in Emergency Medicine at Derriford Hospital in the South West of England. He is pursuing a research programme that includes methods of assessing and improving patient–provider communication in the ED, and the use of Patient Reported Measures to improve quality in emergency care. His other academic interests include sepsis, geriatric emergency medicine and undergraduate training in resuscitation and emergency care.

Jason E. Smith

Professor Jason E. Smith's research portfolio covers a broad range of areas within emergency medicine, including the management of pain, severe sepsis, chest pain and traumatic cardiac arrest. He has a specific interest in clinician-patient communication in the ED.

He is the Chief Investigator of the PASTIES (Pain Solutions in the Emergency Setting) study, and is a co-applicant on the RAPID-CTCA trial group. He has also been appointed as Defence Professor of Emergency Medicine.

Professor Smith is keen to develop an active programme of research looking at communication in the Emergency Department.